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Performance and Congestion Analysis of the Portuguese Hospital Services

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  • Simões, Pedro
  • Cunha Marques, Rui

Abstract

The health care services have been characterised by a growing demand by the citizens leading to the need of more and more resources. Population aging, new pathologies and drugs as well as new treatments are some of the major factors for this. However, in hospitals, for example, consumption of a large number of inputs frequently has not corresponded to the production of the same or more proportion of outputs. Sometimes, the outputs even decline with the increase of inputs due to the influence of the congestion effect on efficiency. The heavy burden of the health sector on the state budget brings about the interest of research over its efficiency. This paper aims to assess the performance of the Portuguese hospitals and particularly the contribution of the congestion effect. We use the non-parametric technique of data envelopment analysis (DEA) for this purpose and a double-bootstrap procedure to take into account the influence of operational environment on efficiency. Afterwards, by comparing three different approaches we determine the importance of congestion in efficiency measurement and discuss its computation methodologically. The results suggest significant levels of inefficiency in 68 major Portuguese hospitals for the year 2005 and more than half of them were found to be congested.

Suggested Citation

  • Simões, Pedro & Cunha Marques, Rui, 2009. "Performance and Congestion Analysis of the Portuguese Hospital Services," MPRA Paper 16940, University Library of Munich, Germany.
  • Handle: RePEc:pra:mprapa:16940
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    References listed on IDEAS

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    1. Grosskopf, Shawna & Margaritis, Dimitri & Valdmanis, Vivian, 2004. "Competitive effects on teaching hospitals," European Journal of Operational Research, Elsevier, vol. 154(2), pages 515-525, April.
    2. Fare, Rolf & Svensson, Leif, 1980. "Congestion of Production Factors," Econometrica, Econometric Society, vol. 48(7), pages 1745-1753, November.
    3. 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.
    4. Fried, Harold O. & Lovell, C. A. Knox & Schmidt, Shelton S. (ed.), 2008. "The Measurement of Productive Efficiency and Productivity Growth," OUP Catalogue, Oxford University Press, number 9780195183528.
    5. Cherchye, Laurens & Kuosmanen, Timo & Post, Thierry, 2001. "Alternative treatments of congestion in DEA: A rejoinder to Cooper, Gu, and Li," European Journal of Operational Research, Elsevier, vol. 132(1), pages 75-80, July.
    6. Michaela-Maria Schaffhauser-Linzatti & Achim Zeileis & Marion Rauner, 2009. "Effects of the Austrian performance-oriented inpatient reimbursement system on treatment patterns: illustrated on cases with knee-joint problems," 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. 17(3), pages 293-314, September.
    7. Tone, Kaoru & Sahoo, Biresh K., 2004. "Degree of scale economies and congestion: A unified DEA approach," European Journal of Operational Research, Elsevier, vol. 158(3), pages 755-772, November.
    8. 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.
    9. Cooper, W. W. & Gu, Bisheng & Li, Shanling, 2001. "Comparisons and evaluations of alternative approaches to the treatment of congestion in DEA," European Journal of Operational Research, Elsevier, vol. 132(1), pages 62-74, July.
    10. 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.
    11. Odeck, James, 2006. "Congestion, ownership, region of operation, and scale: Their impact on bus operator performance in Norway," Socio-Economic Planning Sciences, Elsevier, vol. 40(1), pages 52-69, March.
    12. Gary Ferrier & Michael Rosko & Vivian Valdmanis, 2006. "Analysis of uncompensated hospital care using a DEA model of output congestion," Health Care Management Science, Springer, vol. 9(2), pages 181-188, May.
    13. 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.
    14. Jacobs,Rowena & Smith,Peter C. & Street,Andrew, 2006. "Measuring Efficiency in Health Care," Cambridge Books, Cambridge University Press, number 9780521851442.
    15. Wholey, Douglas & Feldman, Roger & Christianson, Jon B. & Engberg, John, 1996. "Scale and scope economies among health maintenance organizations," Journal of Health Economics, Elsevier, vol. 15(6), pages 657-684, December.
    16. Kittelsen, Sverre A.C. & Magnussen, Jon, 2009. "Economies of scope in Norwegian hospital production - A DEA analysis," HERO On line Working Paper Series 2003:8, Oslo University, Health Economics Research Programme.
    17. Grosskopf, Shawna & Margaritis, Dimitri & Valdmanis, Vivian, 2001. "The effects of teaching on hospital productivity," Socio-Economic Planning Sciences, Elsevier, vol. 35(3), pages 189-204, September.
    18. 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.
    19. Brockett, Patrick L. & Cooper, William W. & Wang, Yuying & Shin, Hong-Chul, 1998. "Inefficiency and congestion in Chinese production before and after the 1978 economic reforms," Socio-Economic Planning Sciences, Elsevier, vol. 32(1), pages 1-20, March.
    20. Donal. G. McKillop & J. Colin Glass & Christine A. Kerr & Gillian McCallion, 1999. "Efficiency in Northern Ireland Hospitals - A Non-parametric Analysis," The Economic and Social Review, Economic and Social Studies, vol. 30(2), pages 175-196.
    21. 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.
    22. P. Byrnes & R. Färe & S. Grosskopf, 1984. "Measuring Productive Efficiency: An Application to Illinois Strip Mines," Management Science, INFORMS, vol. 30(6), pages 671-681, June.
    23. Wang, Jian & Zhao, Zhong & Mahmood, Amir, 2006. "Relative Efficiency, Scale Effect, and Scope Effect of Public Hospitals: Evidence from Australia," IZA Discussion Papers 2520, Institute for the Study of Labor (IZA).
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    Cited by:

    1. Duen-Yian Yeh & Ching-Hsue Cheng, 2016. "Performance Management of Taiwan’s National Hospitals," International Journal of Information Technology & Decision Making (IJITDM), World Scientific Publishing Co. Pte. Ltd., vol. 15(01), pages 187-213, January.
    2. Zilla Sinuany-Stern & Simona Cohen-Kadosh & Lea Friedman, 2016. "The relationship between the efficiency of orthopedic wards and the socio-economic status of their patients," 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. 24(4), pages 853-876, December.
    3. Jernej Agrež & Nadja Damij, 2015. "Knowledge dynamics assessment in complex organizational systems: a missing person investigation case study," 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. 23(3), pages 527-545, September.
    4. F. Wu & P. Zhou & D. Zhou, 2015. "Measuring Energy Congestion in Chinese Industrial Sectors: A Slacks-Based DEA Approach," Computational Economics, Springer;Society for Computational Economics, vol. 46(3), pages 479-494, October.
    5. repec:eee:ejores:v:266:y:2018:i:2:p:716-735 is not listed on IDEAS
    6. 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.
    7. George Fragkiadakis & Michael Doumpos & Constantin Zopounidis & Christophe Germain, 2016. "Operational and economic efficiency analysis of public hospitals in Greece," Post-Print hal-01414677, HAL.
    8. repec:spr:annopr:v:247:y:2016:i:2:d:10.1007_s10479-014-1710-7 is not listed on IDEAS
    9. 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.
    10. : Álvaro Almeida & José Pedro Fique, 2011. "Evaluating Hospital Efficiency Adjusting for Quality Indicators: an Application to Portuguese NHS Hospitals," FEP Working Papers 435, Universidade do Porto, Faculdade de Economia do Porto.
    11. 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.
    12. Jun Wang & Yong Zha, 2014. "Distinguishing Technical Inefficiency from Desirable and Undesirable Congestion with an Application to Regional Industries in China," Sustainability, MDPI, Open Access Journal, vol. 6(12), pages 1-19, December.

    More about this item

    Keywords

    Hospitals; congestion; efficiency; DEA; Portugal;

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • C14 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Semiparametric and Nonparametric Methods: General
    • I1 - Health, Education, and Welfare - - Health
    • C1 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General

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