IDEAS home Printed from https://ideas.repec.org/a/gam/jworld/v6y2025i2p69-d1657679.html
   My bibliography  Save this article

Accounting for Efficiency: Productivity Assessment of Merged Hospitals in Portugal Using DEA–Malmquist Analysis

Author

Listed:
  • Natália Maria Pereira Macedo

    (School of Economics and Management, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal)

  • Anabela Martins Silva

    (School of Economics and Management, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal)

  • Amélia Silva

    (CEOS.PP, Instituto Superior de Contabilidade e Administração do Porto, Polytechnic of Porto, Rua Jaime Lopes Amorim, s/n, 4465-004 Matosinhos, Portugal)

Abstract

This study analyses the effects of public hospital mergers in Portugal, particularly the creation of hospital centers, on productivity levels. Grounded in the theoretical frameworks of New Public Management and Efficiency Theory, a Data Envelopment Analysis (DEA) approach, combined with the Malmquist Productivity Index, was used to evaluate performance. Results for the 2013–2015 period show no statistically significant difference in productivity levels between merged hospitals (hospital centers) and non-merged hospitals (hospital units). However, for hospitals merged in 2007, there is evidence of significant productivity gains in the post-merger period (2008–2014). These findings partially support the assumptions of New Public Management and Efficiency Theory concerning efficiency improvements through hospital mergers in the public sector.

Suggested Citation

  • Natália Maria Pereira Macedo & Anabela Martins Silva & Amélia Silva, 2025. "Accounting for Efficiency: Productivity Assessment of Merged Hospitals in Portugal Using DEA–Malmquist Analysis," World, MDPI, vol. 6(2), pages 1-19, May.
  • Handle: RePEc:gam:jworld:v:6:y:2025:i:2:p:69-:d:1657679
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/2673-4060/6/2/69/pdf
    Download Restriction: no

    File URL: https://www.mdpi.com/2673-4060/6/2/69/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Gaynor, Martin & Laudicella, Mauro & Propper, Carol, 2012. "Can governments do it better? Merger mania and hospital outcomes in the English NHS," Journal of Health Economics, Elsevier, vol. 31(3), pages 528-543.
    2. 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.
    3. repec:ptu:bdpart:a200804 is not listed on IDEAS
    4. Dyson, R. G. & Allen, R. & Camanho, A. S. & Podinovski, V. V. & Sarrico, C. S. & Shale, E. A., 2001. "Pitfalls and protocols in DEA," European Journal of Operational Research, Elsevier, vol. 132(2), pages 245-259, July.
    5. Liu, Fuh-Hwa Franklin & Wang, Peng-hsiang, 2008. "DEA Malmquist productivity measure: Taiwanese semiconductor companies," International Journal of Production Economics, Elsevier, vol. 112(1), pages 367-379, March.
    6. Ouellette, Pierre & Vierstraete, Valerie, 2004. "Technological change and efficiency in the presence of quasi-fixed inputs: A DEA application to the hospital sector," European Journal of Operational Research, Elsevier, vol. 154(3), pages 755-763, May.
    7. G D Ferrier & V G Valdmanis, 2004. "Do mergers improve hospital productivity?," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 55(10), pages 1071-1080, October.
    Full references (including those not matched with items on IDEAS)

    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. Giménez, Víctor & Prieto, William & Prior, Diego & Tortosa-Ausina, Emili, 2019. "Evaluation of efficiency in Colombian hospitals: An analysis for the post-reform period," Socio-Economic Planning Sciences, Elsevier, vol. 65(C), pages 20-35.
    2. Xian‐Hui He & Yung‐ho Chiu & Tzu‐Han Chang & Liang‐Chun Lu & Shih‐Yung Chiu, 2021. "Analyzing hospital medical efficiency of administration and medical treatment in China," Managerial and Decision Economics, John Wiley & Sons, Ltd., vol. 42(6), pages 1564-1578, September.
    3. Helda Azevedo & Céu Mateus, 2014. "Cost effects of hospital mergers in Portugal," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(9), pages 999-1010, December.
    4. Angeliki Flokou & Vassilis Aletras & Dimitris Niakas, 2017. "Decomposition of potential efficiency gains from hospital mergers in Greece," Health Care Management Science, Springer, vol. 20(4), pages 467-484, December.
    5. Bojiang Yang & Youliang Zhang & Hongjun Zhang & Rui Zhang & Baoyu Xu, 2016. "Factor-specific Malmquist productivity index based on common weights DEA," Operational Research, Springer, vol. 16(1), pages 51-70, April.
    6. Chen, Chien-Ming, 2013. "Super efficiencies or super inefficiencies? Insights from a joint computation model for slacks-based measures in DEA," European Journal of Operational Research, Elsevier, vol. 226(2), pages 258-267.
    7. Apostolos Christopoulos & Ioannis Dokas & Sofia Katsimardou & Eleftherios Spyromitros, 2022. "The Malmquist Productivity measure for UK-listed firms in the aftermath of the global financial crisis," Operational Research, Springer, vol. 22(2), pages 1617-1634, April.
    8. Mustafa Jahangoshai Rezaee & Abuzar Karimdadi & Hamidreza Izadbakhsh, 2019. "Road map for progress and attractiveness of Iranian hospitals by integrating self-organizing map and context-dependent DEA," Health Care Management Science, Springer, vol. 22(3), pages 410-436, September.
    9. Sebastian Kohl & Jan Schoenfelder & Andreas Fügener & Jens O. Brunner, 2019. "The use of Data Envelopment Analysis (DEA) in healthcare with a focus on hospitals," Health Care Management Science, Springer, vol. 22(2), pages 245-286, June.
    10. Vincenzo Atella & Federico Belotti & Silvio Daidone & Giuseppe Ilardi & Giorgia Marini, 2012. "Cost-containment policies and hospital efficiency: evidence from a panel of Italian hospitals," CEIS Research Paper 228, Tor Vergata University, CEIS, revised 13 Apr 2012.
    11. Ho, Foo Nin & Huang, Chin-wei, 2020. "The interdependencies of marketing capabilities and operations efficiency in hospitals," Journal of Business Research, Elsevier, vol. 113(C), pages 337-347.
    12. Kerstens, Kristiaan & Van de Woestyne, Ignace, 2014. "Comparing Malmquist and Hicks–Moorsteen productivity indices: Exploring the impact of unbalanced vs. balanced panel data," European Journal of Operational Research, Elsevier, vol. 233(3), pages 749-758.
    13. L-J Kao & C-C Lu & C-C Chiu, 2011. "The training institution efficiency of the semiconductor institute programme in Taiwan—application of spatiotemporal ICA with DEA approach," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 62(12), pages 2162-2172, December.
    14. Ramanathan, Ramakrishnan, 2005. "An analysis of energy consumption and carbon dioxide emissions in countries of the Middle East and North Africa," Energy, Elsevier, vol. 30(15), pages 2831-2842.
    15. H Fukuyama & W L Weber, 2009. "Estimating indirect allocative inefficiency and productivity change," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 60(11), pages 1594-1608, November.
    16. Ying Li & Yung-Ho Chiu & Tai-Yu Lin & Tzu-Han Chang, 2020. "Pre-Evaluating the Technical Efficiency Gains from Potential Mergers and Acquisitions in the IC Design Industry," International Journal of Information Technology & Decision Making (IJITDM), World Scientific Publishing Co. Pte. Ltd., vol. 19(02), pages 525-559, April.
    17. Winter, Vera & Thomsen, Mette Kjærgaard & Schreyögg, Jonas & Blankart, Katharina & Duminy, Lize & Schoenenberger, Lukas & Ansah, John P. & Matchar, David & Blankart, Carl Rudolf & Oppel, Eva & Jensen,, 2019. "Improving Service Provision - The Health Care Services' Perspective," SMR - Journal of Service Management Research, Nomos Verlagsgesellschaft mbH & Co. KG, vol. 3(4), pages 163-183.
    18. A. Guerrini & G. Romano & L. Carosi & F. Mancuso, 2017. "Cost Savings in Wastewater Treatment Processes: the Role of Environmental and Operational Drivers," Water Resources Management: An International Journal, Published for the European Water Resources Association (EWRA), Springer;European Water Resources Association (EWRA), vol. 31(8), pages 2465-2478, June.
    19. Sufian, Fadzlan & Abdul Majid, Muhamed Zulkhibri, 2007. "Consolidation and efficiency: Evidence from non-bank financial institutions in Malaysia," MPRA Paper 12128, University Library of Munich, Germany, revised 01 May 2007.
    20. Yu, Shasha & Lei, Ming & Deng, Honghui, 2023. "Evaluation to fixed-sum-outputs DMUs by non-oriented equilibrium efficient frontier DEA approach with Nash bargaining-based selection," Omega, Elsevier, vol. 115(C).

    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:gam:jworld:v:6:y:2025:i:2:p:69-:d:1657679. 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: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.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.