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Changes in hospital efficiency and size: An integrated propensity score matching with data envelopment analysis

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  • Cinaroglu, Songul

Abstract

Turkey has made huge investments in city hospitals. The distinguishing feature of these hospitals is that they are physically large. Although many studies have investigated the efficiency of public hospitals, there are a few studies on the effect of hospital size on efficiency. This study examines the effect of hospital size on changes in public hospital efficiencies. The analysis is made up of three steps. First, using a bootstrap data envelopment analysis (DEA), the pure efficiency scores of each hospital were calculated. Second, propensity score matching (PSM) was used to ensure that any differences could be attributed to a particular class of hospital size, and not be due to differences in sample characteristics between the intervention and control groups. To highlight a potential time difference between small and large hospitals, the efficiencies of hospitals were examined from 2014 to 2017. Third, the Mann–Whitney U test was used to conduct a robustness check of the DEA and PSM results. Fourth, logistic regression was used on balanced data to examine the determinants of the efficiency of public hospitals. There are remarkable differences in the results obtained before and after matching the groups based on the bed-occupancy rate. Additionally, urban location is a key predictor of efficient and inefficient hospitals. This study also highlights that integrating DEA and PSM is a useful strategy in accurately identifying predictors of efficiencies of hospitals by creating balanced groups. Health policymakers should consider the efficiency advantages of high workload and service burden in the planning of public hospitals.

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  • 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).
    • Handle: RePEc:eee:soceps:v:76:y:2021:i:c:s0038012120307977
    DOI: 10.1016/j.seps.2020.100960
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    1. Leopold Simar & Paul Wilson, 2000. "A general methodology for bootstrapping in non-parametric frontier models," Journal of Applied Statistics, Taylor & Francis Journals, vol. 27(6), pages 779-802.
    2. Grosskopf, Shawna & Margaritis, Dimitri & Valdmanis, Vivian, 2004. "Competitive effects on teaching hospitals," European Journal of Operational Research, Elsevier, vol. 154(2), pages 515-525, April.
    3. Gintare Mazeikaite & Cathal O’Donoghue & Denisa M. Sologon, 2019. "The Great Recession, financial strain and self-assessed health in Ireland," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(4), pages 579-596, June.
    4. Lindlbauer, Ivonne & Schreyögg, Jonas & Winter, Vera, 2016. "Changes in technical efficiency after quality management certification: A DEA approach using difference-in-difference estimation with genetic matching in the hospital industry," European Journal of Operational Research, Elsevier, vol. 250(3), pages 1026-1036.
    5. Ian McLoughlin & Prue Burns & Evelyn Looi & Amrik Sohal & Helena Teede, 2020. "Brokering knowledge into the public sector: understanding improvement facilitators’ priorities in the redesign of hospital care," Public Management Review, Taylor & Francis Journals, vol. 22(6), pages 836-856, June.
    6. Emek, Uğur, 2015. "Turkish experience with public private partnerships in infrastructure: Opportunities and challenges," Utilities Policy, Elsevier, vol. 37(C), pages 120-129.
    7. Oliver Tiemann & Jonas Schreyögg, 2012. "Changes in hospital efficiency after privatization," Health Care Management Science, Springer, vol. 15(4), pages 310-326, December.
    8. Cyril F. CHANG & Howard P. TUCKMAN, 1991. "Financial Vulnerability And Attrition As Measures Of Nonprofit Performance," Annals of Public and Cooperative Economics, Wiley Blackwell, vol. 62(4), pages 655-672, October.
    9. Chung‐Hua Shen & Yuan Chang, 2012. "To Join Or Not To Join? Do Banks That Are Part Of A Financial Holding Company Perform Better Than Banks That Are Not?," Contemporary Economic Policy, Western Economic Association International, vol. 30(1), pages 113-128, January.
    10. Patrick L. Brockett & William W. Cooper & Linda L. Golden & John J. Rousseau & Yuying Wang, 2005. "Financial Intermediary Versus Production Approach to Efficiency of Marketing Distribution Systems and Organizational Structure of Insurance Companies," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 72(3), pages 393-412, September.
    11. Guerriero, Francesca & Miglionico, Giovanna & Olivito, Filomena, 2016. "Location and reorganization problems: The Calabrian health care system case," European Journal of Operational Research, Elsevier, vol. 250(3), pages 939-954.
    12. Matthias Staat, 2006. "Efficiency of hospitals in Germany: a DEA-bootstrap approach," Applied Economics, Taylor & Francis Journals, vol. 38(19), pages 2255-2263.
    13. Zack Cooper & Stephen Gibbons & Simon Jones & Alistair McGuire, 2012. "Does Competition Improve Public Hospitals' Efficiency? Evidence from a Quasi-Experiment in the English National Health Service," CEP Discussion Papers dp1125, Centre for Economic Performance, LSE.
    14. Martin Gaynor & Rodrigo Moreno-Serra & Carol Propper, 2013. "Death by Market Power: Reform, Competition, and Patient Outcomes in the National Health Service," American Economic Journal: Economic Policy, American Economic Association, vol. 5(4), pages 134-166, November.
    15. Léopold Simar & Paul W. Wilson, 1998. "Sensitivity Analysis of Efficiency Scores: How to Bootstrap in Nonparametric Frontier Models," Management Science, INFORMS, vol. 44(1), pages 49-61, January.
    16. Conor Keegan & Aoife Brick & Brendan Walsh & Adele Bergin & James Eighan & Maev‐Ann Wren, 2019. "How many beds? Capacity implications of hospital care demand projections in the Irish hospital system, 2015‐2030," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 569-582, January.
    17. Monica Giancotti & Annamaria Guglielmo & Marianna Mauro, 2017. "Efficiency and optimal size of hospitals: Results of a systematic search," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-40, March.
    18. Daniel Bilodeau & Pierre-Yves Crémieux & Brigitte Jaumard & Pierre Ouellette & Tsévi Vovor, 2004. "Measuring Hospital Performance in the Presence of Quasi-Fixed Inputs: An Analysis of Québec Hospitals," Journal of Productivity Analysis, Springer, vol. 21(2), pages 183-199, March.
    19. Hau L. Lee & V. Padmanabhan & Seungjin Whang, 1997. "Information Distortion in a Supply Chain: The Bullwhip Effect," Management Science, INFORMS, vol. 43(4), pages 546-558, April.
    20. 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.
    21. Lee, Hakyeon & Park, Yongtae & Choi, Hoogon, 2009. "Comparative evaluation of performance of national R&D programs with heterogeneous objectives: A DEA approach," European Journal of Operational Research, Elsevier, vol. 196(3), pages 847-855, August.
    22. Barua, Anitesh & Brockett, P. L. & Cooper, W. W. & Deng, Honghui & Parker, Barnett R. & Ruefli, T. W. & Whinston, A., 2004. "DEA evaluations of long- and short-run efficiencies of digital vs. physical product "dot com" companies," Socio-Economic Planning Sciences, Elsevier, vol. 38(4), pages 233-253, December.
    23. Ismet Sahin & Yasar Ozcan & Hacer Ozgen, 2011. "Assessment of hospital efficiency under health transformation program in Turkey," 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. 19(1), pages 19-37, March.
    24. Huanming Wang & Wei Xiong & Guangdong Wu & Dajian Zhu, 2018. "Public–private partnership in Public Administration discipline: a literature review," Public Management Review, Taylor & Francis Journals, vol. 20(2), pages 293-316, February.
    25. Edgar Alfonso & Dusko Kalenatic & Cesar López, 2010. "Modeling the synergy level in a vertical collaborative supply chain through the IMP interaction model and DEA framework," Annals of Operations Research, Springer, vol. 181(1), pages 813-827, December.
    26. Liang, Li-Lin & Tussing, A. Dale, 2019. "The cyclicality of government health expenditure and its effects on population health," Health Policy, Elsevier, vol. 123(1), pages 96-103.
    27. Garcia-Lacalle, Javier & Martin, Emilio, 2010. "Rural vs urban hospital performance in a 'competitive' public health service," Social Science & Medicine, Elsevier, vol. 71(6), pages 1131-1140, September.
    28. Yasar A. Ozcan, 2014. "Evaluation of Performance in Health Care," International Series in Operations Research & Management Science, in: Health Care Benchmarking and Performance Evaluation, edition 2, chapter 0, pages 3-14, Springer.
    29. Francesco Longo & Luigi Siciliani & Giuseppe Moscelli & Hugh Gravelle, 2019. "Does hospital competition improve efficiency? The effect of the patient choice reform in England," Health Economics, John Wiley & Sons, Ltd., vol. 28(5), pages 618-640, May.
    30. 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.
    31. Chen, Andrew & Hwang, Yuhchang & Shao, Benjamin, 2005. "Measurement and sources of overall and input inefficiencies: Evidences and implications in hospital services," European Journal of Operational Research, Elsevier, vol. 161(2), pages 447-468, March.
    32. R. D. Banker & A. Charnes & W. W. Cooper, 1984. "Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis," Management Science, INFORMS, vol. 30(9), pages 1078-1092, September.
    33. Andrew M. Jones, 2007. "Identification of treatment effects in Health Economics," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1127-1131, November.
    34. Mariateresa Torchia & Andrea Calabrò, 2018. "Increasing the Governance Standards of Public-Private Partnerships in Healthcare. Evidence from Italy," Public Organization Review, Springer, vol. 18(1), pages 93-110, March.
    35. Patrick L. Brockett & Boaz Golany, 1996. "Using Rank Statistics for Determining Programmatic Efficiency Differences in Data Envelopment Analysis," Management Science, INFORMS, vol. 42(3), pages 466-472, March.
    36. Jonas Schreyögg & Tom Stargardt & Oliver Tiemann, 2011. "Costs and quality of hospitals in different health care systems: a multi‐level approach with propensity score matching," Health Economics, John Wiley & Sons, Ltd., vol. 20(1), pages 85-100, January.
    37. Ya Chen & Justin Wang & Joe Zhu & H. David Sherman & Shin-Yi Chou, 2019. "How the Great Recession affects performance: a case of Pennsylvania hospitals using DEA," Annals of Operations Research, Springer, vol. 278(1), pages 77-99, July.
    38. Yasar A. Ozcan, 2014. "Health Care Benchmarking and Performance Evaluation," International Series in Operations Research and Management Science, Springer, edition 2, number 978-1-4899-7472-3, December.
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