Fatores determinantes da eficiência do setor bancário em Portugal: uma aplicação através de modelos de regressão fracional

The participation in the Euro area and the current financial crisis substantially conditioned the development of the Portuguese banking industry, for which is expected a continuous fall in income and a growing competitive pressure, improving the need to look carefully to issues as efficiency as an essential survival factor. Efficiency indicators of the main banks operating in Portugal were measured through DEA methodology. The application of two-stage models allowed circumventing the usual problems inherent to the coexistence of the production and intermediation approaches. The application of regression for proportions, more appropriate than traditional linear and Tobit regressions, to deal with the fractional nature of the DEA scores, allowed the identification of efficiency determinant factors for the main banks operating in Portugal. The fractional regression models demonstrate evidence of improved specification comparing to traditional regression models. The variables that appear to major influence on overall efficiency are internationalization, size and type of ownership of capital.info:eu-repo/semantics/publishedVersio

The optimum size of the portuguese public hospital

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and EconomicsIn a context of intensive structural reform, this paper estimates optimum bed-sizes for the Portuguese public hospitals. Considering costs and production data for the period 2003-2006, we estimate a production-theoretic quadratic cost-function, adjusted to better describe the underlying technology. Room for short-run scale-economies exploitation is found, but long-run scale-diseconomies are unambiguous. In light of these predictions and of an optimum around 233 fully-occupied beds, there is mixed evidence of potential gains from two hospital mergers and from one of the forthcoming constructions of public hospitals. The results are expected to contribute to shape the hospital network in a cost-efficient manner

A step forward on order-α robust nonparametric method: inclusion of weight restrictions, convexity and non-variable returns to scale

Partial frontiers have been recently developed in order to overcome several drawbacks of the traditional nonparametric techniques. These robust frontier (order-a and order-m) methods avoid the curse of dimensionality, are less sensitive to outliers and extreme data and may include direct environmental information in the model. Nonetheless, the disadvantages of these partial frontier-based methods according to the formulation proposed in the literature are that they do not allow weight restrictions or non-variable returns to scale technology. The procedure here proposed is an extension of the traditional order-a method, allowing the estimation of an empirical convex a-level, assuming also some additional constraints, such as the virtual weight restrictions and non-variable returns to scale. In the particular case of nonconvex attainable sets, unrestricted formulations and variable returns to scale assumption, the proposed procedure returns the same results as the standard order-ainfo:eu-repo/semantics/publishedVersio

Variations in medical practices: identification, causes and consequences

ABSTRACT - Background: Unwarranted variations in healthcare are thought to describe healthcare provision beyond what is clinically necessary and without additional clinical benefits raising concerns on quality, equity and efficiency of healthcare systems. This thesis aims to 1) identify geographical variations in Portugal and research on the potential of identification of geographical variations to optimize care; 2) understand how hospital characteristics affect provision of healthcare; 3) use stochastic frontier analysis to estimate innefficiencies resulting from non-optimal care and compare hospitals. Methods: Firstly, nine healthcare activities performed in Portuguese National Health Service hospitals between 2002 and 2009 were analyzed according to area of residence of patients. Secondly, low-risk c-sections geographical variation and excess consumption was compared between five European countries. Thirdly, avoidable c-section rates are computed for Portuguese hospitals and hospital characteristics are studied to understand how they affect those rates. Fourthly, advantages and drawbacks of stochastic frontier analysis method for healthcare efficiency measurement are studied. Fifthly, stochastic frontier analysis is applied to healthcare activity of four European countries to compare hospital efficiency levels within and between countries. Results: Variations in medical practice exist in Portugal but their magnitude and evolution varies with the procedure in analysis. Portugal’s performance on international comparisons depend on the scope of the procedure. Availability of resources affect medical practice in a modest extent. SFA is a good analytical tool to compare hospital’s efficiency levels. Efficiency levels of Portuguese hospitals are not homogenous even though inefficiencies can be attributed to random shocks out of hospital control. Conclusions: The identification of variations in medical practice provides signals on where clinical harmonization is required while international comparisons provide benchmarking that flags improvement opportunities. Resources affect medical practice in a modest extent and so, policies on resource affection may result in modest results. Policies on medical incentives towards an objective may be more effective than common policies on resource reduction. More than looking towards an optimal threshold of care we shall guarantee that care is provided to who can benefit from it and look towards clinical outcomes optimization.RESUMO - Contexto: Identificar variações não desejadas da prática médica é identificar cuidados de saúde prestados além do que é clinicamente necessário e sem benefício clínico adicional, com implicações ao nível da qualidade, equidade e eficiência do sistema de saúde. Esta tese tem como objectivos: 1) identificar variações geográficas da prática médica em Portugal e potenciar essa identificação para optimização dos cuidados prestados; 2) compreender como é que as características dos hospitais afectam os cuidados prestados; 3) utilizar a análise de fronteira estocástica no cálculo da ineficiência gerada pela não-optimização dos cuidados e comparar hospitais. Métodos: Primeiro foram analisados nove procedimentos realizados nos hospitais do Serviço Nacional de Saúde entre 2002 e 2009 tendo em consideração o local de residência dos doentes. De seguida, considerando apenas as cesarianas de baixo risco foi analisado para além das variações geográficas, a realização em excesso deste tipo de procedimentos e comparados os resultados de cinco países europeus. Seguiu-se uma análise às taxas de cesarianas evitáveis e de que forma as características dos hospitais se relacionam com estas. Por fim, foram estudadas as vantagens e limitações da análise de fronteira estocástica no cálculo da eficiência hospitalar e aplicou-se este método no cálculo da eficiência dos hospitais de quatro países europeus. Resultados: Em Portugal, existem variações da prática médica embora a sua magnitude e evolução varie conforme o procedimento em análise. O desempenho de Portugal em comparação com outros países europeus também depende do procedimento e da própria definição do âmbito do procedimento. A disponibilidade de recursos afecta a prática médica de forma modesta. A análise de fronteira estocástica é uma boa ferramenta para estimar e comparar níveis de eficiência dos hospitais. Em Portugal, os níveis de eficiência não são homogéneos entre hospitais embora as ineficiências possam ser atribuídas a factores externos e aleatórios fora do controlo dos hospitais. Conclusões: A identificação das variações da prática médica indica as áreas onde algum tipo de harmonização clínica é necessária e as comparações internacionais identificam áreas com potencial de melhoria. A disponibilidade de recursos afecta a prática médica de forma modesta pelo que políticas de saúde de redução de recursos poderão, também elas, ter resultados modestos. Políticas de saúde com incentivos dirigidos aos médicos poderão ser mais eficientes na homogeneização da prática médica. Mais do que definir um nível de actividade óptimo urge garantir que os cuidados de saúde são dirigidos a quem beneficia deles optimizando os resultados clínicos

Public-private partnerships in health care services: Do they outperform public hospitals regarding quality and access? Evidence from Portugal

Public-private partnerships (PPPs) are widely spread long-term arrangements between governments and strategic private partner(s). One of their objectives is to reduce the financial pressure on the public treasury with regard to new investments. PPPs have been employed within the health care sector which, in turn, carries a huge social burden. In Portugal, for instance, PPPs in health care concern bundling hospital infrastructure and clinical services management. Notwithstanding the need to ensure sustainability and efficient use of hospital resources, it is clearly compulsory to guarantee that patients receive appropriate and timely care, with maximum security, and equitable manner. Still, little or even no attention has been paid in the literature to the clinical response capacity of PPP hospitals and to the populism arguing that these entities have a lower social performance than typical public hospitals. This study uses robust benchmarking methodologies alongside recent data about Portuguese hospitals (FY2012-FY2017) to demystify this idea and to demonstrate that, actually, PPP hospitals can deliver health care services with social performance levels at least as good as public hospitals.info:eu-repo/semantics/publishedVersio

Public-private partnerships in health care services: Do they outperform public hospitals regarding quality and access? Evidence from Portugal

Public-private partnerships (PPPs) are widely spread long-term arrangements between governments and strategic private partner(s). One of their objectives is to reduce the financial pressure on the public treasury with regard to new investments. PPPs have been employed within the health care sector which, in turn, carries a huge social burden. In Portugal, for instance, PPPs in health care concern bundling hospital infrastructure and clinical services management. Notwithstanding the need to ensure sustainability and efficient use of hospital resources, it is clearly compulsory to guarantee that patients receive appropriate and timely care, with maximum security, and equitable manner. Still, little or even no attention has been paid in the literature to the clinical response capacity of PPP hospitals and to the populism arguing that these entities have a lower social performance than typical public hospitals. This study uses robust benchmarking methodologies alongside recent data about Portuguese hospitals (FY2012-FY2017) to demystify this idea and to demonstrate that, actually, PPP hospitals can deliver health care services with social performance levels at least as good as public hospitals.info:eu-repo/semantics/publishedVersio

Evaluating Portuguese Public Hospitals Performance: Any Difference before and during COVID-19?

COVID-19 is a well-known respiratory disease that has spread worldwide since January 2020, causing many deaths and massive pressure on health systems. This pandemic’s appearance compromised health service sustainability and quality as many procedures were postponed or canceled, with an expected increase of adverse events like nosocomial infections, in-hospital deaths, and the worsening of the patient’s clinical status. For instance, the year 2020 featured an increase in undesirable results in Portugal: a rise of 10% in delayed first medical appointments, 0.02% in avoidable bloodstream infections, and more than 100 post-operative pulmonary embolisms and septicemia cases per 100,000 inpatients. Therefore, assessing whether the healthcare providers’ performance has changed is paramount. In this case, we evaluated public hospitals in Portugal. To this end, we developed a network data envelopment analysis model relating to efficiency and effectiveness. We observed consistent drops in efficiency when the pandemic started, followed by a recovery to levels above the pre-pandemic ones. Regarding effectiveness, we observed a positive trend during the evaluated period. We conclude that, apart from the great resilience of public healthcare providers, the Portuguese state was unprepared for a pandemic like COVID-19, but still the actions taken (including massive vaccination) were beneficial.info:eu-repo/semantics/publishedVersio

Transaction costs in healthcare: empirical evidence from Portuguese hospitals

Transaction Cost Economics has been used in the healthcare context to discuss the make-or-buy dichotomy, focusing on minimizing production or governance costs, respectively. Nevertheless, it is important to recognize that there are other relevant costs, which influence these decisions in health care. Thus, the purpose of this research project was to study such additional variables which may significantly influence the dynamics of transaction costs in hospitals. Semi-structured interviewing was used to collect the data, complemented by some document analysis and observation in the visits made to the hospitals studied. The interviews were conducted during a period of three months, with directors and administrators of four Portuguese hospitals. A deeper study was developed in one of the hospitals where it was possible to get information from additional interviews and documents. Two important findings should be highlighted. Firstly, the internal transaction costs derived from the hospital’s own internal contracting process which generates retention costs of medical personnel and costs of control of the internal contract itself. Secondly, they were studied the intangible costs, particularly those related to the decision of carrying out a process that could deteriorate the patient’s health or her/his critical situation, making the total cost, including treatment and possible re-hospitalizations higher than the cost of having treated the patient internally since the initial cost was considered greater than treating the patient outside hospital facilities. These variables should be considered when studying or using TCE in hospitals, complementing and extending the traditional framework as it is discussed here.- (undefined