Coresponding Author: Nikos Polyzos, Associate Professor of Health Service Management, Former Secretary General of Ministry of Health

Abstract Purpose: The purpose of this study was to access the performance of 117 Greek National Health System (NHS) hospitals for the year 2011, to compare the findings with the results from similar studies of the previous years (2009 and 2010) and to investigate the changes during the last three years of financial crisis. Method: An input-oriented Data Envelopment Analysis was used to measure three indicators, technical, pure technical and scale efficiency indicators. Data was collected from the reports of the web-based facility (ESY.net) which was developed by the General Secretary of Ministry of Health and Social Solidarity. The input variables were the number of physicians, the number of nurses and other personnel, the number of beds and expenditures of every hospital. The output variables were the number of inpatient and outpatient visits. Hospitals were categorized into three size groups. Results: Between the years 2009-2011, all hospitals, especially middle-sized hospitals showed performance improvement on all three indicators. Specific problems were noticed mainly in large-sized hospitals. The technical efficiency of Large-sized hospitals was estimated at 80%, of Middle-sized hospitals at 82% and of Small hospitals-Health Care Centres at 89%. Pure technical and scale efficiency varied between satisfactory levels throughout the study period. Conclusion: Comparing the 2009-2011 data, an improvement of technical efficiency in NHS hospitals has been achieved up to 100%, mainly in the middle-sized hospitals. Specifically, an increase of best practice hospitals has been noted, especially in the middle and small-sized hospitals, when certain units were added the technical efficiency reached over 80%. The consequences of the spending-cuts and the constant reforms appear to have a positive effect on hospitals' efficiency. Hippokratia 2012, 16, 4: 350-35

Análise do desempenho de hospitais públicos e filantrópicos brasileiros

This paper presents the results of a research that aimed at identifying optimal performance standards of Brazilian public and philanthropic hospitals. In order to carry out the analysis, a model based on Data Envelopment Analysis (DEA) was developed. We collected financial data from hospitals’ financial statements available on the internet, as well as operational data from the Information Technology Department of the Brazilian Public Health Care System – SUS (DATASUS). Data from 18 hospitals from 2007 to 2011 were analyzed. Our DEA model used both operational and financial indicators (variables). In order to develop this model, two indicators were considered inputs: Values (in Brazilian Reais) of Fixed Assets and Planned Capacity. On the other hand, the following indicators were considered outputs: Net Margin, Return on Assets and Institutional Mortality Rate. As regards the proposed model, there were five hospitals with optimal performance and four hospitals were considered inefficient, upon the analysis of the variables, considering the analyzed period. Analysis of the weights indicated the most relevant variables for determining efficiency and scale variable values, which is an important tool to aid the decision-making by hospital managers. Finally, the scale variables determined the returns on production, indicating that 14 hospitals work with scale diseconomies. This may indicate inefficiency in the resource management of the Brazilian public health-care system, by analyzing this set of proposed variables.Este artigo apresenta os resultados de uma pesquisa que visou identificar padrões ótimos de desempenho empregados por hospitais públicos e filantrópicos brasileiros. Para realizar tal análise, desenvolveu-se um modelo com base na análise envoltória de dados (Data Envelopment Analysis – DEA). Foram coletados dados financeiros a partir das demonstrações financeiras dos hospitais disponíveis na Internet, assim como dados operacionais coletados por meio do Departamento de Informática do Sistema Único de Saúde (DATASUS). No total, foram analisados dados de 18 hospitais entre os anos de 2007 e 2011. O modelo DEA desenvolvido considerou simultaneamente indicadores (variáveis) operacionais e financeiros. No desenvolvimento desse modelo, foram considerados como inputs (entradas) os seguintes indicadores: Valor (em R$) empregado no Imobilizado e Capacidade Planejada. Por sua vez, foram utilizados como outputs (saídas) os seguintes indicadores: Margem Líquida, Retorno Sobre o Ativo e Taxa de Mortalidade Institucional. No que tange ao modelo proposto, considerando o período analisado, cinco hospitais apresentaram um desempenho ótimo e quatro hospitais foram considerados ineficientes ao analisar o conjunto de variáveis utilizadas. Por meio da análise dos pesos foram identificadas as variáveis mais relevantes para a determinação da eficiência e dos valores da Variável de Escala, o que constitui uma importante ferramenta no auxílio da tomada de decisão por parte dos gestores hospitalares. Por fim, as variáveis de escala determinaram os retornos de produção, indicando que 14 hospitais trabalham com deseconomias de escala. Isto pode indicar uma ineficiência na gestão dos recursos na saúde pública brasileira, ao menos analisando o conjunto de variáveis propostas

Rendimiento hospitalario y benchmarking en España

La tarea de medir el rendimiento de los centros hospitalarios y elaborar un ranking de los mismos a partir de este criterio, constituye uno de los campos donde los investigadores necesitan modelos que tengan en cuenta la distinta naturaleza de las unidades de decisión a comparar. Este trabajo, en primer lugar, proporciona una revisión y crítica de varios enfoques que pretenden la consecución del anterior objetivo, centrándose especialmente en las medidas de productividad y eficiencia. Asimismo, revela que los resultados de estudios relativos al funcionamiento de los hospitales parecen ser muy sensibles a la elección de variables, la estructura del modelo, suposiciones subyacentes y metodología empleada. De este modo, esta comunicación propone la utilización de un análisis envolvente de datos (DEA) perfeccionado: el método de eficiencia cruzada (X-DEA), al objeto de realizar un ranking de 756 hospitales españoles. En el mismo se efectúa un análisis detallado teniendo en cuenta la tipología del hospital. En este trabajo también se propone un método para determinar las puntuaciones de cada hospital en materia de eficiencia identificando unos factores críticos de rendimiento, de forma que puedan ser empleados como una herramienta para la gestión hospitalaria al objeto de establecer programas de mejora en la posición de cada hospital dentro del ranking del conjunto de los mismos. El tema objeto de esta investigación cobra especial relevancia actualmente en España donde la situación económica está llevando a los responsables políticos a recortar gastos en la mayoría de las actividades del sector público, siendo el sanitario uno de los ámbitos donde este tipo de políticas está generando mayores controversia

Restructuring the hospital sector in Greece in order to improve effectiveness and efficiency

Το άρθρο αυτό παρουσιάζει τη μελέτη πουαφορούσε στην αναδιάρθρωση του ΕλληνικούΝοσοκομειακού Τομέα Σκοπός της μελέτηςήταν να προτείνει ένα νέο πρότυπο οργάνω-σης των νοσοκομείων σε ομάδες με βάση τηναναμόρφωση της επείγουσας φροντίδας και τηδιαχείριση των πέντε κύριων χρόνιων νοση-μάτων (Οξύ Έμφραγμα του Μυοκαρδίου, Αγγειακό Εγκεφαλικό Επεισόδιο, Καρκίνος, Σακχαρώδης Διαβήτης και Χρόνια ΑποφρακτικήΠνευμονοπάθεια). Στο πλαίσιο της βελτίωσηςτης αποτελεσματικότητας και αποδοτικότηταςτου νοσοκομειακού τομέα παρουσιάστηκανπροτάσεις όπως η συνεργασία ιδιωτικού καιδημόσιου τομέα καθώς και μέτρα περιορισμούτων δαπανών. Η αναδιάρθρωση του δημόσιουνοσοκομειακού τομέα στηρίχθηκε σε έξι δια-κριτά κριτήρια τα οποία συμπεριελάμβαναν τοπληθυσμιακό κριτήριο, τη συγκέντρωση τουπληθυσμού, το μέγεθος του νοσοκομείου, τηνπαλαιότητα των υποδομών, την ένταση της αξιοποίησης της νοσοκομειακής υποδομής και τηνοικονομική αποδοτικότητα του νοσοκομείου.This paper discusses the study focused on thereform of Greek Hospital Sector, also known as“hospital mergers”. The aim of the study was topropose a new pattern of organizing hospitalsin groups based on the reform of emergencycare and the management of five main chronicdiseases (AMI, Stroke, Cancer, Diabetes Mellitusand COPD). The proposals in general concern thecreation of a national network of health servicesprovided mainly by primary healthcare units andthe largest hospitals of the groups in each healthregion. In the context of improving the hospitalsector efficiency, ways of collaborations betweenprivate and public sector and expenditurecontainment measures are presented. Therestructuring of the public hospital sector reliedon six specific criteria including the populationcriterion, catchment area, hospital size,infrastructure age, utilization of hospital facilitiesand cost. Due to its nature, the study was exposedto various factors such as the diversity of actorsbeing involved, collection and compilation of therelevant data in a short term of three months, lastminute adjustments and the variety of audience

Restructuring the hospital sector in Greece in order to improve effectiveness and efficiency

Το άρθρο αυτό παρουσιάζει τη μελέτη πουαφορούσε στην αναδιάρθρωση του ΕλληνικούΝοσοκομειακού Τομέα Σκοπός της μελέτηςήταν να προτείνει ένα νέο πρότυπο οργάνω-σης των νοσοκομείων σε ομάδες με βάση τηναναμόρφωση της επείγουσας φροντίδας και τηδιαχείριση των πέντε κύριων χρόνιων νοση-μάτων (Οξύ Έμφραγμα του Μυοκαρδίου, Αγγειακό Εγκεφαλικό Επεισόδιο, Καρκίνος, Σακχαρώδης Διαβήτης και Χρόνια ΑποφρακτικήΠνευμονοπάθεια). Στο πλαίσιο της βελτίωσηςτης αποτελεσματικότητας και αποδοτικότηταςτου νοσοκομειακού τομέα παρουσιάστηκανπροτάσεις όπως η συνεργασία ιδιωτικού καιδημόσιου τομέα καθώς και μέτρα περιορισμούτων δαπανών. Η αναδιάρθρωση του δημόσιουνοσοκομειακού τομέα στηρίχθηκε σε έξι δια-κριτά κριτήρια τα οποία συμπεριελάμβαναν τοπληθυσμιακό κριτήριο, τη συγκέντρωση τουπληθυσμού, το μέγεθος του νοσοκομείου, τηνπαλαιότητα των υποδομών, την ένταση της αξιοποίησης της νοσοκομειακής υποδομής και τηνοικονομική αποδοτικότητα του νοσοκομείου.This paper discusses the study focused on thereform of Greek Hospital Sector, also known as“hospital mergers”. The aim of the study was topropose a new pattern of organizing hospitalsin groups based on the reform of emergencycare and the management of five main chronicdiseases (AMI, Stroke, Cancer, Diabetes Mellitusand COPD). The proposals in general concern thecreation of a national network of health servicesprovided mainly by primary healthcare units andthe largest hospitals of the groups in each healthregion. In the context of improving the hospitalsector efficiency, ways of collaborations betweenprivate and public sector and expenditurecontainment measures are presented. Therestructuring of the public hospital sector reliedon six specific criteria including the populationcriterion, catchment area, hospital size,infrastructure age, utilization of hospital facilitiesand cost. Due to its nature, the study was exposedto various factors such as the diversity of actorsbeing involved, collection and compilation of therelevant data in a short term of three months, lastminute adjustments and the variety of audience

echnical efficiency of teaching hospitals in Iran: the use of Stochastic Frontier Analysis, 1999–2011

Background: Hospitals are highly resource-dependent settings, which spend a large proportion of healthcare financial resources. The analysis of hospital efficiency can provide insight into how scarce resources are used to create health values. This study examines the Technical Efficiency (TE) of 12 teaching hospitals affiliated with Tehran University of Medical Sciences (TUMS) between 1999 and 2011. Methods: The Stochastic Frontier Analysis (SFA) method was applied to estimate the efficiency of TUMS hospitals. A best function, referred to as output and input parameters, was calculated for the hospitals. Number of medical doctors, nurses, and other personnel, active beds, and outpatient admissions were considered as the input variables and number of inpatient admissions as an output variable. Results: The mean level of TE was 59% (ranging from 22 to 81%). During the study period the efficiency increased from 61 to 71%. Outpatient admission, other personnel and medical doctors significantly and positively affected the production ( P < 0.05). Concerning the Constant Return to Scale (CRS), an optimal production scale was found, implying that the productions of the hospitals were approximately constant. Conclusion: Findings of this study show a remarkable waste of resources in the TUMS hospital during the decade considered. This warrants policy-makers and top management in TUMS to consider steps to improve the financial management of the university hospitals

Assessing the queuing process using data envelopment analysis:an application in health centres

Queuing is one of the very important criteria for assessing the performance and efficiency of any service industry, including healthcare. Data Envelopment Analysis (DEA) is one of the most widely-used techniques for performance measurement in healthcare. However, no queue management application has been reported in the health-related DEA literature. Most of the studies regarding patient flow systems had the objective of improving an already existing Appointment System. The current study presents a novel application of DEA for assessing the queuing process at an Outpatients’ department of a large public hospital in a developing country where appointment systems do not exist. The main aim of the current study is to demonstrate the usefulness of DEA modelling in the evaluation of a queue system. The patient flow pathway considered for this study consists of two stages; consultation with a doctor and pharmacy. The DEA results indicated that waiting times and other related queuing variables included need considerable minimisation at both stages

Data Envelopment Analysis for Relative Efficiency Measurement of Chinese Hospitals: A Systematic Review

The purpose was to explore the gap between China and the international world in efficiency measurement of hospitals with Data Envelopment Analysis, and to improve the standardization of healthcare efficiency measurement in China. A systematic review was conducted using appropriate search strategies. Studies were included containing DEA approaches regarding general hospital efficiency, published in international literature and in both Chinese and English about Chinese hospitals from January 2004 to October 2014. The results showed that statistical significances were found in indicators such as number of DMUs, percentage of allocative efficiency studies, ratio of studies with multiple years, number of studies with monetary indicators in input and output sets, etc. The statistical insignificance in some indicators such as the number of input and output indicators were also found among China, Europe, USA and others. Some problems were found in current DEA-based hospital efficiency studies in China, such as inappropriate selection of input-output indicators, no bias-correction on efficiency scores, etc. The standardization of DEA methods applied in China’s hospital efficiency research needs to be improved. Chinese researchers should pay more attention to latest international research findings, so as to keep pace with the cutting edge hospital efficiency research

Assessing frontline HIV service provider efficiency using data envelopment analysis: a case study of Philippine social hygiene clinics (SHCs)

AbstractBackground:Globally, local and frontline HIV service delivery units have been deployed to halt the HIV epidemic.However, with the limited resources, there is a need to understand how these units can deliver their optimumoutputs/outcomes efficiently given the inputs. This study aims to determine the efficiency of the social hygieneclinics (SHC) in the Philippines as well as to determine the association of the meta-predictor to the efficiencies.Methods:In determining efficiency, we used the variables from two data sources namely the 2012 Philippine HIVCosting study and 2011 Integrated HIV Behavioral and Serologic Surveillance, as inputs and outputs, respectively.Various data management protocols and initial assumptions in data matching, imputation and variable selection,were used to create the final dataset with 9 SHCs. We used data envelopment analysis (DEA) to analyse theefficiency, while variations in efficiencies were analysed using Tobit regression with area-specific meta-predictors.Results:There were potentially inefficient use of limited resources among sampled SHC in both aggregate and keypopulations. Tobit regression results indicated that income was positively associated with efficiency, while HIVprevalence was negatively associated with the efficiency variations among the SHCs.Conclusions:We were able to determine the inefficiently performing SHCs in the Philippines. Though currentlyinefficient, these SHCs may adjust their inputs and outputs to become efficient in the future. While there wereindications of income and HIV prevalence to be associated with the efficiency variations, the results of this casestudy may only be limited in generalisability, thus further studies are warranted