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Hospital efficiency with risk adjusted mortality as undesirable output: the Turkish case

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  • Murat Bilsel
  • Nurhan Davutyan

Abstract

We analyze the operational performance of 202 Turkish rural general hospitals. To help improve performance on both input and output space, we adopt a directional distance approach. We treat a mortality based measure as a “needs indicator”. We derive pure technical, scale and output congestion inefficiency measures and show how they vary across size classes. We show that “reducing mortality” involves sacrificing some good outputs. This is a trade off that holds at the potential output level. Second stage regressions of the inefficiency scores against hospital and rural district level variables, pinpoint critical areas for performance improvement. In particular we show the relative scarcity of nurses is linked to output congestion. Copyright Springer Science+Business Media, LLC 2014

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  • Murat Bilsel & Nurhan Davutyan, 2014. "Hospital efficiency with risk adjusted mortality as undesirable output: the Turkish case," Annals of Operations Research, Springer, vol. 221(1), pages 73-88, October.
    • Handle: RePEc:spr:annopr:v:221:y:2014:i:1:p:73-88:10.1007/s10479-011-0951-y
    DOI: 10.1007/s10479-011-0951-y
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    5. Greta Falavigna & Roberto Ippoliti & Alessandro Manello, 2013. "Hospital organization and performance: a directional distance function approach," Health Care Management Science, Springer, vol. 16(2), pages 139-151, June.
    6. Yauheniya Varabyova & Jonas Schreyögg, 2018. "Integrating quality into the nonparametric analysis of efficiency: a simulation comparison of popular methods," Annals of Operations Research, Springer, vol. 261(1), pages 365-392, February.
    7. Zilla Sinuany-Stern & Simona Cohen-Kadosh & Lea Friedman, 2016. "The relationship between the efficiency of orthopedic wards and the socio-economic status of their patients," Central European Journal of Operations Research, Springer;Slovak Society for Operations Research;Hungarian Operational Research Society;Czech Society for Operations Research;Österr. Gesellschaft für Operations Research (ÖGOR);Slovenian Society Informatika - Section for Operational Research;Croatian Operational Research Society, vol. 24(4), pages 853-876, December.
    8. Margit Sommersguter-Reichmann, 2022. "Health care quality in nonparametric efficiency studies: a review," Central European Journal of Operations Research, Springer;Slovak Society for Operations Research;Hungarian Operational Research Society;Czech Society for Operations Research;Österr. Gesellschaft für Operations Research (ÖGOR);Slovenian Society Informatika - Section for Operational Research;Croatian Operational Research Society, vol. 30(1), pages 67-131, March.
    9. Cheng, Gang & Zervopoulos, Panagiotis D., 2014. "Estimating the technical efficiency of health care systems: A cross-country comparison using the directional distance function," European Journal of Operational Research, Elsevier, vol. 238(3), pages 899-910.
    10. Alonso, José M. & Clifton, Judith & Díaz-Fuentes, Daniel, 2015. "The impact of New Public Management on efficiency: An analysis of Madrid's hospitals," Health Policy, Elsevier, vol. 119(3), pages 333-340.
    11. Cinaroglu, Songul, 2021. "Changes in hospital efficiency and size: An integrated propensity score matching with data envelopment analysis," Socio-Economic Planning Sciences, Elsevier, vol. 76(C).
    12. Resul TELLI & Zehra Vildan SERIN, 2023. "A Comparative Analysis on Healthcare Spending Efficiency Among the G-8 Countries and Turkey," Journal of Economic Policy Researches, Istanbul University, Faculty of Economics, vol. 10(1), pages 281-302, January.
    13. Ferreira, D.C. & Marques, R.C., 2021. "Public-private partnerships in health care services: Do they outperform public hospitals regarding quality and access? Evidence from Portugal," Socio-Economic Planning Sciences, Elsevier, vol. 73(C).
    14. Guccio, C. & Lisi, D. & Martorana, M.F. & Pignataro, G., 2020. "Incorporating quality in the efficiency assessment of hospitals using a generalized directional distance function approach," Health, Econometrics and Data Group (HEDG) Working Papers 20/17, HEDG, c/o Department of Economics, University of York.
    15. Ali Bahari & Ali Emrouznejad, 2014. "Influential DMUs and outlier detection in data envelopment analysis with an application to health care," Annals of Operations Research, Springer, vol. 223(1), pages 95-108, December.
    16. Arnaud Abad, 2020. "Environmental Efficiency and Productivity Analysis," Working Papers hal-03032038, HAL.
    17. Hervé Leleu & Albane Tarnaud, 2016. "The duality of Shephard’s weakly disposable technology," Working Papers 2016-EQM-06, IESEG School of Management.
    18. Ortega-Díaz, M. Isabel & Martín, Juan Carlos, 2022. "How to detect hospitals where quality would not be jeopardized by health cost savings? A methodological approach using DEA with SBM analysis," Health Policy, Elsevier, vol. 126(10), pages 1069-1074.
    19. Sommersguter-Reichmann, Margit & Stepan, Adolf, 2015. "The interplay between regulation and efficiency: Evidence from the Austrian hospital inpatient sector," Socio-Economic Planning Sciences, Elsevier, vol. 52(C), pages 10-21.
    20. Erus, Burcay & Hatipoglu, Ozan, 2017. "Physician payment schemes and physician productivity: Analysis of Turkish healthcare reforms," Health Policy, Elsevier, vol. 121(5), pages 553-557.
    21. Ferreira, D.C. & Marques, R.C., 2019. "Do quality and access to hospital services impact on their technical efficiency?," Omega, Elsevier, vol. 86(C), pages 218-236.
    22. Akkan, Can & Karadayi, Melis Almula & Ekinci, Yeliz & Ülengin, Füsun & Uray, Nimet & Karaosmanoğlu, Elif, 2020. "Efficiency analysis of emergency departments in metropolitan areas," Socio-Economic Planning Sciences, Elsevier, vol. 69(C).
    23. Miroslav Marić & Zorica Stanimirović & Srdjan Božović, 2015. "Hybrid metaheuristic method for determining locations for long-term health care facilities," Annals of Operations Research, Springer, vol. 227(1), pages 3-23, April.

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