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Doctors, nurses, and the optimal scale size in the Portuguese public hospitals

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  • Ferreira, Diogo Cunha
  • Nunes, Alexandre Morais
  • Marques, Rui Cunha

Abstract

This study analyses the scale efficiency, optimal scale for hospital clinical staff, and the exogenous dimensions that can be associated with them. They offer useful insights for health policy design, particularly when human resources need to be reallocated across the country due to uneven distributions. Initial data considered a sample of 27 Portuguese general/acute-care public hospitals belonging to the National Health Service, observed between 2013 and 2016. This resulted into a sample of 108 hospitals-year. Data Envelopment Analysis was employed to assess scale efficiency and optimal scale associated with the workforce and at the overall hospital level. Quality and access to health care services adjusted the measures of scale efficiency and optimal size. A multiple regression analysis was carried out to associate optimal scale and scale efficiency to demographics. Optimal scale centred on 274 full-time equivalent (FTE) doctors and 475 FTE nurses. Overall, there is an excess of FTE doctors and FTE nurses, even after potential reallocations. There is an uneven distribution of health workforce, with excess of staff located in urban areas. Hospitals productivity would increase if they reduced their operational scale. Drivers of potential change include population size, childhood mortality rate, birth rate, and purchasing power parity. Health policies are required, not to hire more staff, but rather to promote the reallocation of employees to deprived regions.

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  • Ferreira, Diogo Cunha & Nunes, Alexandre Morais & Marques, Rui Cunha, 2018. "Doctors, nurses, and the optimal scale size in the Portuguese public hospitals," Health Policy, Elsevier, vol. 122(10), pages 1093-1100.
    • Handle: RePEc:eee:hepoli:v:122:y:2018:i:10:p:1093-1100
    DOI: 10.1016/j.healthpol.2018.06.009
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    Cited by:

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    2. Diogo Cunha Ferreira & Alexandre Morais Nunes, 2019. "Technical efficiency of Portuguese public hospitals: A comparative analysis across the five regions of Portugal," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 411-422, January.
    3. Paulo Caldas & Miguel Varela, 2023. "The Portuguese Public Hospitals Performance Evolution before and during the SARS-CoV-2 Pandemic (2017–2022)," Sustainability, MDPI, vol. 15(15), pages 1-31, July.
    4. Ferreira, Pedro L. & Raposo, Vitor & Tavares, Aida Isabel & Correia, Tiago, 2020. "Drivers for emigration among healthcare professionals: Testing an analytical model in a primary healthcare setting," Health Policy, Elsevier, vol. 124(7), pages 751-757.
    5. I. Contreras & S. Lozano & M. A. Hinojosa, 2021. "A bargaining approach to determine common weights in DEA," Operational Research, Springer, vol. 21(3), pages 2181-2201, September.
    6. Alexandre Morais Nunes & Diogo Cunha Ferreira, 2019. "Reforms in the Portuguese health care sector: Challenges and proposals," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 21-33, January.
    7. Laura Botega & Mônica Viegas Andrade & Gilvan Ramalho Guedes, 2020. "Brazilian hospitals’ performance: an assessment of the unified health system (SUS)," Health Care Management Science, Springer, vol. 23(3), pages 443-452, September.
    8. Liu, Hongda & Wu, Wangqiang & Yao, Pinbo, 2022. "A study on the efficiency of pediatric healthcare services and its influencing factors in China ——estimation of a three-stage DEA model based on provincial-level data," Socio-Economic Planning Sciences, Elsevier, vol. 84(C).
    9. Arantes, Amílcar & Alhais, Andreia Frias & Ferreira, Luis Miguel D.F., 2022. "Application of a purchasing portfolio model to define medicine purchasing strategies: An empirical study," Socio-Economic Planning Sciences, Elsevier, vol. 84(C).
    10. Gualano, Maria Rosaria & Corradi, Alessio & Voglino, Gianluca & Bert, Fabrizio & Siliquini, Roberta, 2021. "Beyond COVID-19: a cross-sectional study in Italy exploring the covid collateral impacts on healthcare services," Health Policy, Elsevier, vol. 125(7), pages 869-876.

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