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Operational efficiency vs clinical safety, care appropriateness, timeliness, and access to health care

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Listed:
  • Diogo Cunha Ferreira

    (University of Lisbon)

  • Alexandre Morais Nunes

    (University of Lisbon
    University of Lisbon)

  • Rui Cunha Marques

    (University of Lisbon)

Abstract

Health care systems face resource scarcity that may jeopardise their financial sustainability as well as the quality of delivered health care. In view of that, the association between technical efficiency, access, and quality of services should be investigated, despite some past attempts that led to mixed, unclear, and perhaps biased results. We use a dataset composed of financial resources, hospital services, appropriateness and timeliness of care, patients’ clinical safety, access to health care services, demographics, and epidemiology variables to study the aforementioned link regarding the Portuguese public hospitals (operating between 2013 and 2016). Quality and access data are aggregated into three main composite indicators, through Grey Relational Analysis (GRA). Bias- and environmentally corrected efficiency scores are estimated via bootstrap-based directional Data Envelopment Analysis. A double bootstrap algorithm is employed, using GRA-based quality indicators as predictors of technical efficiency. Evidence suggests that (1) Portuguese public hospitals exhibit low performance in terms of quality, while the different indicators present considerable correlation among them and with hospital size and patients’ complexity characteristics; (2) patients’ clinical safety, appropriateness and timeliness, as well as access to health care services are consistent and significant predictors of technical efficiency; and (3) the association between efficiency, quality, and access depends on the interaction between appropriateness, timeliness, and access. Therefore, quality and access can be improved with no efficiency sacrifice and vice versa.

Suggested Citation

  • Diogo Cunha Ferreira & Alexandre Morais Nunes & Rui Cunha Marques, 2020. "Operational efficiency vs clinical safety, care appropriateness, timeliness, and access to health care," Journal of Productivity Analysis, Springer, vol. 53(3), pages 355-375, June.
    • Handle: RePEc:kap:jproda:v:53:y:2020:i:3:d:10.1007_s11123-020-00578-6
    DOI: 10.1007/s11123-020-00578-6
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    1. 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.
    2. Schang, Laura & Hynninen, Yrjänä & Morton, Alec & Salo, Ahti, 2016. "Developing robust composite measures of healthcare quality – Ranking intervals and dominance relations for Scottish Health Boards," Social Science & Medicine, Elsevier, vol. 162(C), pages 59-67.
    3. Clara Dismuke & Vania Sena, 2001. "Is there a Trade-Off between Quality and Productivity? The Case of Diagnostic Technologies in Portugal," Annals of Operations Research, Springer, vol. 107(1), pages 101-116, October.
    4. Yauheniya Varabyova & Carl Rudolf Blankart & Aleksandra Torbica & Jonas Schreyögg, 2017. "Comparing the Efficiency of Hospitals in Italy and Germany: Nonparametric Conditional Approach Based on Partial Frontier," Health Care Management Science, Springer, vol. 20(3), pages 379-394, September.
    5. Cinzia Daraio & Léopold Simar, 2005. "Introducing Environmental Variables in Nonparametric Frontier Models: a Probabilistic Approach," Journal of Productivity Analysis, Springer, vol. 24(1), pages 93-121, September.
    6. Vasanthakumar Bhat, 2005. "Institutional arrangements and efficiency of health care delivery systems," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 6(3), pages 215-222, September.
    7. Badin, Luiza & Daraio, Cinzia & Simar, Léopold, 2010. "Optimal bandwidth selection for conditional efficiency measures: A data-driven approach," European Journal of Operational Research, Elsevier, vol. 201(2), pages 633-640, March.
    8. Olson, David L. & Wu, Desheng, 2006. "Simulation of fuzzy multiattribute models for grey relationships," European Journal of Operational Research, Elsevier, vol. 175(1), pages 111-120, November.
    9. B. Dervaux & H. Leleu & E. Minvielle & V. Valdmanis & P. Aegerter & B. Guidet, 2009. "Assessing Performance of French Intensive Care Units: A Directional Distance Function Approach at the Patient Level," Post-Print halshs-00476492, HAL.
    10. 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.
    11. Ferreira, Diogo Cunha & Marques, Rui Cunha & Pedro, Maria Isabel, 2016. "Comparing efficiency of holding business model and individual management model of airports," Journal of Air Transport Management, Elsevier, vol. 57(C), pages 168-183.
    12. Aragon, Y. & Daouia, A. & Thomas-Agnan, C., 2005. "Nonparametric Frontier Estimation: A Conditional Quantile-Based Approach," Econometric Theory, Cambridge University Press, vol. 21(2), pages 358-389, April.
    13. Chowdhury, Hedayet & Zelenyuk, Valentin, 2016. "Performance of hospital services in Ontario: DEA with truncated regression approach," Omega, Elsevier, vol. 63(C), pages 111-122.
    14. Diogo Ferreira & Rui Marques, 2015. "Did the corporatization of Portuguese hospitals significantly change their productivity?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(3), pages 289-303, April.
    15. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-255, March-Apr.
    16. Møller Dahl, Christian & Planck Kongstad, Line, 2017. "The costs of acute readmissions to a different hospital – Does the effect vary across provider types?," Social Science & Medicine, Elsevier, vol. 183(C), pages 116-125.
    17. Simar, Leopold & Wilson, Paul W., 2007. "Estimation and inference in two-stage, semi-parametric models of production processes," Journal of Econometrics, Elsevier, vol. 136(1), pages 31-64, January.
    18. R. G. Chambers & Y. Chung & R. Färe, 1998. "Profit, Directional Distance Functions, and Nerlovian Efficiency," Journal of Optimization Theory and Applications, Springer, vol. 98(2), pages 351-364, August.
    19. 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.
    20. 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.
    21. Chang, Shyr-Juh & Hsiao, Hsing-Chin & Huang, Li-Hua & Chang, Hsihui, 2011. "Taiwan quality indicator project and hospital productivity growth," Omega, Elsevier, vol. 39(1), pages 14-22, January.
    22. 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.
    23. 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.
    24. Yang, Jinqiu & Zeng, Wu, 2014. "The trade-offs between efficiency and quality in the hospital production: Some evidence from Shenzhen, China," China Economic Review, Elsevier, vol. 31(C), pages 166-184.
    25. 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.
    26. Giulia Garavaglia & Emanuele Lettieri & Tommaso Agasisti & Silvano Lopez, 2011. "Efficiency and quality of care in nursing homes: an Italian case study," Health Care Management Science, Springer, vol. 14(1), pages 22-35, March.
    27. Chambers, Robert G. & Chung, Yangho & Fare, Rolf, 1996. "Benefit and Distance Functions," Journal of Economic Theory, Elsevier, vol. 70(2), pages 407-419, August.
    28. Charnes, A. & Cooper, W. W. & Rhodes, E., 1979. "Measuring the efficiency of decision-making units," European Journal of Operational Research, Elsevier, vol. 3(4), pages 339-338, July.
    29. Bădin, Luiza & Daraio, Cinzia & Simar, Léopold, 2012. "How to measure the impact of environmental factors in a nonparametric production model," European Journal of Operational Research, Elsevier, vol. 223(3), pages 818-833.
    30. Chang, Hsihui & Cheng, Mei-Ai & Das, Somnath, 2004. "Hospital ownership and operating efficiency: Evidence from Taiwan," European Journal of Operational Research, Elsevier, vol. 159(2), pages 513-527, December.
    31. Pedro Simões & Rui Marques, 2011. "Performance and congestion analysis of the portuguese hospital services," 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 39-63, March.
    32. Gary Ferrier & Julie Trivitt, 2013. "Incorporating quality into the measurement of hospital efficiency: a double DEA approach," Journal of Productivity Analysis, Springer, vol. 40(3), pages 337-355, December.
    33. Chowdhury, Hedayet & Zelenyuk, Valentin & Laporte, Audrey & Wodchis, Walter P., 2014. "Analysis of productivity, efficiency and technological changes in hospital services in Ontario: How does case-mix matter?," International Journal of Production Economics, Elsevier, vol. 150(C), pages 74-82.
    34. Chang, Hsihui & Chang, Wen-Jing & Das, Somnath & Li, Shu-Hsing, 2004. "Health care regulation and the operating efficiency of hospitals: Evidence from Taiwan," Journal of Accounting and Public Policy, Elsevier, vol. 23(6), pages 483-510.
    35. Allin, Sara & Grignon, Michel & Wang, Li, 2016. "The determinants of efficiency in the Canadian health care system," Health Economics, Policy and Law, Cambridge University Press, vol. 11(1), pages 39-65, January.
    36. 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.
    37. Matranga, Domenica & Sapienza, Francesca, 2015. "Congestion analysis to evaluate the efficiency and appropriateness of hospitals in Sicily," Health Policy, Elsevier, vol. 119(3), pages 324-332.
    38. Anne Hvenegaard & Jacob Arendt & Andrew Street & Dorte Gyrd-Hansen, 2011. "Exploring the relationship between costs and quality: Does the joint evaluation of costs and quality alter the ranking of Danish hospital departments?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(6), pages 541-551, December.
    39. Ivonne Lindlbauer & Jonas Schreyögg, 2014. "The relationship between hospital specialization and hospital efficiency: do different measures of specialization lead to different results?," Health Care Management Science, Springer, vol. 17(4), pages 365-378, December.
    40. Dervaux, B. & Leleu, H. & Minvielle, E. & Valdmanis, V. & Aegerter, P. & Guidet, B., 2009. "Performance of French intensive care units: A directional distance function approach at the patient level," International Journal of Production Economics, Elsevier, vol. 120(2), pages 585-594, August.
    41. Zhou, P. & Ang, B.W. & Wang, H., 2012. "Energy and CO2 emission performance in electricity generation: A non-radial directional distance function approach," European Journal of Operational Research, Elsevier, vol. 221(3), pages 625-635.
    42. Shimshak, Daniel G. & Lenard, Melanie L. & Klimberg, Ronald K., 2009. "Incorporating quality into data envelopment analysis of nursing home performance: A case study," Omega, Elsevier, vol. 37(3), pages 672-685, June.
    43. Guilhermina Rego & Rui Nunes & José Costa, 2010. "The challenge of corporatisation: the experience of Portuguese public hospitals," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(4), pages 367-381, August.
    44. 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, September.
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    Cited by:

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    2. Alicia Ramírez-Orellana & María del Carmen Valls Martínez & Mayra Soledad Grasso, 2021. "Using Higher-Order Constructs to Estimate Health-Disease Status: The Effect of Health System Performance and Sustainability," Mathematics, MDPI, vol. 9(11), pages 1-23, May.
    3. Xinxin Peng & Xiaolei Tang & Jing Hua Zhang & Yijun Chen, 2023. "Smoking Bans and Circulatory System Disease Mortality Reduction in Macao (China): Using GRA Models," IJERPH, MDPI, vol. 20(5), pages 1-14, March.
    4. Vardanyan, Michael & Valdmanis, Vivian G. & Leleu, Hervé & Ferrier, Gary D., 2022. "Estimating technology characteristics of the U.S. hospital industry using directional distance functions with optimal directions," Omega, Elsevier, vol. 113(C).
    5. Rocha, António & Costa, Ana Sara & Figueira, José Rui & Ferreira, Diogo Cunha & Marques, Rui Cunha, 2021. "Quality assessment of the Portuguese public hospitals: A multiple criteria approach," Omega, Elsevier, vol. 105(C).
    6. Paulo Caldas & Miguel Varela, 2023. "The Portuguese Public Hospitals Performance Evolution before and during the SARS-CoV-2 Pandemic (2017–2022)," Sustainability, MDPI, vol. 15(15), pages 1-31, July.
    7. Xinxin Peng & Xiaolei Tang & Yijun Chen & Jinghua Zhang, 2021. "Ranking the Healthcare Resource Factors for Public Satisfaction with Health System in China—Based on the Grey Relational Analysis Models," IJERPH, MDPI, vol. 18(3), pages 1-13, January.

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    More about this item

    Keywords

    Hospitals; Efficiency; Quality; Access; Data Envelopment Analysis; Grey Relational Analysis;
    All these keywords.

    JEL classification:

    • C12 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Hypothesis Testing: General
    • C14 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Semiparametric and Nonparametric Methods: General
    • C18 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Methodolical Issues: General
    • C61 - Mathematical and Quantitative Methods - - Mathematical Methods; Programming Models; Mathematical and Simulation Modeling - - - Optimization Techniques; Programming Models; Dynamic Analysis
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health

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