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Performance Through Efficiency in the Public Healthcare System – A DEA Approach in an Emergent Country

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  • Nistor Cristina Silvia

    (Faculty of Economics and Business Administration, Babes-Bolyai University, Teodor Mihali 58-60, 400591, Cluj-Napoca, Romania)

  • Ștefănescu Cristina Alexandrina

    (Babeș-Bolyai University, Cluj-Napoca, Romania)

  • Crișan Andrei-Răzvan

    (Babeș-Bolyai University, Cluj-Napoca, Romania)

Abstract

Aiming to analyze the efficiency of the public sector, this paper enriches the literature by providing insights of the healthcare system for an emergent country - Romania. The empirical findings reached by applying the input orientated-variable return to scale (VRS) model of Data Envelopment Analysis (DEA) and Tobit regression method are determined on two key levels of the study. The Data Envelopment Analysis technique quantifies the efficiency within 20 representative hospitals located in the four administrative macro-regions, highlighting the ways of increasing efficiency, while the Tobit regression identifies the factors that influence the efficiency level. The results of the investigation allow for comparisons with other emerging countries, as efficiency has become an increasingly significant factor for public sector evolution.

Suggested Citation

  • Nistor Cristina Silvia & Ștefănescu Cristina Alexandrina & Crișan Andrei-Răzvan, 2017. "Performance Through Efficiency in the Public Healthcare System – A DEA Approach in an Emergent Country," Studia Universitatis Babeș-Bolyai Oeconomica, Sciendo, vol. 62(1), pages 31-49, April.
    • Handle: RePEc:vrs:subboe:v:62:y:2017:i:1:p:31-49:n:3
    DOI: 10.1515/subboec-2017-0003
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    1. Ng, Ying Chu, 2011. "The productive efficiency of Chinese hospitals," China Economic Review, Elsevier, vol. 22(3), pages 428-439, September.
    2. Rodriguez-Alvarez, Ana & Fernandez-Blanco, Victor & Lovell, C. A. Knox, 2004. "Allocative inefficiency and its cost:: The case of Spanish public hospitals," International Journal of Production Economics, Elsevier, vol. 92(2), pages 99-111, November.
    3. Antonis Adam & Manthos Delis & Pantelis Kammas, 2011. "Public sector efficiency: leveling the playing field between OECD countries," Public Choice, Springer, vol. 146(1), pages 163-183, January.
    4. Afonso, Antonio & St. Aubyn, Miguel, 2005. "Non-Parametric Approaches to Education and Health Efficiency in OECD Countries," Journal of Applied Economics, Universidad del CEMA, vol. 8(2), pages 1-20, November.
    5. O'Neill, Liam & Rauner, Marion & Heidenberger, Kurt & Kraus, Markus, 2008. "A cross-national comparison and taxonomy of DEA-based hospital efficiency studies," Socio-Economic Planning Sciences, Elsevier, vol. 42(3), pages 158-189, September.
    6. Puig-Junoy, Jaume, 2000. "Partitioning input cost efficiency into its allocative and technical components: an empirical DEA application to hospitals," Socio-Economic Planning Sciences, Elsevier, vol. 34(3), pages 199-218, September.
    7. G. Jan van Helden & Åge Johnsen & Jarmo Vakkuri, 2008. "Distinctive research patterns on public sector performance measurement of public administration and accounting disciplines," Public Management Review, Taylor & Francis Journals, vol. 10(5), pages 641-651, September.
    8. Yang, Hongliang & Pollitt, Michael, 2009. "Incorporating both undesirable outputs and uncontrollable variables into DEA: The performance of Chinese coal-fired power plants," European Journal of Operational Research, Elsevier, vol. 197(3), pages 1095-1105, September.
    9. Tsekouras, Kostas & Papathanassopoulos, Fotis & Kounetas, Kostas & Pappous, Giorgos, 2010. "Does the adoption of new technology boost productive efficiency in the public sector? The case of ICUs system," International Journal of Production Economics, Elsevier, vol. 128(1), pages 427-433, November.
    10. Hsuan-Lien Chu & Chia-Yu Chiang, 2013. "The effects of strategic hospital alliances on hospital efficiency," The Service Industries Journal, Taylor & Francis Journals, vol. 33(6), pages 624-635, May.
    11. Lee, Kwang-soo & Chun, Ki-hong & Lee, Jung-soo, 2008. "Reforming the hospital service structure to improve efficiency: Urban hospital specialization," Health Policy, Elsevier, vol. 87(1), pages 41-49, July.
    12. Oliver Tiemann & Jonas Schreyögg, 2012. "Changes in hospital efficiency after privatization," Health Care Management Science, Springer, vol. 15(4), pages 310-326, December.
    13. Boussofiane, A. & Dyson, R. G. & Thanassoulis, E., 1991. "Applied data envelopment analysis," European Journal of Operational Research, Elsevier, vol. 52(1), pages 1-15, May.
    14. Antonis Adam & Manthos Delis & Pantelis Kammas, 2014. "Fiscal decentralization and public sector efficiency: evidence from OECD countries," Economics of Governance, Springer, vol. 15(1), pages 17-49, February.
    15. Cláudia Araújo & Carlos Barros & Peter Wanke, 2014. "Efficiency determinants and capacity issues in Brazilian for-profit hospitals," Health Care Management Science, Springer, vol. 17(2), pages 126-138, June.
    16. Gary Ferrier & Hervé Leleu & James Moises & Vivian Valdmanis, 2013. "The Focus Efficiency of U.S. Hospitals," Atlantic Economic Journal, Springer;International Atlantic Economic Society, vol. 41(3), pages 241-263, September.
    17. Konstantinos Angelopoulos & Apostolis Philippopoulos & Efthymios Tsionas, 2008. "Does public sector efficiency matter? Revisiting the relation between fiscal size and economic growth in a world sample," Public Choice, Springer, vol. 137(1), pages 245-278, October.
    18. Matthias Staat, 2006. "Efficiency of hospitals in Germany: a DEA-bootstrap approach," Applied Economics, Taylor & Francis Journals, vol. 38(19), pages 2255-2263.
    19. James F. Burgess, Jr. & Paul W. Wilson, 1996. "Hospital Ownership and Technical Inefficiency," Management Science, INFORMS, vol. 42(1), pages 110-123, January.
    20. Valdmanis, Vivian, 1992. "Sensitivity analysis for DEA models : An empirical example using public vs. NFP hospitals," Journal of Public Economics, Elsevier, vol. 48(2), pages 185-205, July.
    21. Léopold Simar & Paul Wilson, 2011. "Two-stage DEA: caveat emptor," Journal of Productivity Analysis, Springer, vol. 36(2), pages 205-218, October.
    22. Yasar A. Ozcan, 2008. "Health Care Benchmarking and Performance Evaluation," International Series in Operations Research and Management Science, Springer, number 978-0-387-75448-2, December.
    23. Francesca Manes Rossi & Natalia Aversano, 2015. "Advancing performance measurement," International Journal of Productivity and Performance Management, Emerald Group Publishing Limited, vol. 64(1), pages 76-93, January.
    24. Rumbold, Benedict E. & Smith, Judith A. & Hurst, Jeremy & Charlesworth, Anita & Clarke, Aileen, 2015. "Improving productive efficiency in hospitals: findings from a review of the international evidence," Health Economics, Policy and Law, Cambridge University Press, vol. 10(1), pages 21-43, January.
    25. Juan Du & Justin Wang & Yao Chen & Shin-Yi Chou & Joe Zhu, 2014. "Incorporating health outcomes in Pennsylvania hospital efficiency: an additive super-efficiency DEA approach," Annals of Operations Research, Springer, vol. 221(1), pages 161-172, October.
    26. McDonald, John, 2009. "Using least squares and tobit in second stage DEA efficiency analyses," European Journal of Operational Research, Elsevier, vol. 197(2), pages 792-798, September.
    27. James Langabeer & Yasar Ozcan, 2009. "The economics of cancer care: longitudinal changes in provider efficiency," Health Care Management Science, Springer, vol. 12(2), pages 192-200, June.
    28. Robyn Pilcher & David Gilchrist & Harjinder Singh & Inderpal Singh, 2013. "The Interface between Internal and External Audit in the Australian Public Sector," Australian Accounting Review, CPA Australia, vol. 23(4), pages 330-340, December.
    29. 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.
    30. António Afonso & Ludger Schuknecht & Vito Tanzi, 2005. "Public sector efficiency: An international comparison," Public Choice, Springer, vol. 123(3), pages 321-347, June.
    31. Dobdinga Fonchamnyo & Molem Sama, 2016. "Determinants of public spending efficiency in education and health: evidence from selected CEMAC countries," Journal of Economics and Finance, Springer;Academy of Economics and Finance, vol. 40(1), pages 199-210, January.
    32. Hoff, Ayoe, 2007. "Second stage DEA: Comparison of approaches for modelling the DEA score," European Journal of Operational Research, Elsevier, vol. 181(1), pages 425-435, August.
    33. Roxani Karagiannis, 2015. "A system-of-equations two-stage DEA approach for explaining capacity utilization and technical efficiency," Annals of Operations Research, Springer, vol. 227(1), pages 25-43, April.
    34. Afonso, António & Fernandes, Sónia, 2008. "Assessing and explaining the relative efficiency of local government," Journal of Behavioral and Experimental Economics (formerly The Journal of Socio-Economics), Elsevier, vol. 37(5), pages 1946-1979, October.
    35. Jean Spinks & Bruce Hollingsworth, 2009. "Cross-country comparisons of technical efficiency of health production: a demonstration of pitfalls," Applied Economics, Taylor & Francis Journals, vol. 41(4), pages 417-427.
    36. Niloy Bose & M. Emranul Haque & Denise R. Osborn, 2007. "Public Expenditure And Economic Growth: A Disaggregated Analysis For Developing Countries," Manchester School, University of Manchester, vol. 75(5), pages 533-556, September.
    37. Jos L. T. Blank & Bart L. Van Hulst, 2009. "Productive innovations in hospitals: an empirical research on the relation between technology and productivity in the Dutch hospital industry," Health Economics, John Wiley & Sons, Ltd., vol. 18(6), pages 665-679, June.
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