Metafrontier frameworks for studying hospital productivity growth and quality changes

Analyzing the effect of health reforms on the efficiency of Ecuadorian public hospitals

This study aims to assess whether Ecuadorian health reforms carried out since 2008 have affected the efficiency performance of public hospitals in the country. We contribute to the literature by shedding new light on the effects on public healthcare efficiency for developing countries when policies move toward health equity and universal coverage. We follow a two-stage approach, wherein the first stage we make use of factor and cluster analysis to obtain three clusters of public hospitals based on their technological endowment; we exploit Data Envelopment Analysis for panel data in the second stage to estimate robust efficiency measures over time. Our innovative empirical strategy considers the heterogeneity of healthcare institutions in the analysis of their efficiency performance. The results show a significant decrease in the average efficiency of low and intermediate technology hospitals after the new constitution was adopted in 2008. The decline in efficiency coincides with the two reforms of 2010 and 2011 that brought on higher social security coverage.

Comparing Hospital Efficiency: An Illustrative Study of Knee and Hip Replacement Surgeries in Spain

WHO's Health Systems Performance Assessment framework suggests monitoring a set of dimensions. This study aims to jointly assess productivity and quality using a treatment-based approach, specifically analyzing knee and hip replacement, two prevalent surgical procedures performed with consolidated technology and run in most acute-care hospitals. Focusing on the analysis of these procedures sets out a novel approach providing clues for hospital management improvements, covering an existing gap in the literature. The Malmquist index under the metafrontier context was used to estimate the productivity in both procedures and its decomposition in terms of efficiency, technical and quality change. A multilevel logistic regression was specified to obtain the in-hospital mortality as a quality factor. All Spanish public acute-care hospitals were classified according to their average severity attended, dividing them into three groups. Our study revealed a decrease in productivity mainly due to a decrease in the technological change. Quality change remained constant during the period with highest variations observed between one period to the next according to the hospital classification. The improvement in the technological gap between different levels was due to an improvement in quality. These results provide new insights of operational efficiency after incorporating the quality dimension, specifically highlighting a decreasing operational performance, confirming that the technological heterogeneity is a critical question when measuring hospital performance.

Productivity growth and quality changes of hospitals in Taiwan: does ownership matter?

As the competition in the Taiwanese medical industry becomes increasingly fierce, public hospitals are confronted with challenges in orientation and operations. This study measured changes in the operational efficiency of public and their competitors, non-public hospitals, in Taiwan. This study considered differences in technology and scale between public and non-public hospitals and adopted the quality-incorporating metafrontier Malmquist productivity index to analyze inputs, outputs, and quality achievements of hospitals. The data consisted of 40 public hospitals and 79 non-public hospitals in Taiwan during the period 2008-2014. This study measured productivity growth and quality changes. Moreover, it further identified technological gaps and quality gaps in different types of hospitals with respect to the metafrontier. At the same time, comparisons of changes in quality between public and non-public hospitals were also examined. The empirical results showed that public hospitals were better than non-public ones in terms of productivity. Meanwhile, it was also found that most of the decomposition in productivity was higher in public hospitals than in non-public ones, especially in terms of improvements in technology and quality. This paper presented public hospitals outperformed non-public ones during the research period in spite of the fact that private hospitals had become larger and group-oriented. Therefore, public hospitals and regulators made appropriate adjustments and responses in the face of the pressure of competition in the market.