IDEAS home Printed from
MyIDEAS: Log in (now much improved!) to save this paper

Complexity of Treatment, and Changes in Efficiency and Productivity for Directly Managed Italian Hospitals

Listed author(s):
  • PINTO, Claudio


    (CELPE - Centre of Labour Economics and Economic Policy, University of Salerno - Italy)

Registered author(s):

    Background: Data envelopment analysis (DEA) and the Malmquist index are frequently used in the hospital sector to measure efficiency. However, very few works are published for Italian hospitals, despite the fact that efficiency was the main driver guiding healthcare reform in the 1990s. Objectives: The objective of this study is derive technical efficiency and change in productivity of the Local Health Trust (LHT) in directly managed Italian hospitals. We will also explore whether the complexity of treated hospitals cases influences technical efficiency. Methods/approaches: The DEA technique and DEA-Malmquist index are used to derive technical efficiency, and changes in productivity and efficiency, for directly managed hospitals in Italy's public healthcare system. To control for the influence of the complexity of the treated cases on the technical efficiency, two DEA input models are examined. One of these models, weighs outputs with a case mix index (CMI) as a measure of the complexity of hospital treatment. Results: The results show that efficiency in the model not adjusted is on average 79,52% compared to 81,55 % efficiency in Model B (output adjusted with CMI), in efficiency level. In mean complexity of treatment, as measured with CMI, influence technical efficiency, as indicate in Table 5 and 6. Statistics tests reveal differences in the efficiency score distribution for Model A and Model B (adjusted). The influence of complexity of treatment on technical efficiency analysis, has hospital individual relevance. The Malmquist index reveals productivity improvement for 7 out of the 8 periods measured. Technical efficiency change is positive (improvement) between 2000 and 2005, and fall in 2006 and 2007. Technological change is positive in 1999-2000, 2000-2001, 2002-2003, 2005-2006, 2006-2007. Scale efficiency improves in 2000-2001, 2001-2002,2003-2004, 2004-2005. Practical implications: Between 1999 and 2007, for the sample, improved productivity was examined and attributed to an input reduction of the same output. This could mean that the reforms that took place in the 1990s were successful and that this direction is worth further pursuit. In light of these findings, one must make policy recommendations with caution, despite the fact, the complexity of treatments influence technical efficiency, hence the proportional reduction of the inputs vector.

    If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.

    File URL:
    File Function: Full text
    Download Restriction: no

    Paper provided by CELPE - Centre of Labour Economics and Economic Policy, University of Salerno, Italy in its series CELPE Discussion Papers with number 124.

    in new window

    Length: 40 pages
    Date of creation: 31 Jan 2013
    Handle: RePEc:sal:celpdp:0124
    Contact details of provider: Postal:
    via Giovanni Paolo II, 132, 84084 - Fisciano (SA), ITALY

    Phone: +39 089 962152 -
    Fax: +39 089 962049
    Web page:

    More information through EDIRC

    References listed on IDEAS
    Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:

    in new window

    1. Roberto Cellini & Giacomo Pignataro & Ilde Rizzo, 2000. "Competition and Efficiency in Health Care: An Analysis of the Italian Case," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 7(4), pages 503-519, August.
    2. 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.
    3. Dino Rizzi & Vincenzo Rebba, 2006. "Measuring Hospital Efficiency through Data Envelopment Analysis when Policy-makers� Preferences Matter. An Application to a sample of Italian NHS hospitals," Working Papers 2006_13, Department of Economics, University of Venice "Ca' Foscari".
    4. Aletras, Vassilios & Kontodimopoulos, Nick & Zagouldoudis, Athanasios & Niakas, Dimitris, 2007. "The short-term effect on technical and scale efficiency of establishing regional health systems and general management in Greek NHS hospitals," Health Policy, Elsevier, vol. 83(2-3), pages 236-245, October.
    5. Caves, Douglas W & Christensen, Laurits R & Diewert, W Erwin, 1982. "The Economic Theory of Index Numbers and the Measurement of Input, Output, and Productivity," Econometrica, Econometric Society, vol. 50(6), pages 1393-1414, November.
    Full references (including those not matched with items on IDEAS)

    This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

    When requesting a correction, please mention this item's handle: RePEc:sal:celpdp:0124. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Paolo Coccorese)

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If references are entirely missing, you can add them using this form.

    If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    This information is provided to you by IDEAS at the Research Division of the Federal Reserve Bank of St. Louis using RePEc data.