Modelling generalized firms' restructuring using inverse DEA

The key consideration for firms’ restructuring is improving their operational efficiencies. Market conditions often offer opportunities or generate threats that can be handled by restructuring scenarios through consolidation, to create synergy, or through split, to create reverse synergy. A generalized restructuring refers to a move in a business market where a homogeneous set of firms, a set of pre-restructuring decision making units (DMUs), proceed with a restructuring to produce a new set of post-restructuring entities in the same market to realize efficiency targets. This paper aims to develop a novel inverse Data Envelopment Analysis based methodology, called GInvDEA (Generalized Inverse DEA), for modeling the generalized restructuring. Moreover, the paper suggests a linear programming model that allows determining the lowest performance levels, measured by efficiency that can be achieved through a given generalized restructuring. An application in banking operations illustrates the theory developed in the paper

Analysis of topics in health microeconomics through flexible regression models

The object of discussion is To calculate a new flexible hospital production function by means of a Generalized Additive Model including interactions and to compare it with the classic models Cobb-Douglas and Translog in the prediction of the behavior of productive factors and to study how the number of beds in the hospital affects the hospital activity, the length of stays and, consequently, the waiting list. The GAM model is more appropriate than the Cobb-Douglas or the translog to evaluate hospital production functions, for public hospitals located in Galicia and for the study period. The study also demonstrates the usefulness of simulation techniques to examine a hospital system. There are no significant differences in terms of waiting lists and occupancy rates when the number of beds in larger hospitals increases. Supply-side policies can also be disappointing in their effects on waiting times for small rural hospitals. Greater capacity in terms of more beds is associated with shorter waiting times for medium size hospitals

Quantifying the effects of modelling choices on hospital efficiency measures: A meta-regression analysis

It has often been argued that the results of efficiency analyses in health care are influenced by the modelling choices made by the researchers involved. In this paper we use meta-regression analysis in an attempt to quantify the degree to which modelling factors influence efficiency estimates. The data set is derived from 253 estimated models reported in 95 empirical analyses of hospital efficiency in the 22-year period from 1987 to 2008. A meta-regression model is used to investigate the degree to which differences in mean efficiency estimates can be explained by factors such as: sample size; dimension (number of variables); parametric versus non-parametric method; returns to scale (RTS) assumptions; functional form; error distributional form; input versus output orientation; cost versus technical efficiency measure; and cross-sectional versus panel data. Sample size, dimension and RTS are found to have statistically significant effects at the 1% level. Sample size has a negative (and diminishing) effect on efficiency; dimension has a positive (and diminishing) effect; while the imposition of constant returns to scale has a negative effect. These results can be used in improving the policy relevance of the empirical results produced by hospital efficiency studies.

Emergency Department Nurses\u27 Experience Relating to Hospital Acquisition: A Phenomenological Study

A Paper Presented to Meet Partial Requirements for a MSN Degree Southern Adventist University School of Nursin

An Exploratory Evaluation of State Road Provision to Commuters and Shippers using Data Envelopment Analysis and Tobit Regression

Abstract Due to mounting fiscal pressures over the last few years, the federal government as well as many state and municipal governments in the United States (U.S.) have had to re-examine their transportation policies and programs. Tax increases and/or spending cuts which aim to trim budget deficits are major preoccupations of most policy makers and legislative bodies nowadays. With regard to the task of building new or rehabilitating bridges, highways, and toll gates, cost-benefit analysis and economic impact studies are often undertaken by various government entities to rank and prioritize spending in the hopes of maximizing fiscal efficiency and road usage benefits. Since most highway construction and maintenance expenditures are absorbed by state governments, it is mostly up to state policy makers to decide transportation priorities. However, no research to date has been conducted to evaluate the comparative efficiency of state road provision to commuters and shippers. Such research would be useful to a state government’s budgetary allocation and spending plans. This paper is one of the first to assess and rank the comparative efficiency of all 50 states in the U.S. by using data envelopment analysis and then to explain variations in efficiency ratings by using Tobit regression analysis

An Exploratory Evaluation of State Road Provision to Commuters and Shippers using Data Envelopment Analysis and Tobit Regression

Abstract Due to mounting fiscal pressures over the last few years, the federal government as well as many state and municipal governments in the United States (U.S.) have had to re-examine their transportation policies and programs. Tax increases and/or spending cuts which aim to trim budget deficits are major preoccupations of most policy makers and legislative bodies nowadays. With regard to the task of building new or rehabilitating bridges, highways, and toll gates, cost-benefit analysis and economic impact studies are often undertaken by various government entities to rank and prioritize spending in the hopes of maximizing fiscal efficiency and road usage benefits. Since most highway construction and maintenance expenditures are absorbed by state governments, it is mostly up to state policy makers to decide transportation priorities. However, no research to date has been conducted to evaluate the comparative efficiency of state road provision to commuters and shippers. Such research would be useful to a state government’s budgetary allocation and spending plans. This paper is one of the first to assess and rank the comparative efficiency of all 50 states in the U.S. by using data envelopment analysis and then to explain variations in efficiency ratings by using Tobit regression analysis

Hospital Merger and Acquisition Effects on Healthcare Quality and Cost

Healthcare is as much a business subject to market dynamics as it is a public service, with enormous sums of money and resources devoted to it. Since a person’s health is one of his or her most valuable assets, healthcare will always be in high demand, regardless of the price of medical goods and services. Considering healthcare’s nature as a necessary good and the irreplaceable importance of a medical facility to its service area, any changes in capacity or method of healthcare delivery may have profound effects on the dependent population. Situations in which a hospital merges with a healthcare system or another hospital exemplify such a change, for mergers entail potentially large-scale alterations to the local healthcare market and to the manner in which care is provided. The number of hospital mergers and acquisitions has been steadily increasing since 2003, with the number of deals growing over 40 percent from 2010 to 2015. A concern is that larger institutions or systems wield greater market power and may gain the ability to control the majority of healthcare delivery in the local area; this decrease in competition can lead to rising costs without comparable improvements in quality. On the other hand, consolidations can also present the opportunity for better integration and efficiency of care, more abundant and valuable technological resources, elimination of duplicate services, collaboration among more adept healthcare providers, and overall cost savings from economies of scale. This study explores the effects of hospital consolidation and resultant operational changes on patient outcomes and the costs associated with their care. Furthermore, the effect of hospital ownership status on quality and cost measures will also be assessed. This thesis differs from existing literature because it is the first known study to use hospital-level data from 2010 to 2014 to analyze whether hospital mergers significantly affect healthcare quality and cost

Participation in change : a descripitive model of factors to motivate participation in change

Hospital Mergers have been proved to be troublesome, the most crucial ingredient is believed to be the participation of members of the organization on all levels. When the hospital merger between the hospital of Malmö and the hospital of Lund is a fact, it seems clear that knowledge about managing motivation is important. The knowledge could also lead to increased possibilities to improve support for motivation where needed at the hospital. I have through a literature review created a descriptive model of the theoretical view on motivational factors for participation in change and their relationships. The theoretical model where then tested in a empirical study in which additional data created a more true model of the motivation on participation at the hospital. The findings of the study show how the descriptive model illustrates how the two different departments both work with a empowering philosophy that have built in properties that enable the employees to gain more motivation. The model also underline the importance of the communication role to enlighten the employee in what, where, when and why the change takes place. Furthermore, the approaches used today, have established themselves very well despite the recent launch of one of the divisions. The study also show that the potential adverse impacts from past approaches, had surprisingly little impact on the trustworthiness of the new more participatory approach

Quão eficiente é o desempenho hospitalar pós-fusões?: o caso português

Mestrado em EconomiaAtualmente cada vez mais empresas se juntam para aumentar o seu mercado, obter economias de escala, melhorar as estruturas de custos fixos e, consequentemente, aumentar o lucro. Os hospitais não são exceção. No entanto, a reestruturação de um hospital deve considerar a eficiência do desempenho. A criação dos Centros de Hospitalares (HCʼs) afecta a eficiência dos mesmos, sendo esta a nossa questão fulcral. Para responder a esta questão medimos o impacto das fusões horizontais na eficiência dos hospitais portugueses, utilizando o método Data Envelopment Analysis (DEA). Os resultados empíricos do nosso estudo mostram que as fusões não resultam necessariamente num aumento da eficiência técnica. Algumas fusões hospitalares podem alcançar uma dimensão excessiva, criando deseconomias de escala. A análise sugere, assim, que existem diferenças de acordo com áreas geográficas e estruturas hospitalares. Foram notórias diferenças entre as unidades hospitalares de pequena e grande dimensão, que pensamos que pode ser explicadas pelas necessidades de mercado e problema dos "picos de afluência”. O desempenho das fusões mais antigas, parece permanecer estável nos anos seguintes.Nowadays, more and more firms come together to gain size, scale, improve their fixed cost and increase profitability. Hospitals are no exception. However, restructuring an hospital cannot leave aside aspects of efficiency in performance. How merger of Hospitals Centres (HCʼs) affects the technical efficiency is the focus of this research. We measure the impact on efficiency of Portuguese hospitals, after a horizontal merger, using Data Envelopment Analysis (DEA). The empirical results of our research show that the merger did not result in increased technical efficiency. Some hospital mergers become too large and therefore after the mergers might experience diseconomies of scale. The analysis strongly suggests that there are differences according to geographical areas and hospital sizes. We found differences between small and large units that could be explained by the needs and “peak load” problems. The performance of old mergers seems to remain stable in subsequent years

Why do some inter-organisational collaborations in healthcare work when others do not? A realist review

Background: Inter-organisational collaboration is increasingly prominent within contemporary healthcare systems. A range of collaboration types such as alliances, networks, and mergers have been proposed as a means to turnaround organisations, by reducing duplication of effort, enabling resource sharing, and promoting innovations. However, in practice, due to the complexity of the process, such efforts are often rife with difficulty. Notable contributions have sought to make sense of this area; however, further understanding is needed in order to gain a better understanding of why some inter-organisational collaborations work when others do not, to be able to more effectively implement collaborations in the future. Methods: Realist review methodology was used with the intention of formulating context-mechanism-outcome configurations (CMOCs) to explain how inter-organisational collaborations work and why, combining systematic and purposive literature search techniques. The systematic review encompassed searches for reviews, commentaries, opinion pieces, and case studies on HMIC, MEDLINE, PsycINFO, and Social Policy and Practice databases, and further searches were conducted using Google Scholar. Data were extracted from included studies according to relevance to the realist review. Results: Fifty-three papers were included, informing the development of programme theories of how, why, and when inter-organisational collaborations in healthcare work. Formulation of our programme theories incorporated the concepts of partnership synergy and collaborative inertia and found that it was essential to consider mechanisms underlying partnership functioning, such as building trust and faith in the collaboration to maximise synergy and thus collaborative performance. More integrative or mandated collaboration may lean more heavily on contract to drive collaborative behaviour. Conclusion: As the first realist review of inter-organisational collaborations in healthcare as an intervention for improvement, this review provides actionable evidence for policymakers and implementers, enhancing understanding of mechanisms underlying the functioning and performing of inter-organisational collaborations, as well as how to configure the context to aid success. Next steps in this research will test the results against further case studies and primary data to produce a further refined theory