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Evaluating Hospital Efficiency Adjusting for Quality Indicators: an Application to Portuguese NHS Hospitals

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  • : Álvaro Almeida

    ()
    (CEF.UP, Faculdade de Economia, Universidade do Porto)

  • José Pedro Fique

    ()
    (Faculdade de Economia, Universidade do Porto)

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    Abstract

    The objective of this paper is to develop a methodology to incorporate measures of hospital quality in efficiency analysis, applied to Portuguese NHS hospitals, in order to assess whether there is a trade-off between efficiency and quality in Portuguese hospitals. We develop and compare two methodologies to compute DEA technical efficiency scores adjusted for output quality, for a sample of Portuguese NHS hospitals in 2009. When DEA efficiency scores are adjusted for output quality, the decision making units that lie on the technical efficiency frontier remain largely unaltered, even if a great weight is given to quality indicators over quantity indicators of output. Nevertheless, we find that outside of the frontier adjusting for quality does have an impact in efficiency scores.We conclude that the empirical evidence is not sufficient to identify a clear trade-off between efficiency and quality in the hospitals under review, implying the possibility that efficiency gains may achieved without a significant sacrifice of service quality. Nevertheless, there is enough evidence to conclude that analyzing hospital efficiency without consideration of differences in quality of service will generate biased results. When perceived quality is brought to the analysis, the gap between efficient and inefficient units tends to widen.

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    File URL: http://www.fep.up.pt/investigacao/workingpapers/11.11.02_wp435.pdf
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    Bibliographic Info

    Paper provided by Universidade do Porto, Faculdade de Economia do Porto in its series FEP Working Papers with number 435.

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    Length: 20 pages
    Date of creation: Nov 2011
    Date of revision:
    Handle: RePEc:por:fepwps:435

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    Keywords: Hospital efficiency; Hospital quality; Data Envelopment Analysis;

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    1. Fried, Harold O. & Lovell, C. A. Knox & Schmidt, Shelton S. (ed.), 2008. "The Measurement of Productive Efficiency and Productivity Growth," OUP Catalogue, Oxford University Press, number 9780195183528.
    2. Annika Herr, 2008. "Cost and technical efficiency of German hospitals: does ownership matter?," Health Economics, John Wiley & Sons, Ltd., vol. 17(9), pages 1057-1071.
    3. António Afonso & Miguel St. Aubyn, 2005. "Non-parametric approaches to education and health efficiency in OECD countries," Journal of Applied Economics, Universidad del CEMA, vol. 0, pages 227-246, November.
    4. 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.
    5. Gary Ferrier & Michael Rosko & Vivian Valdmanis, 2006. "Analysis of uncompensated hospital care using a DEA model of output congestion," Health Care Management Science, Springer, vol. 9(2), pages 181-188, May.
    6. Jan Clement & Vivian Valdmanis & Gloria Bazzoli & Mei Zhao & Askar Chukmaitov, 2008. "Is more better? An analysis of hospital outcomes and efficiency with a DEA model of output congestion," Health Care Management Science, Springer, vol. 11(1), pages 67-77, March.
    7. Fare, Rolf, et al, 1989. "Multilateral Productivity Comparisons When Some Outputs Are Undesirable: A Nonparametric Approach," The Review of Economics and Statistics, MIT Press, vol. 71(1), pages 90-98, February.
    8. Carlos Barros & António Gomes de Menezes & Nicolas Peypoch & Bernardin Solonandrasana & José Vieira, 2008. "An analysis of hospital efficiency and productivity growth using the Luenberger indicator," Health Care Management Science, Springer, vol. 11(4), pages 373-381, December.
    9. 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.
    10. Vasanthakumar Bhat, 2005. "Institutional arrangements and efficiency of health care delivery systems," The European Journal of Health Economics, Springer, vol. 6(3), pages 215-222, September.
    11. Simões, Pedro & Cunha Marques, Rui, 2009. "Performance and Congestion Analysis of the Portuguese Hospital Services," MPRA Paper 16940, University Library of Munich, Germany.
    12. Guilhermina Rego & Rui Nunes & José Costa, 2010. "The challenge of corporatisation: the experience of Portuguese public hospitals," The European Journal of Health Economics, Springer, vol. 11(4), pages 367-381, August.
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