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Advancing Hospital Sustainability: A Multidimensional Index Integrating ESG and Digital Transformation

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  • Takeda, Midori
  • Xie, Jun
  • Kurita, Kenichi
  • Managi, Shunsuke

Abstract

Today, most healthcare costs in Japan depend on insurance premiums and public funds. Since the working population supports both groups, it will be difficult to maintain medical expenses in the future due to further declining birth rates and an aging society. Therefore, the sustainability of hospitals is a serious issue. While many methods have been developed to evaluate hospital performance and effectiveness, only some have been used to evaluate sustainability. Against this background, this study develops a comprehensive evaluation system that integrates ESG and digital transformation (DX) into a hospital efficiency and effectiveness assessment. We utilize open databases on hospital performance, financial reports, and scraped information disclosed on hospital websites. SBM (slack-based model)-DEA and super efficiency SBM-DEA were combined to assess hospital sustainability, including overall sustainability and three dimensions of hospital efficiency, effectiveness, and ESG/DX. The results showed that ESG/DX performance, efficiency, and effectiveness positively correlated with hospital sustainability in all groups of hospitals. It also showed that while effectiveness and ESG/DX performance positively contribute to operational efficiency in smaller hospitals, ESG/DX performance negatively contributes to profitability. In rehabilitation hospitals, effectiveness contributes negatively to profitability, indicating that improving effectiveness requires more significant costs than in other hospitals. These findings indicated that while ESG, DX, and effectiveness improve hospital sustainability, the costs of promoting ESG/DX are significant for smaller and rehabilitation hospitals. This index could benefit hospital management and policy recommendations regarding promoting ESG and DX.

Suggested Citation

  • Takeda, Midori & Xie, Jun & Kurita, Kenichi & Managi, Shunsuke, 2024. "Advancing Hospital Sustainability: A Multidimensional Index Integrating ESG and Digital Transformation," MPRA Paper 119930, University Library of Munich, Germany.
  • Handle: RePEc:pra:mprapa:119930
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    1. Zhou, Haibo & Yang, Yi & Chen, Yao & Zhu, Joe, 2018. "Data envelopment analysis application in sustainability: The origins, development and future directions," European Journal of Operational Research, Elsevier, vol. 264(1), pages 1-16.
    2. Michael Spence, 2002. "Signaling in Retrospect and the Informational Structure of Markets," American Economic Review, American Economic Association, vol. 92(3), pages 434-459, June.
    3. Brown, L.D., 2003. "Comparing health systems in four countries: Lessons for the United States," American Journal of Public Health, American Public Health Association, vol. 93(1), pages 52-56.
    4. Kao, Chiang & Pang, Rui-Zhi & Liu, Shiang-Tai & Bai, Xue-Jie, 2021. "Most productive types of hospitals: An empirical analysis," Omega, Elsevier, vol. 99(C).
    5. Chen, Po-Chi & Yu, Ming-Miin & Chang, Ching-Cheng & Hsu, Shih-Hsun & Managi, Shunsuke, 2015. "The enhanced Russell-based directional distance measure with undesirable outputs: Numerical example considering CO2 emissions," Omega, Elsevier, vol. 53(C), pages 30-40.
    6. Jun Xie & Wataru Nozawa & Michiyuki Yagi & Hidemichi Fujii & Shunsuke Managi, 2019. "Do environmental, social, and governance activities improve corporate financial performance?," Business Strategy and the Environment, Wiley Blackwell, vol. 28(2), pages 286-300, February.
    7. Halkos, George & Petrou, Kleoniki Natalia, 2019. "Treating undesirable outputs in DEA: A critical review," Economic Analysis and Policy, Elsevier, vol. 62(C), pages 97-104.
    8. Matthias Staat, 2006. "Efficiency of hospitals in Germany: a DEA-bootstrap approach," Applied Economics, Taylor & Francis Journals, vol. 38(19), pages 2255-2263.
    9. Davis, Peter & Milne, Barry & Parker, Karl & Hider, Phil & Lay-Yee, Roy & Cumming, Jackie & Graham, Patrick, 2013. "Efficiency, effectiveness, equity (E3). Evaluating hospital performance in three dimensions," Health Policy, Elsevier, vol. 112(1), pages 19-27.
    10. Fabrizio Zerbini, 2017. "CSR Initiatives as Market Signals: A Review and Research Agenda," Journal of Business Ethics, Springer, vol. 146(1), pages 1-23, November.
    11. tone, Kaoru, 2010. "Variations on the theme of slacks-based measure of efficiency in DEA," European Journal of Operational Research, Elsevier, vol. 200(3), pages 901-907, February.
    12. Toloo, Mehdi & Tone, Kaoru & Izadikhah, Mohammad, 2023. "Selecting slacks-based data envelopment analysis models," European Journal of Operational Research, Elsevier, vol. 308(3), pages 1302-1318.
    13. Imen Khanchel & Naima Lassoued, 2022. "ESG Disclosure and the Cost of Capital: Is There a Ratcheting Effect over Time?," Sustainability, MDPI, vol. 14(15), pages 1-19, July.
    14. Chang, Hsi-Hui, 1998. "Determinants of Hospital Efficiency: the Case of Central Government-owned Hospitals in Taiwan," Omega, Elsevier, vol. 26(2), pages 307-317, April.
    15. Ting-Ting Li & Kai Wang & Toshiyuki Sueyoshi & Derek D. Wang, 2021. "ESG: Research Progress and Future Prospects," Sustainability, MDPI, vol. 13(21), pages 1-28, October.
    16. Sakis Kotsantonis & Chris Pinney & George Serafeim, 2016. "ESG Integration in Investment Management: Myths and Realities," Journal of Applied Corporate Finance, Morgan Stanley, vol. 28(2), pages 10-16, June.
    17. 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.
    18. Barros, Carlos Pestana & Managi, Shunsuke & Matousek, Roman, 2012. "The technical efficiency of the Japanese banks: Non-radial directional performance measurement with undesirable output," Omega, Elsevier, vol. 40(1), pages 1-8, January.
    19. Monica Singhania & Ibna Bhan & Surabhi Seth, 2025. "Digitalisation and Firm‐Level ESG Performance and Disclosures: A Scientometric Review and Research Agenda," International Journal of Finance & Economics, John Wiley & Sons, Ltd., vol. 30(4), pages 4212-4236, October.
    20. Silvia Solimene & Daniela Coluccia & Stefano Fontana & Carmela Gulluscio & Alessandro Bernardo & Garry D. Carnegie, 2024. "Discerning the state of the art in Italy of voluntary disclosure on biodiversity and endemic species," Meditari Accountancy Research, Emerald Group Publishing Limited, vol. 32(6), pages 2348-2395, October.
    21. Muhammad Hammad Mushtaq & Fahad Noor & M. A. Mujtaba & Salman Asghar & Abdulfatah Abdu Yusuf & Manzoore Elahi M. Soudagar & Abrar Hussain & Mohamed Fathy Badran & Kiran Shahapurkar, 2022. "Environmental Performance of Alternative Hospital Waste Management Strategies Using Life Cycle Assessment (LCA) Approach," Sustainability, MDPI, vol. 14(22), pages 1-16, November.
    22. Tone, Kaoru, 2002. "A slacks-based measure of super-efficiency in data envelopment analysis," European Journal of Operational Research, Elsevier, vol. 143(1), pages 32-41, November.
    23. 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.
    24. 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.
    25. 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.
    26. 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.
    27. Tone, Kaoru, 2001. "A slacks-based measure of efficiency in data envelopment analysis," European Journal of Operational Research, Elsevier, vol. 130(3), pages 498-509, May.
    28. 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, March.
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    • D24 - Microeconomics - - Production and Organizations - - - Production; Cost; Capital; Capital, Total Factor, and Multifactor Productivity; Capacity
    • M14 - Business Administration and Business Economics; Marketing; Accounting; Personnel Economics - - Business Administration - - - Corporate Culture; Diversity; Social Responsibility

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