IDEAS home Printed from https://ideas.repec.org/a/spr/operea/v21y2021i2d10.1007_s12351-019-00483-3.html
   My bibliography  Save this article

Production and quality performance of healthcare services in EU countries during the economic crisis

Author

Listed:
  • Panagiotis Mitropoulos

    (Technological Educational Institute of Western Greece)

Abstract

Healthcare systems are facing tremendous pressure to reduce costs while providing better services without lowering their quality. By utilizing a two-stage network DEA approach we explore whether there is a trade-off between service production and service quality in the healthcare delivery process at a country level. While the first stage deals with production performance of the healthcare systems, the second stage deals with service quality using patient reported safety and satisfaction measures. A critical aspect in this evaluation process is to examine how well the health systems perform from the perspective of the people they are intended to benefit, especially under the current surge of economic crisis. The health systems performance of the European Union member states is assessed, using cross-sectional data from the Eurobarometer survey and Eurostat from 2009 to 2013. In order to dynamically analyze the productivity changes during the economic crisis the corresponding Malmquist index was also developed. The results revealed that the overall technical efficiency increased during the study period. However, the inherent trade-off between health production and service quality was significantly raised indicating that the efficiency gains of several countries were achieved either by sacrificing production or quality. Results also indicate that the economic crisis provided improvement in the technical efficiency, although the technological frontier has presented a negative shift.

Suggested Citation

  • Panagiotis Mitropoulos, 2021. "Production and quality performance of healthcare services in EU countries during the economic crisis," Operational Research, Springer, vol. 21(2), pages 857-873, June.
    • Handle: RePEc:spr:operea:v:21:y:2021:i:2:d:10.1007_s12351-019-00483-3
    DOI: 10.1007/s12351-019-00483-3
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s12351-019-00483-3
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s12351-019-00483-3?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. 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.
    2. Kao, Chiang, 2009. "Efficiency decomposition in network data envelopment analysis: A relational model," European Journal of Operational Research, Elsevier, vol. 192(3), pages 949-962, February.
    3. Fare, Rolf & Grosskopf, Shawna, 1996. "Productivity and intermediate products: A frontier approach," Economics Letters, Elsevier, vol. 50(1), pages 65-70, January.
    4. Sharon Hadad & Yossi Hadad & Tzahit Simon-Tuval, 2013. "Determinants of healthcare system’s efficiency in OECD countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(2), pages 253-265, April.
    5. Pablo Cos & Enrique Moral-Benito, 2014. "Determinants of health-system efficiency: evidence from OECD countries," International Journal of Health Economics and Management, Springer, vol. 14(1), pages 69-93, March.
    6. Afonso, Antonio & St. Aubyn, Miguel, 2005. "Non-Parametric Approaches to Education and Health Efficiency in OECD Countries," Journal of Applied Economics, Universidad del CEMA, vol. 8(2), pages 1-20, November.
    7. E. Grigoroudis & E. Tsitsiridi & C. Zopounidis, 2013. "Linking customer satisfaction, employee appraisal, and business performance: an evaluation methodology in the banking sector," Annals of Operations Research, Springer, vol. 205(1), pages 5-27, May.
    8. Lothgren, Mickael & Tambour, Magnus, 1999. "Productivity and customer satisfaction in Swedish pharmacies: A DEA network model," European Journal of Operational Research, Elsevier, vol. 115(3), pages 449-458, June.
    9. Richard Gearhart, 2016. "No theory: an explanation of the lack of consistency in cross-country health care comparisons using non-parametric estimators," Health Economics Review, Springer, vol. 6(1), pages 1-12, December.
    10. Guilan Kong & Lili Jiang & Xiaofeng Yin & Tianbing Wang & Dong-Ling Xu & Jian-Bo Yang & Yonghua Hu, 2018. "Combining principal component analysis and the evidential reasoning approach for healthcare quality assessment," Annals of Operations Research, Springer, vol. 271(2), pages 679-699, December.
    11. Yasar A. Ozcan & Jaya Khushalani, 2017. "Assessing efficiency of public health and medical care provision in OECD countries after a decade of reform," 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. 25(2), pages 325-343, June.
    12. Panagiotis Mitropoulos & Ioannis Mitropoulos & Haralampos Karanikas & Nikolaos Polyzos, 2018. "The impact of economic crisis on the Greek hospitals' productivity," International Journal of Health Planning and Management, Wiley Blackwell, vol. 33(1), pages 171-184, January.
    13. Hiroyuki Kawaguchi & Kaoru Tone & Miki Tsutsui, 2014. "Estimation of the efficiency of Japanese hospitals using a dynamic and network data envelopment analysis model," Health Care Management Science, Springer, vol. 17(2), pages 101-112, June.
    14. Clemens, Timo & Michelsen, Kai & Commers, Matt & Garel, Pascal & Dowdeswell, Barrie & Brand, Helmut, 2014. "European hospital reforms in times of crisis: Aligning cost containment needs with plans for structural redesign?," Health Policy, Elsevier, vol. 117(1), pages 6-14.
    15. Cook, Wade D. & Liang, Liang & Zhu, Joe, 2010. "Measuring performance of two-stage network structures by DEA: A review and future perspective," Omega, Elsevier, vol. 38(6), pages 423-430, December.
    16. Antonio Afonso & Miguel St. Aubyn, 2011. "Assessing health efficiency across countries with a two-step and bootstrap analysis," Applied Economics Letters, Taylor & Francis Journals, vol. 18(15), pages 1427-1430.
    17. Bruce Hollingsworth, 2008. "The measurement of efficiency and productivity of health care delivery," Health Economics, John Wiley & Sons, Ltd., vol. 17(10), pages 1107-1128, October.
    18. Panagiotis Mitropoulos & Nikolaos Mastrogiannis & Ioannis Mitropoulos, 2014. "Seeking interactions between patient satisfaction and efficiency in primary healthcare: cluster and DEA analysis," International Journal of Multicriteria Decision Making, Inderscience Enterprises Ltd, vol. 4(3), pages 234-251.
    19. Government of India, 2017. "National Health Policy 2017," Working Papers id:11664, eSocialSciences.
    20. Eddy Adang & George Borm, 2007. "Is there an association between economic performance and public satisfaction in health care?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(3), pages 279-285, September.
    21. Khushalani, Jaya & Ozcan, Yasar A., 2017. "Are hospitals producing quality care efficiently? An analysis using Dynamic Network Data Envelopment Analysis (DEA)," Socio-Economic Planning Sciences, Elsevier, vol. 60(C), pages 15-23.
    22. Retzlaff-Roberts, Donna & Chang, Cyril F. & Rubin, Rose M., 2004. "Technical efficiency in the use of health care resources: a comparison of OECD countries," Health Policy, Elsevier, vol. 69(1), pages 55-72, July.
    23. Liang Liang & Wade D. Cook & Joe Zhu, 2008. "DEA models for two‐stage processes: Game approach and efficiency decomposition," Naval Research Logistics (NRL), John Wiley & Sons, vol. 55(7), pages 643-653, October.
    24. Jean Spinks & Bruce Hollingsworth, 2009. "Cross-country comparisons of technical efficiency of health production: a demonstration of pitfalls," Applied Economics, Taylor & Francis Journals, vol. 41(4), pages 417-427.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Roman Lacko & Zuzana Hajduová & Tomáš Bakalár & Henrieta Pavolová, 2022. "Efficiency and Productivity Differences in Healthcare Systems: The Case of the European Union," IJERPH, MDPI, vol. 20(1), pages 1-14, December.
    2. Iveta Vrabková & Sabrina Lee, 2023. "Approximating the influence of external factors on the technical efficiency score of hospital care: evidence from the federal states of Germany," Health Economics Review, Springer, vol. 13(1), pages 1-14, December.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Justyna Kujawska, 2021. "Health System Efficiency in European Countries: Network Data Envelopment Analysis Approach," European Research Studies Journal, European Research Studies Journal, vol. 0(2), pages 1095-1117.
    2. Marianela Carrillo & Jesús M. Jorge, 2017. "DEA-Like Efficiency Ranking of Regional Health Systems in Spain," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 133(3), pages 1133-1149, September.
    3. Angelo Castaldo & Maria Alessandra Antonelli & Valeria De Bonis & Giorgia Marini, 2020. "Determinants of health sector efficiency: evidence from a two-step analysis on 30 OECD countries," Economics Bulletin, AccessEcon, vol. 40(2), pages 1651-1666.
    4. Varabyova, Yauheniya & Müller, Julia-Maria, 2016. "The efficiency of health care production in OECD countries: A systematic review and meta-analysis of cross-country comparisons," Health Policy, Elsevier, vol. 120(3), pages 252-263.
    5. Ozbugday, Fatih Cemil & Tirgil, Abdullah & Kose, Elif Gul, 2020. "Efficiency changes in long-term care in OECD countries: A non-parametric Malmquist Index approach," Socio-Economic Planning Sciences, Elsevier, vol. 70(C).
    6. Marwa Hasni & Safa Bhar Layeb & Najla Omrane Aissaoui & Aymen Mannai, 2022. "Hybrid model for a cross‐department efficiency evaluation in healthcare systems," Managerial and Decision Economics, John Wiley & Sons, Ltd., vol. 43(5), pages 1311-1329, July.
    7. Constantin Ogloblin, 2023. "Health care financing and productivity of health care in OECD countries: a stochastic frontier analysis," Eurasian Economic Review, Springer;Eurasia Business and Economics Society, vol. 13(2), pages 259-283, June.
    8. Sepideh Abolghasem & Mehdi Toloo & Santiago Amézquita, 2019. "Cross-efficiency evaluation in the presence of flexible measures with an application to healthcare systems," Health Care Management Science, Springer, vol. 22(3), pages 512-533, September.
    9. Kristína Kočišová & Jakub Sopko, 2020. "The Efficiency of Public Health and Medical Care Systems in EU Countries: Dynamic Network Data Envelopment Analysis," Acta Universitatis Agriculturae et Silviculturae Mendelianae Brunensis, Mendel University Press, vol. 68(2), pages 383-394.
    10. Yusi Cheng & Xuejie Bai & Yung‐Ho Chiu, 2023. "Performance evaluation for health‐care sectors using a dynamic network data envelopment analysis approach," Managerial and Decision Economics, John Wiley & Sons, Ltd., vol. 44(4), pages 2237-2253, June.
    11. Dino Rizzi & Michele Zanette, 2021. "Potential efficiency gains and expenditure savings in the Italian Regional Healthcare Systems," Politica economica, Società editrice il Mulino, issue 2, pages 187-214.
    12. Panagiotis Mitropoulos & Ioannis Mitropoulos, 2020. "Performance evaluation of retail banking services: Is there a trade‐off between production and quality?," Managerial and Decision Economics, John Wiley & Sons, Ltd., vol. 41(7), pages 1237-1250, October.
    13. Pinto, Claudio, 2019. "Model and measure the relative efficiency of a four-stage production process. An NDEA multiplier relational model under different systems of resource distribution preferences between sub-processes," MPRA Paper 92617, University Library of Munich, Germany.
    14. Varabyova, Yauheniya & Schreyögg, Jonas, 2013. "International comparisons of the technical efficiency of the hospital sector: Panel data analysis of OECD countries using parametric and non-parametric approaches," Health Policy, Elsevier, vol. 112(1), pages 70-79.
    15. See, Kok Fong & Md Hamzah, Nurhafiza & Yu, Ming-Miin, 2021. "Metafrontier efficiency analysis for hospital pharmacy services using dynamic network DEA framework," Socio-Economic Planning Sciences, Elsevier, vol. 78(C).
    16. Tatiana Bencova & Andrea Bohacikova, 2022. "DEA in Performance Measurement of Two-Stage Processes: Comparative Overview of the Literature," Economic Studies journal, Bulgarian Academy of Sciences - Economic Research Institute, issue 5, pages 111-129.
    17. Mustapha D. Ibrahim & Sahand Daneshvar & Mevhibe B. Hocaoğlu & Olasehinde-Williams G. Oluseye, 2019. "An Estimation of the Efficiency and Productivity of Healthcare Systems in Sub-Saharan Africa: Health-Centred Millennium Development Goal-Based Evidence," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 143(1), pages 371-389, May.
    18. Kao, Chiang, 2014. "Network data envelopment analysis: A review," European Journal of Operational Research, Elsevier, vol. 239(1), pages 1-16.
    19. Erika Laranjeira & Helena Szrek, 2016. "Going beyond life expectancy in assessments of health systems’ performance: life expectancy adjusted by perceived health status," International Journal of Health Economics and Management, Springer, vol. 16(2), pages 133-161, June.
    20. Sharon Hadad & Yossi Hadad & Tzahit Simon-Tuval, 2013. "Determinants of healthcare system’s efficiency in OECD countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(2), pages 253-265, April.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:operea:v:21:y:2021:i:2:d:10.1007_s12351-019-00483-3. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.