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Did the corporatization of Portuguese hospitals significantly change their productivity?

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  • Diogo Ferreira

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  • Rui Marques

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Abstract

This paper aims to investigate if the market structure reforms in the Portuguese health system have improved hospital performance and productivity. A robust non-parametric Malmquist index is applied to measure group performance. The significance of the results achieved is examined using a conditional and non-conditional subsampling bootstrapped-based methodology, enhanced by the likelihood cross validation criterion based on the k-nearest neighbors method. The sample contains information about 216 non-corporatized and 176 corporatized Portuguese hospitals for the period 2002–2009. Five models were applied, based on three study dimensions (internment, emergencies and doctor visits). The results show that although corporatized hospitals presented the highest efficiency consistency, they had also the lowest levels of productivity, while the hospitals under the traditional administrative public management system were the ones with the best average performance. However, several best practices were also found in all groups, being the limited companies were often dominated by both non-corporatized and public enterprise entities. Consistent output ranges where all groups present dominance over the others were also identified. It was possible to conclude that the more autonomy the hospital had from the Ministry of Health, the lower was its productivity. Copyright Springer-Verlag Berlin Heidelberg 2015

Suggested Citation

  • 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.
  • Handle: RePEc:spr:eujhec:v:16:y:2015:i:3:p:289-303
    DOI: 10.1007/s10198-014-0574-8
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    Cited by:

    1. Diogo Cunha Ferreira & Rui Cunha Marques, 2016. "Malmquist and Hicks–Moorsteen Productivity Indexes for Clusters Performance Evaluation," International Journal of Information Technology & Decision Making (IJITDM), World Scientific Publishing Co. Pte. Ltd., vol. 15(05), pages 1015-1053, September.
    2. Paulo Caldas & Diogo Cunha Ferreira & Brian Dollery & Rui Cunha Marques, 2018. "Municipal Sustainability Influence by European Union Investment Programs on the Portuguese Local Government," Sustainability, MDPI, Open Access Journal, vol. 10(4), pages 1-23, March.
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    4. Diogo Cunha Ferreira & Alexandre Morais Nunes, 2019. "Technical efficiency of Portuguese public hospitals: A comparative analysis across the five regions of Portugal," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 411-422, January.
    5. 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.
    6. Diogo Ferreira & Rui Cunha Marques, 2018. "Identifying congestion levels, sources and determinants on intensive care units: the Portuguese case," Health Care Management Science, Springer, vol. 21(3), pages 348-375, September.
    7. Aparicio, Juan & Santin, Daniel, 2018. "A note on measuring group performance over time with pseudo-panels," European Journal of Operational Research, Elsevier, vol. 267(1), pages 227-235.
    8. Ferreira, D.C. & Marques, R.C. & Nunes, A.M., 2018. "Economies of scope in the health sector: The case of Portuguese hospitals," European Journal of Operational Research, Elsevier, vol. 266(2), pages 716-735.
    9. Diogo Cunha Ferreira & Rui Cunha Marques, 2020. "A step forward on order-α robust nonparametric method: inclusion of weight restrictions, convexity and non-variable returns to scale," Operational Research, Springer, vol. 20(2), pages 1011-1046, June.
    10. Diogo Cunha Ferreira & Rui Cunha Marques & Alexandre Morais Nunes, 0. "Pay for performance in health care: a new best practice tariff-based tool using a log-linear piecewise frontier function and a dual–primal approach for unique solutions," Operational Research, Springer, vol. 0, pages 1-46.
    11. Ferreira, D.C. & Marques, R.C. & Nunes, A.M. & Figueira, J.R., 2018. "Patients’ satisfaction: The medical appointments valence in Portuguese public hospitals," Omega, Elsevier, vol. 80(C), pages 58-76.
    12. Ferreira, D.C. & Marques, R.C., 2019. "Do quality and access to hospital services impact on their technical efficiency?," Omega, Elsevier, vol. 86(C), pages 218-236.
    13. Juan Aparicio & Sergio Perelman & Daniel Santín, 0. "Comparing the evolution of productivity and performance gaps in education systems through DEA: an application to Latin American countries," Operational Research, Springer, vol. 0, pages 1-35.
    14. 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.
    15. Y. J. F. M. Krabbe-Alkemade & T. L. C. M. Groot & M. Lindeboom, 2017. "Competition in the Dutch hospital sector: an analysis of health care volume and cost," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(2), pages 139-153, March.
    16. Tommaso Agasisti & Ekaterina Shibanova, 2020. "Autonomy, Performance And Efficiency: An Empirical Analysis Of Russian Universities 2014-2018," HSE Working papers WP BRP 224/EC/2020, National Research University Higher School of Economics.
    17. Aparicio, Juan & Crespo-Cebada, Eva & Pedraja-Chaparro, Francisco & Santín, Daniel, 2017. "Comparing school ownership performance using a pseudo-panel database: A Malmquist-type index approach," European Journal of Operational Research, Elsevier, vol. 256(2), pages 533-542.
    18. Diogo Cunha Ferreira & Rui Cunha Marques, 2016. "Should inpatients be adjusted by their complexity and severity for efficiency assessment? Evidence from Portugal," Health Care Management Science, Springer, vol. 19(1), pages 43-57, March.
    19. Guerrini, Andrea & Romano, Giulia & Mancuso, Fabrizio & Carosi, Laura, 2016. "Identifying the performance drivers of wastewater treatment plants through conditional order-m efficiency analysis," Utilities Policy, Elsevier, vol. 42(C), pages 20-31.

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