PERFORMANCE THROUGH EFFICIENCY IN THE PUBLIC HEALTHCARE SYSTEM - A DEA APPROACH IN AN EMERGENT COUNTRY
Keywords:
performance, efficiency, public healthcare system, DEA, emergent countryAbstract
https://doi.org/10.1515/subboec-2017-0003
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.
JEL classification: H41, I18, M40
References
Adam, A., Delis, M.D. and Kammas, P. (2011) ‘Public sector efficiency: leveling the playing field between OECD countries’, Public Choice, 146,163-183
Adam, A., Delis, M.D. and Kammas, P. (2014) ‘Fiscal decentralization and public sector efficiency: evidence from OECD countries’, Economics of Governance, 15(1), 17-49
Afonso A., Schuknecht L. and Tanzi V. (2005) ‘Public sector efficiency: an international comparison’, Public Choice, 123, 321–347
Afonso, A. and Aubyn, M.S. (2005) ‘Non-parametric approaches to education and health efficiency in OECD countries’, Journal of Applied Economics, 8(2), 227-246
Afonso, A. and Fernandes, S. (2008) ‘Assessing and explaining the relative efficiency of local government’, The Journal of Socio-Economics, 37, 1946-1979
Agai, L.A. (2015) The influence of ISO certification on efficiency, customer satisfaction and Service quality in healthcare institutions: The case of the Mater Hospital, A Project Report Submitted To The Chandaria School Of Business In Partial Fulfilment Of The Requirement For The Degree Of Masters In Business Administration (MBA)
Angelopoulos K., Philippopoulos A. and Tsionas E. (2008) ‘Does public sector efficiency matter? Revisiting the relation between fiscal size and economic growth in a world sample’, Public Choice, 137(1), 245-278
Araújo, C., Barros, C.P. and Wanke, P. (2014) ‘Efficiency determinants and capacity issues in Brazilian for-profit hospitals’, Health Care Management Science,17, 126–138
Banker, R.D., Charnes, A. and Cooper, W.W. (1984) ‘Some models for the estimation of technical and scale inefficiencies in Data Envelopment Analysis’, Management Science, 30, 1078–1092
Bates, L.J., Mukherjee, K. and Santerre, R.E. (2006) ‘Market structure and technical efficiency in the hospital services industry: A DEA approach’, Medical Care Research and Review, 63(4), 499–524
Benito, B., Brusca I. and Montesinos, V. (2007) ‘The harmonization of government financial information systems: the role of IPSASs’, International Review of Administrative Sciences, 73(2), 293-317
Blank, J.L. and van Hulst, B.L. (2009) ‘Productive innovations in hospitals: an empirical research on the relation between technology and productivity in the Dutch hospital industry’, Health Economics, 18(6), 665–679
Boldea, M., Parean, M. and Otil, M. (2012) ‘Regional disparity analysis: The case of Romania’, Journal of Eastern Europe Research in Business & Economics, 1, 1-12
Bose, N., Haque, M.E. and Osborn, D.R. (2007) ‘Public expenditure and economic growth: A disaggregated analysis for developing countries’, The Manchester School, 75, 533–556
Boussofiane, A., Dyson, R.G., and Thanassoulis, E. (1991) ‘Applied Data Envelopment Analysis’, European Journal of Operational Research, 52, 1-15
Bowlin, W.F. (1998) ‘Measuring performance: An introduction to Data Envelopment Analysis (DEA)’, Journal of Cost Analysis, 7, 3-27
Bryce C.L., Engberg J.B. and Wholey D.R. (2005) ‘Comparing the agreement among alternative models in evaluating HMO efficiency’, Health Services Research, 35(2), 509–528
Burgess J.F. and Wilson P.W. (1996) ‘Hospital ownership and technical inefficiency’, Management Science, 42(1), 110–123
Charnes, A., Cooper, W.W., Seiford, L. and Stutz, J. (1982) ‘A multiplicative model for efficiency analysis’, Socio-Economic Planning Sciences, 16(5), 223–224
Chu, H.L. and Chiang, C.Y. (2013) ‘The effects of strategic hospital alliances on hospital efficiency’, The Service Industries Journal, 33(6), 624-635
Datta, D., Figueira, J.R., Gourtani, A.M. and Morton. A (2013) ‘Optimal administrative geographies: an algorithmic approach’, Socio-Economic Planning Sciences, 47(3), 247-257
Du, J., Wang, J., Chen, Y. Chou, S. and Zhu, J. (2014) ‘Incorporating health outcomes in Pennsylvania hospital efficiency: an additive super-efficiency DEA approach’, Annals of Operations Research, 221(1), 161-172
Dyson, R.G., Allen, R., Camanho, A.S., Podinovski, V.V., Sarrico, C.S., and Shale, E.A. (2001) ‘Pitfalls and protocols in DEA’, European Journal of Operational Research, 132, 245-259
Ersoy, K., Kavuncubasi, S., Ozcan, Y., and Harris, J. (1997) ‘Technical efficiencies of Turkish Hospitals: DEA approach’, Journal of Medical Systems, 21(2), 67–74
Eurostat (2007) Regions in the European Union. Nomenclature of territorial units for statistics. NUTS 2006/EU-27, Eurostat Methodologies and working papers.
Evans, D.B., Tandon, A., Muray, C.J.L. and Lauer, J.A. (2001) ‘Comparative efficiency of national health systems: Cross national econometric analysis’, British Medical Journal, 323, 307-310
Ferrier, G.D., Leleu, H., Moises, J. and Valdmanis, V.G. (2013) ‘The focus efficiency of US hospitals’, Atlantic Economic Journal, 41(3), 241-263
Fonchamnyo, D.C. and Sama, M.C. (2016) ‘Determinants of public spending efficiency in education and health: evidence from selected CEMAC countries’, Journal of Economics and Finance, 40(1), 199-210
Frohlof, A. (2007) ‘Cost and technical efficiency of German hospitals: A stochastic frontier analysis’, iHEA 2007 6th World Congress: Explorations in Health Economics Paper, Ruhr Economic Paper No. 2,
Goh, S. (2012) ‘Making performance measurement systems more effective in public sector organizations’, Measuring Business Excellence, 16(1), 31-42
Gok, M.S. and Sezen, B (2011) ‘Analyzing the efficiencies of hospitals: An application of Data Envelopment Analysis’, Journal of Global Strategic Management, 10, 137-146
Golany, B. and Roll, Y. (1989) ‘An application procedure for DEA’, Omega, 17, 237-250
Harrison, J., Coppola, M.N. and Wakefield, M. (2004) ‘Efficiency of federal hospitals in the United States’, Journal of Medical Systems, 28, 411–422
Harrison, J., Rouse, P. and de Villiers, C. (2012) ‘Accountability and performance measurement: a stakeholder perspective’, The Business and Economics Research Journal, 5(2), 243-258. Parliament of Romania, Law no. 95/2006 on Healthcare Reform https://ec.europa.eu/migrant-integration/librarydoc/romania-law-no-95/2006-on-healthcare-reform (Accessed 1 September 2016)
Helmig B. and Lapsley I. (2001) ‘On the efficiency of public, welfare and private hospitals in Germany over time: a sectoral data envelopment analysis study’, Health Services Management Research, 14(4), 263–274
Hoff, A. (2007). Second stage DEA: Comparison of approaches for modelling the DEA score. European Journal of Operational Research, 181(1), 425-435.
Hsu, J. (2010) The relative efficiency of public and private service delivery, World Health Report, Background Paper, 39, Health Systems Financing
Hu J.L. and Huang Y.F. (2004) ‘Technical efficiencies in large hospitals: a managerial perspective’, International Journal of Management, 21(4), 506–513
Hwang, J. and Akdede, S.H. (2011) ‘The influence of governance on public sector efficiency: A cross-country analysis’, Social Science Journal, 48(4), 735-738
International Public Sector Accounting Standards Board (2011) Consultation paper on ‘Reporting service performance information’, October 2011
International Public Sector Accounting Standards Board (2013) Exposure Draft 54 ‘Reporting service performance information’, December 2013
Karagiannis, R. (2013) ‘A system-of-equations two-stage DEA approach for explaining capacity utilization and technical efficiency’, Annals of Operations Research, 227(1), 25-43
Kirigia, J.M., Emrouznejad, A., Cassoma, B., Asbu, E.Z. and Barry, S. (2008) ‘A performance assessment method for hospitals: the case of municipal hospitals in Angola’, Journal of Medical Systems, 32(6), 509-519
Kong, D. (2005) ‘Performance-based budgeting: the US experience’, Public Organizational Review: A Global Journal, 5(2), 91-107
Langabeer, J.R. and Ozcan, Y.A. (2009) ‘The economics of cancer care: Longitudinal changes in provider efficiency’, Health Care Management Science, 12 (2), 192–200
Lee, K.S., Chun, K.H. and Lee, J.S. (2008) ‘Reforming the hospital service structure to improve efficiency: Urban hospital specialization’, Health Policy, 87(1), 41–49
Lobo, M.S., Ozcan, Y.A., Lins, M.P.E., Silva, A.C.M and Fiszman, R. (2014) ‘Teaching hospitals in Brazil: Findings on determinants for efficiency’, International Journal of Healthcare Management, 7(1), 60-68
McDonald, J. (2009). Using least squares and tobit in second stage DEA efficiency analyses. European Journal of Operational Research, 197(2), 792-798.
Mulgan, R. (2000) ‘Accountability: An ever-expanding concept?’, Public Administration, 78(3), 555–573
Ng, Y.C. (2011) ‘The productive efficiency of Chinese hospitals’, China Economic Review, 22, 428–439
Organisation for Economic Cooperation and Development (2004), Public sector modernisation: governing for performance. http://www.oecd.org/site/govgfg/39044817.pdf (Accessed 1 September 2016)
ÓNeill L, Rauner M, Heidenberger K. and Kraus M. (2008) ‘A cross-national comparison and taxonomy of DEA based hospital efficiency studies’, Socio-Economic Planning Sciences, 42(3), 158–189
Osgood, D.W., Finken, L.L. and McMorris, B.J. (2002) ‘Analyzing multiple-item measures of crime and deviance II: Tobit regression analysis of transformed scores’, Journal of Quantitative Criminology, 18(4), 319-347
Ozcan Y.A. (2008) Health care benchmarking and performance evaluation: an assessment using data envelopment analysis (DEA), International Series in Operations Research and Management Science. Springer Science and Business Media, LLC New York, NY
Ozcan, Y.A. and McCue, M. J. (1996) ‘Development of a financial performance index for hospitals: DEA approach’, Journal of the Operational Research Society, 47(1), 18-26
Pilcher, R., Gilchrist, D., Singh, I. and Singh, H. (2013) ‘The interface between internal and external audit in the Australian public sector’, Australian Accounting Review, 23(4), 330-340
Puig-Junoy, J. (2000) ‘Partitioning input cost efficiency into its allocative and technical components: an empirical DEA application to hospitals’, Socio-Economic Planning Sciences, 34(3), 199-218
Rezapoor, A., Shokuh, M. H., & Faradonbeh, S. B. (2014). Studying effects of production factors in hospitals affiliated with Tehran University of Medical Sciences (2008-2011). Journal of Health Policy and Sustainable Health, 1(2).
Rodriguez-Alvarez, A., Fernandez-Blanco, V. and Knox Lovell, C.A. (2004) ‘Allocative inefficiency and its cost: the case of Spanish public hospitals’, International Journal of Production Economics, 92, 99–111
Rossi, F.M. and Aversano, N. (2015) ‘Advancing performance measurement Italian local government vis-à-vis the IPSASB project’, International Journal of Productivity and Performance Management, 64(1), 76-93
Rumbold, B.E., Smith, J.A, Hurst, J., Charlesworth, A. and Clarke, A. (2015) ‘Improving productive efficiency in hospitals: findings from a review of the international evidence’, Health Economics, Policy and Law, 10, 21-43
Simar, L., & Wilson, P. W. (2011). Two-stage DEA: caveat emptor. Journal of Productivity Analysis, 36(2), 205.
Spinks, J. and Hollingsworth, B. (2009) ‘Cross-country comparisons of technical efficiency of health production: A demonstration of pitfalls’, Applied Economics, 41, 417–427
Staat, M. (2006) ‘Efficiency of hospitals in Germany: a DEA-bootstrap approach’, Applied Economics, 38(19), 2255-2263
Thanassoulis, E. (1993) ‘A comparison of regression analysis and data envelopment analysis as alternative methods for performance assessments’, Journal of the Operational Research Society, 44(11), 1129-1144
Thompson, J.D., Averill, R.F. and Fetter, R.B (1979) ‘Planning, budgeting, and controlling-One look at the future: case-mix cost accounting’, Health Care Services Research, 14, 111–125
Tiemann O. and Schreyögg, J. (2012) ‘Changes in hospital efficiency after privatization’, Health Care Management Science, 15(4), 310-326
Tiemann O. and Schreyögg J (2009) ‘Effects of ownership on hospital efficiency in Germany’, Business Research, 2(2), 115–145
Tsekourasa, K., Papathanassopoulosb, F., Kounetasa, K. and Pappousc, G. (2010) ‘Does the adoption of new technology boost productive efficiency in the public sector? The case of ICUs system’, International Journal of Production Economics, 128(1), 427–433
Valdmanis, V. (1992) ‘Sensitivity analysis for DEA models: An empirical example using public vs. NFP hospitals’, Journal of Public Economics, 48(2), 185-205
van Helden, J., Johnsen, Å. and Vakkuri, J. (2008) ‘Distinctive research patterns on public sector performance measurement of public administration and accounting disciplines’, Public Management Review, 10(5), 641-651
Wang, M.T., Selman, R.L., Dishion, T. J. and Stormshak, E.A. (2010) ‘A tobit regression analysis of the covariation between middle school students' perceived school climate and behavioral problems’, Journal of Research on Adolescence, 20 (2), 274-286
Yang, H., & Pollitt, M. (2009). Incorporating both undesirable outputs and uncontrollable variables into DEA: The performance of Chinese coal-fired power plants. European Journal of Operational Research, 197(3), 1095-1105.
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