Efficiency Of Public Hospitals Research Articles

Leadership styles on job satisfaction and security among healthcare workers during the COVID-19 pandemic.

Hospitals employ many social workers, whose tasks are complicated and arduous. Quality of life assessments by healthcare professionals (HCWs) are essential for better healthcare and skillful health service delivery. HCWs have been under tremendous mental and psychological strain and at high risk of virus acquisition since the COVID-19 pandemic outbreak. This study evaluated public hospital efficiency issues and remedies in the Kingdom of Saudi Arabia. The study examined leadership styles and job satisfaction among Saudi Arabian healthcare workers (HCWs). Between September 1 and December 31, 2021, a descriptive cross-sectional investigation was conducted. During the COVID-19 pandemic, a verified web-based survey reached the appropriate sample and data was collected. A web-based self-administered survey collected demographic data, leadership style using Multifactor Leadership Questionnaire Form 6-S (MLQ-6S), and health care employee satisfaction (SEHC) from HCWs. Leadership styles affected HCW job satisfaction, according to this study. Individual concern, idealized influence, contingent compensation, and inspiring motivation were negatively correlated with work satisfaction ratings. Creating a special training programme for new leaders should cover leadership styles and approaches, the skills needed to foster a productive workplace with high-quality care, and the creation of motivated work opportunities that can boost worker engagement and satisfaction.

Effects of private health insurance on waiting time in public hospitals.

The Australian government pays $6.7 billion per year in rebates to encourage Australians to purchase private health insurance (PHI) and an additional $6.1 billion to cover services provided in private hospitals. What is the justification for large government subsidies to a private industry when all Australians already have free coverage under Medicare? The government argues that more people buying PHI will relieve the burden on the public system and may reduce waiting times. However, the evidence supporting this is sparse. We use an instrumental variable approach to study the causal effects of higher PHI coverage in the area on waiting times in public hospitals in the same area. The instrument used is area-level average house prices, which correlate with average income and wealth, thus influencing the purchase of PHI due to tax incentives, but not directly affecting waiting times in public hospitals. We use 2014-2018 hospital admission and elective surgery waiting list data linked at the patient level from the Victorian Center for Data Linkage. These data cover all inpatient admissions in all hospitals in Victoria (both public and private hospitals) and those registered on the waiting list for elective surgeries in public hospitals in Victoria. We find that one percentage point increase in PHI coverage leads to about 0.34days (or 0.5%) reduction in waiting times in public hospitals on average. The effects vary by surgical specialities and age groups. However, the practical significance of this effect is limited, if not negligible, despite its statistical significance. The small effect suggests that raising PHI coverage with the aim to taking the pressure off the public system is not an effective strategy in reducing waiting times in public hospitals. Alternative policies aiming at improving the efficiency of public hospitals and advancing equitable access to care should be a priority for policymakers.

Analysis of the Operational Efficiency of Public Hospitals in Tianjin City based on a Three-Stage Data Envelopment Analysis Model

The purpose is to analyze the operational efficiency of 132 public hospitals in Tianjin in 2021, providing reference for them to fully play the role of "leading institutions" and optimize resource allocation. We constructed an evaluation index system with multiple inputs, outputs, and environmental variables and utilized a three-stage DEA model to assess efficiency by removing the influence of random errors and environmental factors. The average comprehensive technical efficiency, pure technical efficiency, and scale efficiency of public hospitals were 0.865, 0.989, and 0.875, respectively. Among them, seven districts, including Heping, Hedong, and Hexi, had a comprehensive technical efficiency of 1. Among the remaining nine districts, except for Baodi, the rest showed an increasing trend in scale efficiency. Public hospitals in Tianjin City exhibit high operational efficiency, but significant variations exist among different districts, leading to uneven development. The main reason for this disparity is the presence of scale inefficiency. It is recommended to prioritize resource optimization and address the shortcomings that hinder efficiency improvement in a targeted manner. Emphasizing the "triple integration" of service capacity, efficiency, and quality in public hospitals is essential to maximize both social and economic benefits."

New Public Management and hospital efficiency: the case of Norwegian public hospital trusts

New Public Management-inspired reforms in the Norwegian hospital sector have introduced several features from the private sector into a predominantly public healthcare system. Since the late 1990s, several reforms have been carried out with the intention of improving the utilization of resources. There is, however, limited knowledge about the long-term, and sector-wide effects of these reforms. In this study, using a panel data set of all public hospital trusts spanning nine years, we provide an analysis of the efficiency of hospital trusts using data envelopment analysis (DEA), as well as a Malmquist productivity index. Thereafter we use the efficiency scores as the dependent variable in a second-stage panel data regression analysis. We show that during the period between 2011 and 2019, on average, efficiency has increased over time. Further, in the second-stage analysis, we show that New Public Management features related to incentivization are associated with the level of hospital efficiency. We find no association between degree of competition and efficiency.

Evaluation and optimization of hospital system in Chinese provinces: does mortality matter?

During the production process of goods and services, sometimes undesirable outputs are difficult to avoid. However, this aspect is often ignored. Hospitals produce patient care, but undesirable outputs do arise. The novelty of this paper is to introduce the mortality as an undesirable output into the derivation of the public hospital efficiency measure. Similar to the production of economic goods and pollution where the latter increase along with the former, our description of mortality in hospital is considered as weakly disposable. Based on an extension model of Kuosmanen [Am. J. Agric. Econ. 87 (2005) 1077–1082], we evaluate the public hospital efficiency with and without incorporating mortality under four scenarios. We apply this model to measure public hospital efficiency in Chinese provinces. The results indicate that no matter whether one considers undesirable outputs within the objective functions, it has a significant impact on benchmarking once the mortality is included to define the production technology.

A Study on the Effectiveness and Efficiency of Public or Private Hospitals within Pakistan

Hospitals play a very important role in human lives. People are in search of quality and timely healthcare facilities. This paper talks about the efficiency and effectiveness of healthcare services. One needs to identify the factors and mechanisms to enhance the performance of government and private hospitals. This study aims to find the important variables that were required to find the best solution for public and private hospitals in Pakistan. The major contributions of the paper are as follows. The paper first deliberates on the need for technical excellence as compared to interpersonal excellence for hospital management. It also performs a qualitative review of the literature on the important variables for determining the effectiveness and efficiencies of the hospital. Then, the paper presents a public survey about the effectiveness and efficiency of public and private hospitals using different questionnaires. These questionnaires were filled by the relatives of patients or patients themselves when they visited hospitals. On this dataset, the paper applies a machine learning algorithm i.e., random forest, to predict which hospital type is suitable for them while considering the variables. These variables include; the services of the hospital, admission process, treatment, doctor's behavior, timely treatment, and knowledge of the staff about SOPs. The data was split into 75 % training and 25 % testing dataset. Python’s Library SK-learn was used for implementation. The accuracy of the classifier on the test dataset is 96.91 %. The paper then determines the variables that are contributing the most to the measure of effectiveness and efficiencies of hospitals. The algorithm also ranks these features that can be used to improve a hospital's performance. It also provides a benchmark to the patients in the selection of hospitals for healthcare facilities.

Efficiency effects of public hospital closures in the context of public hospital reform: a multistep efficiency analysis.

In the wake of hospital reforms introduced in 2011 in Turkey, public hospitals were grouped into associations with joint management and some shared operational and administrative functions, similar in some ways to hospital trusts in the English National Health Service. Reorganization of public hospitals effect hospital and market area characteristics and existence of hospitals. The objective of this study is to examine the effect of closure on competitive hospital performances. Using administrative data from Turkish Public Hospital Statistical Yearbooks for the years 2005 to 2007 and 2014 to 2017, we conducted a three-step efficiency analysis by incorporating data envelopment analysis (DEA) and propensity score matching techniques, followed by a difference-in-differences (DiD) regression. First, we used bootstrapped DEA to calculate the efficiency scores of hospitals that were located near hospitals that had been closed. Second, we used nearest neighbour propensity score matching to form control groups and ensure that any differences between these and the intervention groups could be attributed to being near a hospital that had closed rather than differences in hospital and market area characteristics. Lastly, we employed DiD regression analysis to explore whether being near a closed hospital had an impact on the efficiency of the surviving hospitals while considering the effect of the 2011 hospital reform policies. To shed light on a potential time lag between hospital closure and changes in efficiency, we used various periods for comparison. Our results suggest that the efficiency of public hospitals in Turkey increased in hospitals that were located near hospitals that closed in Turkey from 2011. Hospital closure improves the efficiency of competitive hospitals under hospital market reforms. Future studies may wish to examine the efficiency effects of government and private sector collaboration on competition in the hospital market.

Measuring efficiency of public hospitals under the impact of Covid-19: the case of Türkiye

The Covid-19 pandemic has had serious medical, administrative and financial effects on the health system and hospitals around the world. In Türkiye, compared to 2019 realizations, in 2020 and 2021 respectively there were 39% and 21% decrease in the number of outpatient services and 29% and 17% decline in total inpatient services of public hospitals. The main subject of this research is how the pandemic period affects the Turkish public hospitals’ efficiency. We have measured the technical efficiency of outpatient and inpatient care services of Turkish public hospitals using Stochastic Frontier Analysis (SFA). The dataset includes 563 hospitals for the years 2015 through 2021. Inputs of number of physicians, nurses and other medical staff, and number of beds and their interactions with each other are introduced to the SFA models of outputs of outpatient visits and inpatient discharges adjusted with case mix index are derived. Firstly, we found that the years associated with Covid-19 have a significant negative impact on the inpatient service efficiency. Training and Research and City Hospitals have low efficiency scores in outpatient services but high efficiency scores in inpatient services. In addition, the regions with high population rates have positive impact in outpatient efficiency and negative impact in inpatient efficiency. During the pandemic, city hospitals, have received large investments, gained a key role by increasing both the patient load and their efficiency. Future reforms can be guided by taking advantage of the efficiency differences of hospitals in different environmental factors.

Assessment of the Efficiency of Public Hospitals in Romania

Considering the high pressure on the healthcare limited resources, mainly on hospitals, determined by the population ageing, and the increased incidence of chronic and infectious diseases, it is essential to both decrease expenditures and provide good quality healthcare. In this paper we focus on the efficiency of Romanian public hospitals. Our research goals are to identify and examine the inefficient public hospitals in Romania; to determine sources of inefficiency in Romanian public hospitals; to describe a potential reduction in all inputs on average to rationalize hospital resources; and recommend that hospital management be improved. We propose an approach that contains preliminary data analyses to obtain homogeneous distributions, then we use Data Envelopment Analysis to estimate the technical efficiency scores for the hospitals in the sample. The results showed that more than half of the examined small hospitals were technically inefficient and that they could have produced a larger number of discharges and consequently an increased number of inpatient days. Possible reductions in inputs were also indicated. These results suggest ways of improving hospital management and restructuring and reorganizing decisions that can be implemented in the hospital network.

The influence of SYRIZA-ANEL Greek health policies on hospital efficiency

BackgroundWe analyse the impact of the three following categories of Health Policies (HP) carried out by the Greek SYRIZA-ANEL governments on the efficiency of Greek public general hospitals. These governments have implemented policies intended to change the rate of contributions to publicly funded healthcare (PCnH), policies to affect the volume and quality of publicly funded health care (PVQH) and those intended to affect the costs of publicly funded healthcare (PCH). A literary review of the PCnH. PVQH and PCH policies of the Greek SYRIZA-ANEL governments was carried out and an efficiency window-DEA study was executed using data from the Ministry of Health (MoH) and the Greek Statistical Authority (ELSTAT).MethodsThe study was designed to assess the impact of PCnH. PVQH and PCH policies by the Greek SYRIZA-ANEL governments on the efficiency of Greek general hospitals. The data was collected from HEAL-Link scientific journals. Information on HPs was extracted from the work collected. The values of inputs and outputs used for the efficiency study were obtained from ELSTAT and Greek MoH databases.ResultsHPs of the Greek SYRIZA-ANEL governments extend to all three HP categories of the sample used. These policies have a dual effect on both the inputs and outputs used in efficiency. Efficiency values exhibit fluctuations with good and bad years. The SYRIZA-ANEL governments seek to ensure more equality in access to health services. Some of the policies reduce costs and have a positive impact on efficiency, while others have the opposite effect. The increase in outputs achieved as a result of health policies is counter balanced by an increase in inputs.ConclusionsThe PCnH, PVQH and PCH policies of the SYRIZA-ANEL governance seem to have a dual orientation: some policies reduce the cost of a category and contain the total cost, thus positively contributing to an increase in efficiency. Certain policies are aimed more at fulfilling the criterion of equality in the provision of health services and thus the cost inevitably increases. From the window-DEA study, three relatively “good” years emerge (2015, 2016, 2018) and two “bad years” (2017, 2019). This analysis will be useful for further research on the effect of health policies on hospital efficiency in other countries and periods.

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.

Measuring the efficiency of public hospitals: A multistage data envelopment analysis in Fujian Province, China.

The present study aimed to evaluate the operational efficiency of public hospitals in Fujian Province and the factors responsible for the inefficiency of these hospitals and provide relevant suggestions for health policymakers in allocating service resources. In the first stage of the research, the variables affecting the efficiency of hospitals were extracted by qualitative and quantitative methods, including literature optimization, gray related analysis and gray clustering evaluation. In the second stage, the data envelopment analysis (DEA) method was used to evaluate the operational efficiency of 49 hospitals of different levels and types selected by sampling in 2020. Finally, a Tobit regression model with introduced institutional factors and background factors was established to study the main influencing factors of hospital inefficiency. In the first stage, 10 input variables and 10 output variables necessary from the mangers' point of view were identified to test efficiency. In the second stage, the average comprehensive TE, PTE, and SE of 49 sample hospitals was 0.802, 0.888, and 0.902, respectively. 22.45% of these hospitals met the effective criteria, i.e., the overall effective rate was 22.45%. The low SE value of the hospital was the main reason hindering the improvement of the comprehensive efficiency value. The overall effective rate of secondary public hospitals (30.77%) was higher than that of tertiary public hospitals (19.44%), and the overall effective rate of public specialized hospitals (30%) was higher than that of general public hospitals (18.92%). Based on the third stage results, the bed occupancy rate (BOR) and the proportion of beds (POB) were major factors affecting the operation efficiency of grade III hospitals (p < 0.01). However, the operating efficiency of grade II hospitals was significantly affected by POB and regional per capita GDP(GDPPC) (p < 0.05). Moreover, the impact of BOR and GDPPC was positive, and POB was negatively correlated with hospital operation efficiency. The study results indicated that the overall operation efficiency of public hospitals in Fujian Province is low. This study revealed that intervention should be strengthened from a policy and management perspective to improve the operation efficiency of public hospitals.

Benchmarking the operational efficiency of Mexican hospitals – a longitudinal study

PurposeThis study aims to benchmark the operational efficiency of fifty-eight public hospitals across Mexico between 2015 and 2018 and identifies the most critical inputs affecting their efficiency. In doing so, the study analyzes the impact of policy changes in the Mexican healthcare system introduced in recent years.Design/methodology/approachTo measure the operational efficiency of Mexican public hospitals, data envelopment analysis (DEA) window analysis variable returns to scale (VRS) methodology using longitudinal data collected from the National Institute for Transparency and Access to Information (IFAI). Hospital groups are developed and compared using a categorization approach according to their average and most recent efficiency.FindingsResults show that most of the hospitals in the study fall in the moving ahead category. The hospitals in the losing momentum or falling behind categories are mostly large units. Hospitals with initially low efficiency scores have either increased their efficiency or at least maintained a steady improvement. Finally, the findings indicate that most hospitals classified as moving ahead focused on a single care area (cancer, orthopedic care, child care and trauma).Research limitations/implicationsThis study examined the technical efficiency of the Mexican healthcare system over a four-year period. Contrary to conventional belief, results indicate that most public Mexican hospitals are managed efficiently. However, recent changes in public and economic policies that came into effect in the current administration (2018) will likely have long-lasting effects on the hospitals' operational efficiency, which could impact the results of this study.Originality/valueTo the best of authors’ knowledge, this is the first study that examines the efficiency of the complex Mexican healthcare system using longitudinal data.

Technical efficiency of Kosovo public hospitals

Aim: The goal of this paper is to evaluate the technical efficiency of Kosovo public hospitals and to propose ways to improve the situation.&#x0D; Methods: An input-oriented Data Envelopment Analysis model with a constant return to scale was applied for a 3-year period from 2018 to 2020. Input variables of number of beds, number of specialists and how they are used to produce outputs of inpatient discharges and surgical operations, are examined.&#x0D; Results: The analysis highlights the marked hospital technical inefficiencies. This study clearly points out the greater attention of public healthcare institutions toward production efficiency. Results illustrate that at least half of Kosovo Public Hospitals operate inefficiently compared to their counterparts. Inefficient, compared to efficient hospitals, on average utilize at least (depending on scenarios analysed) 30% more beds and specialists.&#x0D; Conclusions: The resources available for public health services in Kosovo are the lowest in Europe and the challenge remains to secure financial resources and use them effectively. The study illustrates that most of Kosovo Public Hospitals run inefficiently. Productivity is low, efficiency needs to be improved, especially in terms of introducing modern treatment methods such as daycare. Based on this research, it seems advisable to decrease the number of beds while rationalizing the number of specialized physicians with respect to the special requirements of therapeutic and diagnostic processes in the individual hospitals.

Study of the medical service efficiency of county-level public general hospitals based on medical quality constraints: a cross-sectional study

ObjectivesSince the new medical reform in 2009, county-level hospitals in China have achieved rapid development, but health resource waste and shortage issues still exist.DesignWe applied the meta-frontier and slacks-based measurement-undesirable...

Measuring Productivity and Relative Efficiency of Public Tertiary Traditional Chinese Medicine Hospitals in Hubei, China.

Improving the productivity and relative efficiency of traditional Chinese medicine (TCM) hospitals is pivotal for hospital managers and policymakers to optimize the utilization of TCM resources in China. This study aimed to measure the productivity and relative efficiency of public tertiary TCM hospitals in Hubei Province. The input and output indicators data were extracted from the Health Commission of Hubei Province (HCHP) from 2019 to 2021. The Bootstrap-Malmquist-DEA model was employed to measure the productivity and relative efficiency of the hospitals. The statistical significance was set at P < .05. The numbers of total diagnostic patients and discharged patients declined by 23.44% and 28.34% from 2019 to 2020, and then increased by 25.76% and 20.44% respectively from 2020 to 2021. The average bias-corrected technical efficiency (TE) scores of the TCM hospitals from 2019 to 2021 were 0.8391, 0.8048, and 0.8559, indicating good efficiency. The average total factor productivity (TFP) in 2020 and 2021 decreased compared to that in 2019, with scores of 0.7479 and 0.8996, respectively. Between 2019 and 2020, the TFP changes among 19 out of 21 (90.48%) TCM hospitals and the technological changes (TC) among 20 out of 21 (95.24%) were less than 1.0000 (P < .05). The TFP changes of 17 out of 21 (80.95%) TCM hospitals and the TC of 20 out of 21 (95.24%) were less than 1.0000 (P < .05) between 2019 and 2021. COVID-19 might have constrained the provision of healthcare services by the public tertiary TCM hospitals in Hubei Province. Priority should be given to the utilization of healthcare resources, performance evaluation, information system strengthening, and internal hospital management to boost technical efficiency. TCM hospitals need to focus further on technology innovation to improve their technological progress.

Technical Efficiency in Public Hospitals: A Meta-Regression Analysis

Bu çalışmanın amacı, kamu hastanelerinin etkinliğinin hesaplanmasında Veri Zarflama Analizini kullanan çalışmaları incelemek ve teknik etkinliklerini etkileyen faktörleri meta-regresyon analizi ile belirlemektir. 1998-2021 yılları arasında yayımlanmış ve dahil etme kriterlerini sağlayan 30 ampirik makale bu çalışmanın örneklemini oluşturmaktadır. Meta-regresyon analizi sonuçlarına göre çalışmaların yayın yılı ve ülkelerin gelir grupları ortalama teknik etkinliği etkilememektedir. Hastane sayısı, değişken sayısı, veri toplama yılı ve ülkenin bulunduğu kıta değişkenleri ortalama teknik etkinlik tahmini üzerinde istatistiksel olarak anlamlıdır. Çalışma, kamu hastanelerinin büyük çoğunluğunun etkinliklerinin optimalin üstünde olduğunu göstermiştir. Bu çalışmanın, sağlık alanındaki politikacılara ve yöneticilere hastanelerin etkinliğinin artması konusunda farkındalık sağlaması beklenmektedir.

A Study on the Impact of Management Accounting Application on the Management Efficiency of Public Hospitals in Thanh Hoa Province, Vietnam

Based on the actual situation of Public Hospitals in Thanh Hoa Province and the role of Management Accountants in performing the management function of managers, the authors conduct a study on the relationship between accounting application management to management efficiency in Public Hospitals in Thanh Hoa Province to find out the relationship between the application of management accounting to the operation management of the hospital, thereby making necessary recommendations for the application of Management Accounting. Management accounting in hospitals is reasonable and appropriate, bringing a positive impact on management in Public Hospitals in the current context of Financial Autonomy.

Analysis of factors influencing technical efficiency of public district hospitals in KwaZulu-Natal province, South Africa

BackgroundDistrict hospitals are crucial in supporting primary health care and serve as a gateway to more specialist care through a referral system. Majority of South Africans access health care services through the public sector district health system. Given the enormous task assigned to the public district hospital within the country, this study examined factors influencing their technical efficiency.MethodData were collected for 38 public district hospitals in KwaZulu-Natal province from 2014/15 to 2016/17. Data envelopment analysis (DEA) was used to determine the technical efficiency of the hospitals, adopting both the constant return to scale (CRS) and variable return to scale (VRS) models. Tobit regression model was used to determine factors related to the technical efficiency of the district hospitals.ResultsThis study showed that a significant proportion of the district hospitals were technically inefficient. The Tobit regression model identified catchment population, the proportion of inpatients treated per medical personnel, the proportion of inpatients treated per nursing personnel and expenditure per patient day equivalent as factors influencing technical efficiency of the district hospitals.ConclusionFindings from this study suggest that the technical efficiency of the district hospitals can be enhanced through an effective referral system and improved peoples’ health-seeking behaviour. In addition, a standard mix of clinical staff toward efficient service delivery and periodic cost analysis of health services with the view to saving cost and maintaining the quality of health care should be considered.

The Impact of County Medical Community Reform on the Medical Service Efficiency of County-Level Public General Hospitals in China: A Case Study of Shanxi Province.

China introduced the county medical community (CMC) reform, aimed to provide high-quality medical resources to rural citizens, in 2017. This study examines the impact of the reform on the medical service efficiency of county-level public general hospitals in Shanxi Province, China. In total, 92 county-level public general hospitals from Shanxi Province were taken as the research objective, and the super-efficiency SBM-DEA model was applied to measure medical service efficiency. Further, a two-way fixed-effect model was used to evaluate the impact of CMC reform on the medical service efficiency of county-level public general hospitals by using health statistics data from 2014 to 2018. The study reveals that the CMC reform improved the medical service efficiency of county-level public general hospitals by 15.6%. Moreover, the CMC reform had regional heterogeneity in its impact on the medical service efficiency of county-level public general hospitals. The CMC reform improved the medical service efficiency of hospitals in the southern region more than in the northern region of the province. The medical service efficiency of hospitals in the central region was also improved by CMC reform, but the causal relationship was not found significant. Further, hospital-level factors (e.g., fixed assets, hospital stay, and regional health center) and environmental factors (e.g., GDP, population, urbanization rate, and government subsidies) affected the medical service efficiency of county-level public hospitals during the process of promoting the CMC reform.