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Risk-Adjusted Mortality, varieties of congestion and patient satisfaction in Turkish provincial general hospitals

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  • Davutyan, Nurhan
  • Bilsel, Murat
  • Tarcan, Menderes
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    Abstract

    Abstract: We analyze the operational performance of 330 Turkish provincial general hospitals. To help improve performance on both input and output space, we adopt a directional distance approach. We treat a mortality based variable as “bad output”. Congested hospitals are those for whom the switch from strong to weak disposability of mortality is costly. Thus we are able to address the “quality or adequacy of care” issue. We identify congested hospitals using 3 different direction vectors and derive the associated congestion inefficiency scores. For each case, we show these scores are negatively related to patient satisfaction. We separate congested hospitals into two groups: (i) those requiring uniform sacrifice of good outputs and/or extra inputs in order to reduce mortality, and (ii) those that do not. The latter ones free up some inputs in addition to requiring extra amounts of other inputs and/or produce more of some outputs but less of others as the price of reducing mortality. The first group can be said to operate at “capacity” whereas the latter can be said to display “negative marginal productivity”. Patient dissatisfaction is demonstrably higher in the latter group of hospitals, whereas mortality reduction is positively related to patient satisfaction in “capacity constrained” hospitals. The first group is more likely to be located in emigrating whereas the second one in immigrating regions.

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    Bibliographic Info

    Paper provided by University Library of Munich, Germany in its series MPRA Paper with number 37437.

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    Date of creation: 12 Mar 2012
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    Handle: RePEc:pra:mprapa:37437

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    Keywords: Directional distance; bad outputs; hospital quality;

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    1. Pablo Arocena & Ariadna Garc�a-Prado, 2007. "Accounting for quality in the measurement of hospital performance: evidence from Costa Rica," Health Economics, John Wiley & Sons, Ltd., vol. 16(7), pages 667-685.
    2. Murty, Sushama & Russell, R. Robert, 2010. "On modeling pollution-generating technologies," The Warwick Economics Research Paper Series (TWERPS) 931, University of Warwick, Department of Economics.
    3. Jacobs,Rowena & Smith,Peter C. & Street,Andrew, 2006. "Measuring Efficiency in Health Care," Cambridge Books, Cambridge University Press, number 9780521851442, April.
    4. Andrés J. Picazo-Tadeo & Diego Prior, 2005. "Efficiency and environmental regulation: a "complex situation"," Working Paper 200502, Department of Business Economics, Universitat Autonoma de Barcelona.
    5. 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.
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