Performance and Congestion Analysis of the Portuguese Hospital Services

The health care services have been characterised by a growing demand by the citizens leading to the need of more and more resources. Population aging, new pathologies and drugs as well as new treatments are some of the major factors for this. However, in hospitals, for example, consumption of a large number of inputs frequently has not corresponded to the production of the same or more proportion of outputs. Sometimes, the outputs even decline with the increase of inputs due to the influence of the congestion effect on efficiency. The heavy burden of the health sector on the state budget brings about the interest of research over its efficiency. This paper aims to assess the performance of the Portuguese hospitals and particularly the contribution of the congestion effect. We use the non-parametric technique of data envelopment analysis (DEA) for this purpose and a double-bootstrap procedure to take into account the influence of operational environment on efficiency. Afterwards, by comparing three different approaches we determine the importance of congestion in efficiency measurement and discuss its computation methodologically. The results suggest significant levels of inefficiency in 68 major Portuguese hospitals for the year 2005 and more than half of them were found to be congested.Hospitals; congestion; efficiency; DEA; Portugal

Measuring the total factor productivity of the portuguese water and sewerage services

A reduzida produtividade dos serviços de água e de saneamento tem justificado as dificuldades que os operadores destas entidades têm em melhorar a qualidade de serviço e em aumentar o seu grau de cobertura. Melhorar a produtividade constitui, portanto, uma das melhores formas de proteger os interesses dos consumidores. Este artigo apresenta um estudo empírico que determina a produtividade total dos fatores dos serviços de água e de saneamento portugueses. Os resultados obtidos são aqui apresentados e discutidos, evidenciando a reduzida produtividade deste setor em Portugal e realçando que os operadores privados e mais rurais são aqueles que apresentam maiores valores de produtividade.The poor productivity in the water and sewerage services (WSS) has been a justification for the difficulties these entities face when trying to expand the service coverage, enhance the quality of service and reduce the cost of service. Improving the WSS productivity is, therefore, one of the best ways of protecting the customer's interests. This article presents an empirical study that computes the total factor productivity (TFP). It stresses the results obtained and discusses them, proving the low productivity of this sector in Portugal and pointing to the conclusion that the private and the rural WSS are the most productive ones

Revisiting the strengths and limitations of regulatory contracts in infrastructure industries

This paper evaluates regulation by contract in public-private partnerships (PPPs) in infrastructure services. Although the benefits of competition for the market and of regulatory contracts are widely acknowledged, the literature indentifies several failures in their design. These ‘flaws’ are present in both developed and developing countries and arise in all types of contracts. This study analyses both short and long term contracts, focusing on purely contractual PPPs and institutionalized PPPs (mixed companies). The evidence suggests that for all kinds of contracts, the major problems tend to arise in the preparation of public tender documents: the ‘best’ bidder is not often the winner. The likely results include redistribution in favor of the private partner, weak incentives for high performance, and renegotiation of contracts. Moreover, risks are not allocated correctly nor is effective monitoring ensured. This review of contract procedures and design allows us to draw several implications for policy-makers and to present suggestions and recommendations for improving regulatory contracts.regulation by contract; bidding documents; contract design; risk; monitoring

Comparing alternative instruments to measure service quality in higher education

The purpose of this work is to examine the performance of five alternative measures of service quality in the high education sector – SERVQUAL (Service Quality), Importance-weighted SERVQUAL, SERVPERF (Service Performance), Importance-weighted SERVPERF and HedPERF (Higher Education Performance). We aim at determining which instrument has the superior measurement capability. Data were collected by means of a structured questionnaire containing perception items enhanced from the SERVPERF and HEdPERF scales and expectation items from the SERVQUAL scale, both modified to fit into the higher education sector. The first draft of the questionnaire was subject to a pilot testing through a focus group and an expert evaluation. Data were gathered from a 360 students’ sample of a Portuguese university in Lisbon. Scales were compared in terms of unidimensionality, reliability, validity and explained variance. Managerial conclusions were also drawn.service quality scales; higher education; reliability

Quantitative studies of water and sanitation utilities: a literature survey

This paper performs a literature update of quantitative studies of water and sanitation services (WSS). There are 190 studies which use cost or production functions to evaluate the performance of WSS utilities. The studies examine (1) the scale, scope or density economies of utilities in a particular country or region, (2) the influence of ownership on efficiency, (3) the existence and power of incentives associated with different governance systems (including external regulation), and (4) performance assessment (benchmarking). In addition, this paper presents some patterns regarding quantitative methods adopted over time and major trends in results.benchmarking; water and sanitation utilities; literature survey

Comparing Airport regulation in Europe: Is there need for a European Regulator?

This paper provides an overview of how the major airports are regulated in Europe. In order to eliminate the potential of airports to exercise market power and protect the public interest, it has become increasingly necessary to set a common regulatory framework. We intend to discuss the need of a single regulator in Europe to monitor or establish the quality of service and the charges practiced by the airports, to ensure cost-relatedness, transparency and non-discrimination. The existing regulatory approaches regarding aeronautical charges and their economic implications are also analyzed. We propose the creation of a European Observatory for this sector.airports, economic regulation, European Observatory

A meta-regression analysis of benchmarking studies on water utilities market structure

This paper updates the literature on water utility benchmarking studies carried out worldwide, focusing on scale and scope economies. Using meta-regression analysis, the study investigates which variables from published studies influence these economies. Our analysis led to several conclusions. The results indicate that there is a higher probability of finding diseconomies of scale and scope in large utilities; however, only the results for scale economies are significant. Diseconomies of scale and scope are more likely to be found in publicly-owned utilities than when the ownership is mostly private; as would be expected, multi-utilities are more likely to have scale and scope economies.economies of scale; economies of scope; meta-regression analysis; water utilities

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

Efficiency of the Portuguese metros. is it different from other European metros?

This research analyses the performance of Portuguese metros in the European context. By means of two non-parametric benchmarking techniques, respectively performance indicators and data envelopment analysis, we compute the efficiency of 37 European metros. In order to provide statistical inference and robustness to our results we apply the recent technique of bootstrap. We also use the partial frontiers (order-m) to identify outliers and the double bootstrap procedure in a second stage methodology to take into account the influence of the operational environment. The results show important levels of inefficiency both in the Portuguese metros and in other European metros.Metro; Efficiency; Portugal; Performance Indicator; Data Envelopment Analysis