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Assessing Hospital Efficiency: Non-parametric Evidence for Portugal

Author

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  • António Afonso
  • Sónia Fernandes

Abstract

We compute DEA efficiency scores and Malmquist indexes for a panel data set comprising 68 Portuguese public hospitals belonging to the National Health System (NHS) in the period 2000-2005, when several units started being run in an entrepreneurial framework. With data on hospital services’ and resource quantities we construct an output distance function, we assess by how much can output quantities be proportionally expanded without changing input quantities Our results show that, on average, the NHS hospital sector revealed positive but small productivity growth between 2000 and 2004. The mean TFP indices vary between 0.917 and 1.109, implying some differences in the Malmquist indices across specifications. Furthermore, there are significant fluctuations among NHS hospitals in terms of individual efficiency scores from one year to the other.

Suggested Citation

  • António Afonso & Sónia Fernandes, 2008. "Assessing Hospital Efficiency: Non-parametric Evidence for Portugal," Working Papers Department of Economics 2008/07, ISEG - Lisbon School of Economics and Management, Department of Economics, Universidade de Lisboa.
  • Handle: RePEc:ise:isegwp:wp72008
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    References listed on IDEAS

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    1. Jacobs,Rowena & Smith,Peter C. & Street,Andrew, 2006. "Measuring Efficiency in Health Care," Cambridge Books, Cambridge University Press, number 9780521851442.
    2. Antonio Afonso & Sonia Fernandes, 2006. "Measuring local government spending efficiency: Evidence for the Lisbon region," Regional Studies, Taylor & Francis Journals, vol. 40(1), pages 39-53.
    3. 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.
    4. Elizabeth Docteur & Howard Oxley, 2003. "Health-Care Systems: Lessons from the Reform Experience," OECD Health Working Papers 9, OECD Publishing.
    5. Elvira Lima & David K. Whynes, 2003. "Finance and performance of Portuguese hospitals," NIMA Working Papers 20, Núcleo de Investigação em Microeconomia Aplicada (NIMA), Universidade do Minho.
    6. Afonso, Antonio & St. Aubyn, Miguel, 2006. "Cross-country efficiency of secondary education provision: A semi-parametric analysis with non-discretionary inputs," Economic Modelling, Elsevier, vol. 23(3), pages 476-491, May.
    7. E Zere & Diane Mcintyre & T Addison, 2001. "Technical Efficiency And Productivity Of Public Sector Hospitals In Three South African Provinces," South African Journal of Economics, Economic Society of South Africa, vol. 69(2), pages 336-358, June.
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    9. Seiford, Lawrence M. & Thrall, Robert M., 1990. "Recent developments in DEA : The mathematical programming approach to frontier analysis," Journal of Econometrics, Elsevier, vol. 46(1-2), pages 7-38.
    10. repec:ags:jaecon:37549 is not listed on IDEAS
    11. Mónica Duarte Oliveira & Carlos Gouveia Pinto, 2005. "Health care reform in Portugal: an evaluation of the NHS experience," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 203-220.
    12. António Afonso & Ludger Schuknecht & Vito Tanzi, 2005. "Public sector efficiency: An international comparison," Public Choice, Springer, vol. 123(3), pages 321-347, June.
    13. Margit Sommersguter-Reichmann, 2000. "The impact of the Austrian hospital financing reform on hospital productivity: empirical evidence on efficiency and technology changes using a non-parametric input-based Malmquist approach," Health Care Management Science, Springer, vol. 3(4), pages 309-321, September.
    14. Charnes, A. & Cooper, W. W. & Rhodes, E., 1978. "Measuring the efficiency of decision making units," European Journal of Operational Research, Elsevier, vol. 2(6), pages 429-444, November.
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    16. Zere, E., 2000. "Hospital Efficiency in Sub-Saharan Africa. Evidence from South Africa," Research Paper 187, World Institute for Development Economics Research.
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    Citations

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    Cited by:

    1. Abbas, Touqeer & Awan, Masood Sarwar & Aslam, Muhammad Amir & Waqas, Muhammad, 2011. "Analyzing the efficiency differences among basic health units in Sargodha District," MPRA Paper 32244, University Library of Munich, Germany.
    2. António Afonso & Ricardo Sousa, 2011. "The macroeconomic effects of fiscal policy in Portugal: a Bayesian SVAR analysis," Portuguese Economic Journal, Springer;Instituto Superior de Economia e Gestao, vol. 10(1), pages 61-82, April.
    3. 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.
    4. 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.
    5. António AFONSO, & Mohamed AYADI, & Sourour RAMZI, 2013. "Assessing productivity performance of basic and secondary education in Tunisia: a Malmquist analysis," Working Papers Department of Economics 2013/19, ISEG - Lisbon School of Economics and Management, Department of Economics, Universidade de Lisboa.
    6. PINTO, Claudio, 2013. "Complexity of Treatment, and Changes in Efficiency and Productivity for Directly Managed Italian Hospitals," CELPE Discussion Papers 124, CELPE - Centre of Labour Economics and Economic Policy, University of Salerno, Italy.

    More about this item

    Keywords

    Public hospitals; Data Envelopment Analysis; Malmquist indices; Portugal.;

    JEL classification:

    • C14 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Semiparametric and Nonparametric Methods: General
    • C61 - Mathematical and Quantitative Methods - - Mathematical Methods; Programming Models; Mathematical and Simulation Modeling - - - Optimization Techniques; Programming Models; Dynamic Analysis
    • D24 - Microeconomics - - Production and Organizations - - - Production; Cost; Capital; Capital, Total Factor, and Multifactor Productivity; Capacity
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

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