Advancing efficiency analysis using data envelopment analysis: the case of German health care and higher education sectors

The main goal of this dissertation is to investigate the advancement of efficiency analysis through DEA. This is practically followed by the case of German health care and higher education organizations. Towards achieving the goal, this dissertation is driven by the following research questions: 1.How the quality of the different DEA models can be evaluated? 2.How can hospitals’ efficiency be reliably measured in light of the pitfalls of DEA applications? 3.In measuring teaching hospital efficiency, what should be considered? 4.At the crossroads of internationalization, how can we analyze university efficiency? Both the higher education and the health care industries are characterized by similar missions, organizational structures, and resource requirements. There has been increasing pressure on universities and health care delivery systems around the world to improve their performance during the past decade. That is, to bring costs under control while ensuring high-quality services and better public accessibility. Achieving superior performance in higher education and health care is a challenging and intractable issue. Although many statistical methods have been used, DEA is increasingly used by researchers to find best practices and evaluate inefficiencies in productivity. By comparing DMU behavior to actual behavior, DEA produces best practices frontier rather than central tendencies, that is, the best attainable results in practice. The dissertation primarily focuses on the advancement of DEA models primarily for use in hospitals and universities. In Section 1 of this dissertation, the significance of hospital and university efficiency measurement, as well as the fundamentals of DEA models, are thoroughly described. The main research questions that drive this dissertation are then outlined after a brief review of the considerations that must be taken into account when employing DEA. Section 2 consists of a summary of the four contributions. Each contribution is presented in its entirety in the appendices. According to these contributions, Section 3 answers and critically discusses the research questions posed. Using the Translog production function, a sophisticated data generation process is developed in the first contribution based on a Monte Carlo simulation. Thus, we can generate a wide range of diverse scenarios that behave under VRS. Using the artificially generated DMUs, different DEA models are used to calculate the DEA efficiency scores. The quality of efficiency estimates derived from DEA models is measured based on five performance indicators, which are then aggregated into two benchmark-value and benchmark-rank indicators. Several hypothesis tests are also conducted to analyze the distributions of the efficiency scores of each scenario. In this way, it is possible to make a general statement regarding the parameters that negatively or positively affect the quality of DEA estimations. In comparison with the most commonly used BCC model, AR and SBM DEA models perform much better under VRS. All DEA applications will be affected by this finding. In fact, the relevance of these results for university and health care DEA applications is evident in the answers to research questions 2 and 4, where the importance of using sophisticated models is stressed. To be able to handle violations of the assumptions in DEA, we need some complementary approaches when units operate in different environments. By combining complementary modeling techniques, Contribution 2 aims to develop and evaluate a framework for analyzing hospital performance. Machin learning techniques are developed to perform cluster analysis, heterogeneity, and best practice analyses. A large dataset consisting of more than 1,100 hospitals in Germany illustrates the applicability of the integrated framework. In addition to predicting the best performance, the framework can be used to determine whether differences in relative efficiency scores are due to heterogeneity in inputs and outputs. In this contribution, an approach to enhancing the reliability of DEA performance analyses of hospital markets is presented as part of the answer to research question 2. In real-world situations, integer-valued amounts and flexible measures pose two principal challenges. The traditional DEA models do not address either challenge. Contribution 3 proposes an extended SBM DEA model that accommodates such data irregularities and complexity. Further, an alternative DEA model is presented that calculates efficiency by directly addressing slacks. The proposed models are further applied to 28 universities hospitals in Germany. The majority of inefficiencies can be attributed to “third-party funding income” received by university hospitals from research-granting agencies. In light of the fact that most research-granting organizations prefer to support university hospitals with the greatest impact, it seems reasonable to conclude that targeting research missions may enhance the efficiency of German university hospitals. This finding contributes to answering research question 3. University missions are heavily influenced by internationalization, but the efficacy of this strategy and its relationship to overall university efficiency are largely unknown. Contribution 4 fills this gap by implementing a three-stage mathematical method to explore university internationalization and university business models. The approach is based on SBM DEA methods and regression/correlation analyses and is designed to determine the relative internationalization and relative efficiency of German universities and analyze the influence of environmental factors on them. The key question 4 posed can now be answered. It has been found that German universities are relatively efficient at both levels of analysis, but there is no direct correlation between them. In addition, the results show that certain locational factors do not significantly affect the university’s efficiency. For policymakers, it is important to point out that efficiency modeling methodology is highly contested and in its infancy. DEA efficiency results are affected by many technical judgments for which there is little guidance on best practices. In many cases, these judgments have more to do with political than technical aspects (such as output choices). This suggests a need for a discussion between analysts and policymakers. In a nutshell, there is no doubt that DEA models can contribute to any health care or university mission. Despite the limitations we have discussed previously to ensure that they are used appropriately, these methods still offer powerful insights into organizational performance. Even though these techniques are widely popular, they are seldom used in real clinical (rather than academic) settings. The only purpose of analytical tools such as DEA is to inform rather than determine regulatory judgments. They, therefore, have to be an essential part of any competent regulator’s analytical arsenal

Analyzing the accuracy of variable returns to scale data envelopment analysis models

The data envelopment analysis (DEA) model is extensively used to estimate efficiency, but no study has determined the DEA model that delivers the most precise estimates. To address this issue, we advance the Monte Carlo simulation-based data generation process proposed by Kohl and Brunner (2020). The developed process generates an artificial dataset using the Translog production function (instead of the commonly used Cobb Douglas) to construct well-behaved scenarios under variable returns to scale (VRS). Using different VRS DEA models, we compute DEA efficiency scores with artificially generated decision-making units (DMUs). We employ five performance indicators followed by a benchmark value and ranking as well as statistical hypothesis tests to evaluate the quality of the efficiency estimates. The procedure allows us to determine which parameters negatively or positively influence the quality of the DEA estimates. It also enables us to identify which DEA model performs the most efficiently over a wide range of scenarios. In contrast to the widely applied BCC (Banker-Charnes-Cooper) model, we find that the Assurance Region (AR) and Slacks-Based Measurement (SBM) DEA models perform better. Thus, we endorse the use of AR and SBM models for DEA applications under the VRS regime

Identifying and prioritizing opportunities for improving efficiency on the farm: holistic metrics and benchmarking with Data Envelopment Analysis

Efficiency benchmarking is a well-established way of measuring and improving farm performance. An increasingly popular efficiency benchmarking tool within agricultural research is Data Envelopment Analysis (DEA). However, the literature currently lacks sufficient demonstration of how DEA could be tuned to the needs of the farm advisor/extension officer, rather than of the researcher. Also, the literature is flooded with DEA terminology that may discourage the non-academic practitioner from adopting DEA. This paper aims at making DEA more accessible to farm consultants/extension officers by explaining the method step-by-step, visually and with minimal use of specialised terminology and mathematics. Then, DEA’s potential for identifying cost-reducing and profit-making opportunities for farmers is demonstrated with a series of examples drawn from commercial UK dairy farm data. Finally, three DEA methods for studying efficiency change and trends over time are also presented. Main challenges are discussed (e.g. data availability), as well as ideas for extending DEA’s applicability in the agricultural industry, such as the use of carbon footprints and other farm sustainability indicators in DEA analyses

Adapting image processing and clustering methods to productive efficiency analysis and benchmarking: A cross disciplinary approach

This dissertation explores the interdisciplinary applications of computational methods in quantitative economics. Particularly, this thesis focuses on problems in productive efficiency analysis and benchmarking that are hardly approachable or solvable using conventional methods. In productive efficiency analysis, null or zero values are often produced due to the wrong skewness or low kurtosis of the inefficiency distribution as against the distributional assumption on the inefficiency term. This thesis uses the deconvolution technique, which is traditionally used in image processing for noise removal, to develop a fully non-parametric method for efficiency estimation. Publications 1 and 2 are devoted to this topic, with focus being laid on the cross-sectional case and panel case, respectively. Through Monte-Carlo simulations and empirical applications to Finnish electricity distribution network data and Finnish banking data, the results show that the Richardson-Lucy blind deconvolution method is insensitive to the distributio-nal assumptions, robust to the data noise levels and heteroscedasticity on efficiency estimation. In benchmarking, which could be the next step of productive efficiency analysis, the 'best practice' target may not perform under the same operational environment with the DMU under study. This would render the benchmarks impractical to follow and adversely affects the managers to make the correct decisions on performance improvement of a DMU. This dissertation proposes a clustering-based benchmarking framework in Publication 3. The empirical study on Finnish electricity distribution network reveals that the proposed framework novels not only in its consideration on the differences of the operational environment among DMUs, but also its extreme flexibility. We conducted a comparison analysis on the different combinations of the clustering and efficiency estimation techniques using computational simulations and empirical applications to Finnish electricity distribution network data, based on which Publication 4 specifies an efficient combination for benchmarking in energy regulation.  This dissertation endeavors to solve problems in quantitative economics using interdisciplinary approaches. The methods developed benefit this field and the way how we approach the problems open a new perspective

Assessing the efficiency of mother-to-child HIV prevention in low- and middle-income countries using data envelopment analysis

AIDS is one of the most significant health care problems worldwide. Due to the difficulty and costs involved in treating HIV, preventing infection is of paramount importance in controlling the AIDS epidemic. The main purpose of this paper is to explore the potential of using Data Envelopment Analysis (DEA) to establish international comparisons on the efficiency of implementation of HIV prevention programmes. To do this we use data from 52 low- and middle-income countries regarding the prevention of mother-to-child transmission of HIV. Our results indicate that there is a remarkable variation in the efficiency of prevention services across nations, suggesting that a better use of resources could lead to more and improved services, and ultimately, prevent the infection of thousands of children. These results also demonstrate the potential strategic role of DEA for the efficient and effective planning of scarce resources to fight the epidemic

Efficiency of Financial Institutions: International Survey and Directions for Future Research

This paper surveys 130 studies that apply frontier efficiency analysis to financial institutions in 21 countries. The primary goals are to summarize and critically review empirical estimates of financial institution efficiency and to attempt to arrive at a consensus view. We find that the various efficiency methods do not necessarily yield consistent results and suggest some ways that these methods might be improved to bring about findings that are more consistent, accurate, and useful. Secondary goals are to address the implications of efficiency results for financial institutions in the areas of government policy, research, and managerial performance. Areas needing additional research are also outlined.

Energy performance of hotel buildings

Master'sMASTER OF SCIENCE (BUILDING

“High Spending, Poor Productivity Gains!” Assessing Public Health System (In)Efficiency and Hospital Performance In The State Of Kuwait: Would More Private Delivery Improve Healthcare?

The healthcare sector in the State of Kuwait has been nurtured for many decades by the government, where the majority of health services in the country are controlled by the Ministry of Health (MoH). Although healthcare services in public sector hospitals are at highly subsidized rates, causing private sector involvement in healthcare to be considerably low, the growing demands for private delivery of care burgeoned participation of private hospitals in Kuwait, and improving hospital efficiency and productivity is more critical and timelier than ever. This dissertation aims to analyze public health system efficiency and hospital performance in the State of Kuwait using data envelopment analysis (DEA) techniques; where we begin by evaluating the input-oriented technical efficiency (TE) of MoH hospitals in 2015-2019 and identifying potential areas for efficiency improvement by exploring influencing institutional and environmental factors. We further conduct an output-oriented comparative study of public-private productivity in view of ownership, hospital management, and other external variables to understand drivers of productive efficiency and potential factors of output maximization disparities in 2019/2020