Assessing the Efficiency and Productivity of the Hospital Clinics on the Island of Rhodes during the COVID-19 Pandemic

(1) Background: The aim was to measure the efficiency and productivity of 15 specialty clinics during the COVID-19 pandemic period 2020-2021 in the General Hospital of Rhodes. (2) Methods: An input-oriented data envelopment analysis and the Malmquist productivity index are used. Labor and capital were used as inputs, and in-patient discharges and days were used as outputs. (3) Results: Five out of the seven clinics in the pathology sector appeared fully efficient with an optimal productivity, and the rest showed progress in 2021. In 2020 the COVID-19 pathology clinic appeared to be inefficient and less productive, while in 2021, it showed a positive performance change. The surgical sector showed very high efficiency rates or even reached an optimal efficiency in both years. The productivity measurement, in most of the surgical clinics, was satisfactory to very high. In 2020 the COVID-19 surgical clinic appeared to be more efficient and productive than in 2021 when its performance declined. (4) Conclusions: The hospital responded to the pressure during the pandemic, by increasing its efficiency and productivity from 2020 to 2021. This was due to the accomplishment of the appropriate organizational changes in the infrastructure, human resources, and technology. The efficiency and productivity assessments should be incorporated in the hospitals' decision making.

Value Realization and Optimization Path of Forest Ecological Products-Case Study from Zhejiang Province, China

In the last decade, more and more attention has been paid to the efficiency of ecological products’ value in the literature. Studying the value-conversion efficiency of forest ecological products can measure and reflect the huge value contained in forests, which is of great significance to promote the transformation between “clear water and green mountains” and “gold and silver mountains” as well as solve the problem of economic development and environmental protection. Studying the value-conversion efficiency of forest ecological products can scientifically evaluate the results of the mutual transformation of “clear water and green mountains” and “gold and silver mountains”, which is of great significance for deepening the theory of the “two mountains”. This paper took Zhejiang Province as the research object, constructed an index system of forest ecological products’ value accounting, used the super-SBM model and Malmquist index to calculate the conversion efficiency of forest ecological products’ value, and proposed optimization paths according to the research results. The results showed that: (1) From 2000 to 2020, the value of forest ecological products in Zhejiang Province showed a fluctuating upward trend. In 2020, the total value of forest ecological products was RMB 973.717 billion. Among them, the value of material products was RMB 12.560 billion, the value of ecological regulatory products was RMB 726.323 billion, and the value of cultural service products was RMB 234.834 billion. (2) There were great differences in the value-conversion efficiency of forest ecological products among cities in Zhejiang Province, but the overall trend was steady and developing in a positive direction. (3) The total-factor productivity of forest ecological products in Zhejiang Province showed a fluctuating trend, and its growth was mainly limited by the technical efficiency and technological progress index. (4) The main reasons for the conversion-efficiency loss of forest ecological products’ value in Zhejiang Province were excessive input and insufficient output. The specific reasons for the loss of efficiency in different cities were different, so it is necessary to find improvement paths according to local conditions. Our research provides a new perspective for the academic community to evaluate the value-realization effect of ecological products as well as a decision-making reference for policy makers of ecological environmental protection and construction.

Analysis of the total factor energy efficiency and its influencing factors of the Belt and Road key regions in China

Energy cooperation has been emphasized strongly in the Belt and Road (B&R) initiative. Therefore, the energy efficiency of China has attracted much attention from experts. However, relevant studies are still insufficient. This paper analyzes the total factor energy efficiency (TFEE) and its influencing factors of 17 B&R key regions from 2005 to 2015. We use the ratio of target energy input and actual energy input to calculate the regional TFEE under environmental constraints. The Malmquist index and the Tobit model are applied to investigate the internal and external influences of TFEE. Measurement analysis shows that the TFEE of the B&R key regions has not improved in recent years and it is unbalanced during the study period. Regions in the east area have the highest TFEE; regions in the west area have the second high TFEE; and regions in the north area have the lowest TFEE. Regression analysis shows that for the B&R key regions, technical changes, coal consumption, research and development, and environmental pollution have mainly negative effects on TFEE; pure efficiency changes, scale efficiency changes, economic structure, opening up, and government finance have mainly positive effects on TFEE. Finally, precise policy implications are proposed.

Temporal and Spatial Differentiations in Environmental Governance

With the general degradation of environmental carrying capacity in recent years, many developing countries are facing with the dual task of economic development and environmental protection. To explore the issue of urban environmental governance, in this research, we establish a Data Envelopment Analysis (DEA) model to investigate the environmental governance regarding temporal and spatial efficiency. Further, we deconstruct environmental governance efficiency into comprehensive efficiency, pure technical efficiency, and scale efficiency and develop a Tobit model to analyze the influencing factors affecting urban environmental governance efficiency. In addition, the above DEA, Tobit model, and deconstruction of efficiency have been applied to study environmental governance efficiency for the Yangtze River urban agglomeration. Findings include: (1) The gap in environmental governance efficiency between cities is highly noticeable, as the highest efficiency index is 0.934, the lowest is only 0.246, and the comprehensive efficiency index has fallen sharply from 0.708 to 0.493 in the past 10 years; (2) Environmental governance efficiency is basically driven by technological progress, while the scale efficiency change index is the main driver of the technological progress change index; (3) For environmental governance efficiency, urbanization and capital openness are irrelevant factors, economic level and urban construction are unfavorable factors, and industrial structure and population density are favorable factors. These findings will help urban agglomerations to effectively avoid the adverse effects of environmental governance efficiency in economic development, and achieve a coordinated development of urban construction and environmental governance.

Efficiency and productivity assessment of public hospitals in Greece during the crisis period 2009-2012

Background

This study is an initial effort to examine the dynamics of efficiency and productivity in Greek public hospitals during the first phase of the crisis 2009–2012. Data were collected by the Ministry of Health after several quality controls ensuring comparability and validity of hospital inputs and outputs. Productivity is estimated using the Malmquist Indicator, decomposing the estimated values into efficiency and technological change.

Methods

Hospital efficiency and productivity growth are calculated by bootstrapping the non-parametric Malmquist analysis. The advantage of this method is the estimation efficiency and productivity through the corresponding confidence intervals. Additionally, a Random-effects Tobit model is explored to investigate the impact of contextual factors on the magnitude of efficiency.

Results

Findings reveal substantial variations in hospital productivity over the period from 2009 to 2012. The economic crisis of 2009 had a negative impact in productivity. The average Malmquist Productivity Indicator (MPI) score is 0.72 with unity signifying stable production. Approximately 91% of the hospitals score lower than unity. Substantial increase is observed between 2010 and 2011, as indicated by the average MPI score which fluctuates to 1.52. Moreover, technology change scored more than unity in more than 75% of hospitals. The last period (2011–2012) has shown stabilization in the expansionary process of productivity. The main factors contributing to overall productivity gains are increases in occupancy rates, type and size of the hospital.

Conclusions

This paper attempts to offer insights in efficiency and productivity growth for public hospitals in Greece. The results suggest that the average hospital experienced substantial productivity growth between 2009 and 2012 as indicated by variations in MPI. Almost all of the productivity increase was due to technology change which could be explained by the concurrent managerial and financing healthcare reforms. Hospitals operating under decreasing returns to scale could achieve higher efficiency rates by reducing their capacity. However, certain social objectives should also be considered. Emphasis perhaps should be placed in utilizing and advancing managerial and organizational reforms, so that the benefits of technological improvements will have a continuing positive impact in the future.

Electronic supplementary material

The online version of this article (doi:10.1186/s12962-017-0068-5) contains supplementary material, which is available to authorized users.

Social Progress in Spanish Municipalities (2001-2011)

This paper proposes a methodology for the assessment of social progress in the biggest Spanish municipalities between years 2001 and 2011. We follow recent descriptions of QoL to elaborate a measurement framework composed of eight dimensions, for which 16 subindicators are elaborated from information collected using different data sources. Weight constrained Data Envelopment Analysis is used to estimate QoL composite indicators in both periods and to compute a Malmquist index of social progress, which assesses the evolution of the indicators during the decade. The results evidence positive social progress with an average improvement of about 5% during the decade. While the Central-Northern regions still show the highest levels of QoL, the Southern regions (including the islands) dominate the improvement trend. We then decompose the Malmquist index into a catching-up effect and a frontier shift effect. Positive catching-up is measured in almost all the regions. The worst performing municipalities in 2001 experienced the largest catching-up effects, a trend that contributes to territorial convergence. The frontier shift also shows a positive trend.

Productivity changes in OECD healthcare systems: bias-corrected Malmquist productivity approach

This study evaluates productivity changes in the healthcare systems of 30 Organization for Economic Co-operation and Development (OECD) countries over the 2002-2012 periods. The bootstrapped Malmquist approach is used to estimate bias-corrected indices of healthcare performance in productivity, efficiency and technology by modifying the original distance functions. Two inputs (health expenditure and school life expectancy) and two outputs (life expectancy at birth and infant mortality rate) are used to calculate productivity growth. There are no perceptible trends in productivity changes over the 2002-2012 periods, but positive productivity improvement has been noticed for most OECD countries. The result also informs considerable variations in annual productivity scores across the countries. Average annual productivity growth is evenly yielded by efficiency and technical changes, but both changes run somewhat differently across the years. The results of this study assert that policy reforms in OECD countries have improved productivity growth in healthcare systems over the past decade. Countries that lag behind in productivity growth should benchmark peer countries' practices to increase performance by prioritizing an achievable trajectory based on socioeconomic conditions. For example, relatively inefficient countries in this study indicate higher income inequality, corresponding to inequality and health outcomes studies. Although income inequality and globalization are not direct measures to estimate healthcare productivity in this study, these issues could be latent factors to explain cross-country healthcare productivity for future research. Copyright © 2016 John Wiley & Sons, Ltd.

Assessing the technical efficiency of health posts in rural Guatemala: a data envelopment analysis

INTRODUCTION

Strengthening health service delivery to the rural poor is an important means of redressing inequities. Meso-level managers can help enhance efficiency in the utilization of existing resources through the application of practical tools to analyze routinely collected data reflecting inputs and outputs. This study aimed to assess the efficiency and change in productivity of health posts over two years in a rural department of Guatemala.

METHODS

Data envelopment analysis was used to measure health posts' technical efficiency and productivity change for 2008 and 2009. Input/output data were collected from the regional health office of Alta Verapaz for 34 health posts from the 19 districts comprising the health region.

RESULTS

Technical efficiency varied widely across health posts, with mean scores of 0.78 (SD=0.24) and 0.75 (SD=0.21) in 2008 and 2009, respectively. Overall, productivity increased by 4%, though 47% of health posts experienced a decline in productivity. Results were combined on a bivariate plot to identify health posts at the high and low extremes of efficiency, which should be followed up to determine how and why their production processes are operating differently.

CONCLUSIONS

Assessing efficiency using the data that are available at the meso-level can serve as a first step in strengthening performance. Further work is required to support managers in the routine application of efficiency analysis and putting the results to use in guiding efforts to improve service delivery and increase utilization.