-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this research is to explore the operational performance of the Ministry of Health’s general public hospitals
following the implementation of the Health Transformation Program in Turkey. This study adopts the Malmquist index to analyze
the operational performance of the 352 Ministry of Health’s general hospitals during the period 2005–2008. The result show
that the operational performance of these hospitals regardless of the attributes present a common tendency that the performance
of 2005–2007 progressed as compared to the previous year, while that of 2008 has regressed as compared to 2007.
KeywordsHospital performance–Technical efficiency–Malmquist index–Data envelopment analysis–Health care policy evaluation
Central European Journal of Operations Research 04/2012; 19(1):19-37. · 0.48 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND:: Over the last couple of decades, hospitals in the United States are facing pressures to maximize performance in terms of production efficiency and quality. An increasing emphasis on value-based purchasing on the part of third-party payers as well as the prevalence of pay for performance initiatives create an imperative for more accurate assessments of health care provider performance. PURPOSES:: The objectives of this study were to measure hospital performance in terms of both technical efficiency and quality using data envelopment analysis (DEA) models in urban acute care hospitals. METHODOLOGY/APPROACH:: In this observational cross-sectional study of a nationally representative sample of 371 urban acute care hospitals, hospital performance was assessed using slack-based additive DEA models. The technical inputs included in the DEA models were total number of beds setup and staffed, nonphysician full-time equivalent staffing, and nonpayroll operating expenses. The technical outputs were adjusted patient days, total number of outpatient visits, and training full-time equivalent, obtained from the American Hospital Association 2008 database. The quality measures used for the quality of care dimension of performance were survival rates for acute myocardial infarction, congestive heart failure, and pneumonia obtained from the Nationwide Inpatient Sample 2008 data. FINDINGS:: Less than 20% of the sample hospitals were optimally performing for both quality and efficiency. Tobit regression analysis of the DEA scores found that public, small, teaching hospitals had higher DEA efficiency and quality scores. PRACTICE IMPLICATIONS:: DEA is a promising tool for benchmarking both aspects of performance: efficiency and quality of hospitals. Because quality is a multidimensional construct, the choice of an appropriate composite quality measure has to be addressed in future research. However, incorporating quality into the DEA models would be a better reflection of the hospital product.
Health care management review 03/2012; · 1.30 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Successful implementations and the ability to reap the benefits of electronic medical record (EMR) systems may be correlated with the type of enterprise application strategy that an administrator chooses when acquiring an EMR system. Moreover, identifying the most optimal enterprise application strategy is a task that may have important linkages with hospital performance.
This study explored whether hospitals that have adopted differential EMR enterprise application strategies concomitantly differ in their overall efficiency. Specifically, the study examined whether hospitals with a single-vendor strategy had a higher likelihood of being efficient than those with a best-of-breed strategy and whether hospitals with a best-of-suite strategy had a higher probability of being efficient than those with best-of-breed or single-vendor strategies. A conceptual framework was used to formulate testable hypotheses.
A retrospective cross-sectional approach using data envelopment analysis was used to obtain efficiency scores of hospitals by EMR enterprise application strategy. A Tobit regression analysis was then used to determine the probability of a hospital being inefficient as related to its EMR enterprise application strategy, while moderating for the hospital's EMR "implementation status" and controlling for hospital and market characteristics.
The data envelopment analysis of hospitals suggested that only 32 hospitals were efficient in the study's sample of 2,171 hospitals. The results from the post hoc analysis showed partial support for the hypothesis that hospitals with a best-of-suite strategy were more likely to be efficient than those with a single-vendor strategy.
This study underscores the importance of understanding the differences between the three strategies discussed in this article. On the basis of the findings, hospital administrators should consider the efficiency associations that a specific strategy may have compared with another prior to moving toward an enterprise application strategy.
Health care management review 11/2011; 37(1):4-13. · 1.30 Impact Factor
-
Yasar A Ozcan
Health Care Management Science 08/2011; · 1.05 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study evaluates the productivity changes for the Veterans Integrated Service Networks (VISNs) that the Veterans Health Administration (VHA) created, comparing performance in 1994 with that in 2004. This represents periods before and after the VHA in 1995 reconfigured provider units into 21 regionalized delivery systems and engaged in other important system innovations. Productivity is measured using the Malmquist Index approach (a longitudinal version of the data envelopment analysis [DEA]). Results indicate that the VISN restructuring generally produced improvements in overall productivity (Malmquist scores) and in VISN adaptations to structural/technological change. They also show that the VISNs overall did not produce "changes in efficiency," reflecting challenges they may have faced in making "technical change" through management adaptations. The findings are consistent with what would be expected, given the major changes that did occur within the VHA in recent years as well as the before and after design used in this study.
Medical Care Research and Review 02/2011; 68(1 Suppl):20S-35S. · 2.96 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This paper evaluates the performance of 198 ambulatory surgery centres (ASCs) operating in the State of Pennsylvania during the fiscal year 2006. Performance is assessed from technical efficiency view using data envelopment analysis (DEA). Multi-input/output model included two inputs: number of operating rooms and labour, and patient surgical visits differentiated by age groups: 0-17, 18-64, 65+ as three outputs. Input oriented models were employed to assess various DEA efficiency models. Results show that about 48 (24%) of ASCs are efficient with a mean efficiency score of 0.60. The results also indicate that appropriate utilization of operating rooms and labour inputs are the main determinants of ASC efficiency.
Health Services Management Research 11/2009; 22(4):184-90.
-
[show abstract]
[hide abstract]
ABSTRACT: Renewed debate over competition in healthcare suggests that greater specialization is good for the health economy. In essence, greater specialization is hypothesized to lead to lower average costs, due to learning curve effects, scale, or other operating efficiencies. This hypothesis was tested in oncology care, since this disease group is one of the few with existing specialized cancer centers already in place. Data envelopment analysis (DEA), and specifically a longitudinal Malmquist index over a 5-year period was applied to the major, specialized inpatient cancer centers to determine if these specialized centers achieve higher productivity over time, and if scale leads to higher operating efficiency. Results suggest policy and payer implications since these DRG-exempt hospitals may not be improving their technical efficiency over time. Despite advancements in technology and greater scale, the average efficiency of cancer care has marginally declined. Similarly, when compared to other hospitals with greater numbers of other service offerings, oncology care has not benefited from increasing returns to scale.
Health Care Management Science 07/2009; 12(2):192-200. · 1.05 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study investigates how hospital electronic medical record (EMR) use influences quality performance. Data include nonfederal acute care hospitals in the United States. Sources of the data include the American Hospital Association, Hospital Quality Alliance, the Healthcare Information and Management Systems Society, and the Centers for Medicare and Medicaid Services case-mix index sets. The authors use a retrospective cross-sectional format with linear regression to assess the relationship between hospital EMR use and quality performance. Quality performance is measured using 10 process indicators related to 3 clinical conditions: acute myocardial infarction, congestive heart failure, and pneumonia. The authors also use a propensity score adjustment to control for possible selection bias. After this adjustment, the authors identify a positive significant relationship between EMR use and 4 of the 10 quality indicators. They conclude that there is limited evidence of the relationship between hospital EMR use and quality.
Medical Care Research and Review 09/2008; 65(4):496-513. · 2.96 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Using a sample of Virginia hospitals, performance measures of quality were examined as they related to technical efficiency. Efficiency scores for the study hospitals were computed using Data Envelopment Analysis (DEA). The study found that the technically efficient hospitals were performing well as far as quality measures were concerned. Some of the technically inefficient hospitals were also performing well with respect to quality. DEA can be used to benchmark both dimensions of hospital performance: technical efficiency and quality. The results have policy implications in view of growing concern that hospitals may be improving their efficiency at the expense of quality.
Journal of Medical Systems 07/2008; 32(3):193-9. · 1.13 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The recent focus on health care quality improvement and cost containment has led some policymakers and practitioners to advocate the adoption of health information technology. One such technology is the Electronic Medical Record (EMR), which is predicted to change and improve health care in the USA. Little is known about factors that influence hospital adoption of this relatively new technology. The purpose of this paper is to determine the national prevalence of EMR adoption in acute care hospitals while examining the organizational and environmental correlates using a Resource Dependence Theoretical Perspective. Significant predictors of hospital EMR use may indicate barriers to use for some hospitals and can be used to guide policy. This study uses a non-experimental cross sectional design to examine hospital EMR use in 2004. A logistic regression approach is used to determine the correlations between hospital EMR use and organizational and environmental characteristics. Hospital EMR use was identified using the HIMSS Analytics data. Organizational and environmental variables were measured using data from the AHA, CMS (financial and case mix) and ARF. Hospital EMR adoption is significantly associated with environmental uncertainty, type of system affiliation, size, and urbanness. The effects of competition, munificence, ownership, teaching status, public payer mix, and operating margin were not statistically significant. Significant predictors of hospital EMR adoption represent barriers that may prevent certain hospitals from obtaining and using EMRs. These hospitals include those that are smaller, more rural, non-system affiliated, and in areas of low environmental uncertainty. Since EMR adoption may be an organizational survival strategy for hospitals to improve quality and efficiency, hospitals that are at risk of missing the wave of implementation should be offered services and incentives to enable them to implement and maintain EMR systems.
Journal of Medical Systems 11/2007; 31(5):375-84. · 1.13 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Provider efficiency in the dialysis industry in the U.S.A. has been of great interest for a variety of parties mainly because of the continuing growth in the number of such patients and providers and in the industry's costs. This study examined technical efficiency longitudinally among the multiple-output producers of freestanding facilities, as the dominant group of providers, using the DEA-based Malmquist index. Nationally representative data were obtained from Independent Renal Facility Cost Report Data Files for the years 1994 through 2000. The resulting sample comprised 140 facilities that had operated throughout the seven study years and jointly produced all dialysis outputs with nonzero inputs. The results show that over the period 1994-2000, on average multi-output, freestanding dialysis facilities did not achieve improvement in productivity. Decomposition of the Malmquist productivity indices showed improvement in technical efficiency but at the same time regress in technologies with potential to improve their quality of care. Negative change in technology was the major source of negative movement in productivity. The study concludes that under the fixed-price payment policy, multiple dialysis outputs are produced efficiently, but it may be that the quality of care is being sacrificed.
Health Care Management Science 12/2004; 7(4):253-61. · 1.05 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study is to discern what factors affect the longevity of amalgam and of composite restorations by dentists who perform posterior restorations. Data are obtained from the Washington Dental Service and contain 1.5 million patient encounters representing visits to 23,000 providers from January 1993 through 31 December 1999. Analysis of provider performance is estimated through Data Envelopment Analysis. The principal finding is that the most efficient dentists produce posterior restorations that survive almost 5 months (4.6 months) longer than those by inefficient providers (chi2 = 18.98, p < 0.0001). The findings suggest that there is no difference in restoration longevity between amalgam and composite restorations when the restoration is performed by efficient provider.
Journal of Medical Systems 11/2003; 27(5):445-56. · 1.13 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this investigation was to examine the technical efficiency of mechanical ventilation nonsurgery (DRG 475) among University Hospital Consortium (UHC) hospitals that consists of volunteer, teaching hospitals across the nation. The data for this study was retrieved from the 1997 UHC database that includes charge and discharge information for 69 hospitals. Data on 7961 patients classified with mechanical ventilation were aggregated to the hospital level. We retained data from a total of 62 hospitals, the other seven hospitals had missing data. The research questions were (1) Do UHC hospitals differ significantly in their efficiencies in the treatment of mechanically ventilated patients? (2) What inputs and outputs contribute most to the inefficiencies associated with mechanical ventilation? Of the 62 hospitals analyzed using data envelopment analysis technique, 10 were considered efficient and 52 were inefficient as compared to their benchmark peers. Efficient and inefficient hospitals did significantly differ between the transferred output variable and between the respiratory, laboratory, and radiology input variables. All inputs demonstrated excessive resource utilization among inefficient hospitals as compared to efficient hospitals. A total reduction of about $19 million dollars in ancillary services would need to occur for inefficient hospitals to approach the frontier of efficient hospitals. This study demonstrates that mechanical ventilation is costly, yet the specified ancillary services are capable of being reduced yielding technical efficiency as demonstrated by 10 efficient hospitals.
Journal of Medical Systems 07/2002; 26(3):227-40. · 1.13 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To examine market competition and facility characteristics that can be related to technical efficiency in the production of multiple dialysis outputs from the perspective of the industrial organization model.
Freestanding dialysis facilities that operated in 1997 submitted cost report fonns to the Health Care Financing Administration (HCFA), and offered all three outputs--outpatient dialysis, dialysis training, and home program dialysis.
The Independent Renal Facility Cost Report Data file (IRFCRD) from HCFA was utilized to obtain information on output and input variables and market and facility features for 791 multiple-output facilities. Information regarding population characteristics was obtained from the Area Resources File.
Cross-sectional data for the year 1997 were utilized to obtain facility-specific technical efficiency scores estimated through Data Envelopment Analysis (DEA). A binary variable of efficiency status was then regressed against its market and facility characteristics and control factors in a multivariate logistic regression analysis.
The majority of the facilities in the sample are functioning technically inefficiently. Neither the intensity of market competition nor a policy of dialyzer reuse has a significant effect on the facilities' efficiency. Technical efficiency is significantly associated, however, with type of ownership, with the interaction between the market concentration of for-profits and ownership type, and with affiliations with chains of different sizes. Nonprofit and government-owned Facilities are more likely than their for-profit counterparts to become inefficient producers of renal dialysis outputs. On the other hand, that relationship between ownership form and efficiency is reversed as the market concentration of for-profits in a given market increases. Facilities that are members of large chains are more likely to be technically inefficient.
Facilities do not appear to benefit from joint production of a variety of dialysis outputs, which may explain the ongoing tendency toward single-output production. Ownership form does make a positive difference in production efficiency, but only in local markets where competition exists between nonprofit and for-profit facilities. The increasing inefficiency associated with membership in large chains suggests that the growing consolidation in the dialysis industry may not, in fact, be the strategy for attaining more technical efficiency in the production of multiple dialysis outputs.
Health Services Research 07/2002; 37(3):711-32. · 2.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study uses Data Envelopment Analysis to examine public sector hospital efficiency in 80 provincial markets in Turkey. Outputs of the study includes mortality rate as quality measure as well as inpatient discharges and outpatient visits. Patient beds, four levels of health labor, and expenditures are used to capture capital, labor and material resources as inputs. Results show that 55% of the public hospitals in served markets are operated inefficiently. Analysis of inefficient provinces suggests that in those 44 inefficient provinces are collectively overbedded, employ excessive number of specialists and other health labor. They spent approximately $70,000,000 from their revolving funds in excess compared to efficient provinces.
Journal of Medical Systems 11/2000; 24(6):307-320. · 1.13 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The rapid increase in the number of hospitals becoming members of multihospital systems in recent decades has led to the formation of local and regional clusters that have the potential to function as regional systems, a model long advocated as a policy strategy for improving health system performance.
This study addresses both cluster efficiency and the hierarchical configuration with which hospitals are grouped into clusters.
This study uses 2004 data from the American Hospital Association Annual Survey multihospital system designations updated to 2005. Efficiencies are measured using data envelopment analysis.
The data envelopment analysis results show that 20 clusters or 5.8% of the sample of 343 clusters are highly efficient; the remaining 323 or 94.2% of the clusters received lesser efficiency scores, averaging 0.73 on the data envelopment analysis measure. The study found the number of beds in the primary hospitals and the percentage of hospitals in the clusters that were urban, two of three variables that reflect patterns of regional model service configurations, to be significantly correlated with cluster efficiency.
Results suggest that many hospital clusters have evolved service configurations that are consistent with historically conceptualized regional organizational forms and that the particular regional pattern of distributing service capacities across cluster members might contribute to measured performance. The study also confirms the applicability of data envelopment analysis for assessing the performance of complex, multiunit organizations.
Health care management review 34(3):251-61. · 1.30 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We use data envelopment analysis (DEA) to examine the relationship between hospital electronic medical record (EMR) use and efficiency in a national sample of acute care hospitals. Data sources include the American Hospital Association (AHA), Health Information Management Systems Society (HIMSS), and Case Mix Index. Using two research approaches including a retrospective, cross-sectional design and a first differencing repeated measures design, we find limited evidence that EMRs can improve hospital efficiency. Small hospitals may benefit in the area of efficiency through EMR use, but medium and large hospitals generally do not demonstrate such a difference. Likewise, there does not appear to be a significant increase in efficiency over time associated with EMRs when compared to the efficiency of hospitals without such documentation.
Socio-Economic Planning Sciences.
-
[show abstract]
[hide abstract]
ABSTRACT: Women with a previous history of breast cancer are at increased risk for developing cancer in the opposite breast. However, the literature is inconsistent regarding whether a previous history of breast cancer is associated positively with mammography utilization. Some studies indicate that women with a previous history of breast cancer are less likely to utilize mammography, although behavioral models of health care theorize that women with a history of breast cancer may be more vigilant regarding the disease. We analyzed responses from 830 women > or =50 years who participated in the 1998 National Health Interview Survey. A significantly greater proportion of women with breast cancer reported had a mammogram in the previous year (73.13%) as compared with women who did not have breast cancer (56.69%). Although a previous history of breast cancer was found to be associated positively with mammography use, women with public sources of health insurance are less likely to report mammography use. Results indicate that women with a previous history of breast cancer appear aware of the necessity for continued screening. However, enabling factors such as type of health insurance continue to exert an influence upon the utilization of mammography.
Women s Health Issues 13(2):62-7. · 1.61 Impact Factor
