Performance of hospital services in Ontario: DEA with truncated regression approach

In this work, we analyze production performance of hospital services in Ontario (Canada), by investigating its key determinants. Using data for the years 2003 and 2006, we follow the two-stage approach of Simar and Wilson (2007) [76]. Specifically, we use Data Envelopment Analysis (DEA) at the first stage to estimate efficiency scores and then use truncated regression estimation with double-bootstrap to test the significance of explanatory variables. We also examine distributions of efficiency across geographic locations, size and teaching status. We find that several organizational factors such as occupancy rate, rate of unit-producing personnel, outpatient–inpatient ratio, case-mix index, geographic locations, size and teaching status are significant determinants of efficiency.

[1]  Antreas D. Athanassopoulos,et al.  Assessing the technical and allocative efficiency of hospital operations in Greece and its resource allocation implications , 2001, Eur. J. Oper. Res..

[2]  Jeffrey A. Alexander,et al.  Measuring Comparative Hospital Performance , 2002, Journal of healthcare management / American College of Healthcare Executives.

[3]  Qi Li,et al.  Nonparametric testing of closeness between two unknown distribution functions , 2009 .

[4]  Do Nonprofit Hospitals Exercise Market Power , 1998 .

[5]  Martin Marshall,et al.  Impact of star performance ratings in English acute hospital trusts , 2005, Journal of health services research & policy.

[6]  Rowena Jacobs,et al.  Measuring Efficiency in Health Care: Analytic Techniques and Health Policy , 2006 .

[7]  Diane Doran,et al.  Nurse Staffing Models, Nursing Hours, and Patient Safety Outcomes , 2004, The Journal of nursing administration.

[8]  P. W. Wilson,et al.  TESTING RESTRICTIONS IN NONPARAMETRIC EFFICIENCY MODELS , 2001 .

[9]  Léopold Simar,et al.  How to measure the impact of environmental factors in a nonparametric production model , 2012, Eur. J. Oper. Res..

[10]  Yasar A. Ozcan,et al.  Health Care Benchmarking and Performance Evaluation: An Assessment Using Data Envelopment Analysis (DEA) , 2007 .

[11]  P. W. Wilson,et al.  Estimation and inference in two-stage, semi-parametric models of production processes , 2007 .

[12]  K. Lohr,et al.  Second-opinion programs: beyond cost-benefit analyses. , 1982, Medical care.

[13]  Abraham Charnes,et al.  Measuring the efficiency of decision making units , 1978 .

[14]  Jos L. T. Blank,et al.  Environmental factors and productivity on Dutch hospitals: a semi-parametric approach , 2009, Health care management science.

[15]  M. Farrell The Measurement of Productive Efficiency , 1957 .

[16]  Qi Li,et al.  Nonparametric testing the similarity of two unknown density functions: local power and bootstrap analysis , 1999 .

[17]  Peter T. Ward,et al.  The effect of location, strategy, and operations technology on hospital performance , 2002 .

[18]  J. Colin Glass,et al.  Rationalizing Northern Ireland Hospital Services Towards Larger Providers: Best-Practice Efficiency Studies and Current Policy , 1999 .

[19]  Mette Asmild,et al.  Rationalising inefficiency: Staff utilisation in branches of a large Canadian bank , 2013 .

[20]  M. Monette Hospital readmission rates under the microscope , 2012, Canadian Medical Association Journal.

[21]  D. Niakas,et al.  Balancing efficiency of health services and equity of access in remote areas in Greece. , 2006, Health policy.

[22]  W. W. Young,et al.  The Measurement of Hospital Case Mix , 1982, Medical care.

[23]  D Nath,et al.  The Technical Efficiency of Hospitals under a Single Payer System: The Case of Ontario Community Hospitals , 2001, Health care management science.

[24]  J. L. Navarro-Espigares,et al.  Efficiency and quality in health services: a crucial link , 2011 .

[25]  A. U.S.,et al.  Measuring the efficiency of decision making units , 2003 .

[26]  R. Fetter,et al.  Case mix definition by diagnosis-related groups. , 1980, Medical care.

[27]  Yasar A. Ozcan,et al.  Data Envelopment Analysis Comparison of Hospital Efficiency and Quality , 2008, Journal of Medical Systems.

[28]  B. Hollingsworth Non-Parametric and Parametric Applications Measuring Efficiency in Health Care , 2003, Health care management science.

[29]  Paul W. Wilson,et al.  Variation In Inefficiency Among Us Hospitals , 1998 .

[30]  R. Russell,et al.  Human Capital and Convergence: A Production-Frontier Approach , 2005 .

[31]  A. Charnes,et al.  Data Envelopment Analysis Theory, Methodology and Applications , 1995 .

[32]  Gary J Young,et al.  Competition among hospitals for HMO business: effect of price and nonprice attributes. , 2002, Health services research.

[33]  A. Worthington,et al.  Frontier Efficiency Measurement in Health Care: A Review of Empirical Techniques and Selected Applications , 2004, Medical care research and review : MCRR.

[34]  Gary D. Ferrier,et al.  Rural hospital performance and its correlates , 1996 .

[35]  R. R. Russell,et al.  Technological Change, Technological Catch-up, and Capital Deepening: Relative Contributions to Growth and Convergence , 2002 .

[36]  Is there a role for the small rural hospital? , 1990, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[37]  A. Laporte,et al.  Analysis of productivity, efficiency and technological changes in hospital services in Ontario: how does case-mix matter? , 2014 .

[38]  Michael D. Rosko,et al.  What Have We Learned From the Application of Stochastic Frontier Analysis to U.S. Hospitals? , 2011, Medical care research and review : MCRR.

[39]  Joe Zhu,et al.  Measuring performance of two-stage network structures by DEA: A review and future perspective , 2010 .

[40]  F Champagne,et al.  A performance assessment framework for hospitals: the WHO regional office for Europe PATH project. , 2005, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[41]  John S. Liu,et al.  Data envelopment analysis 1978-2010: A citation-based literature survey , 2013 .

[42]  C. Sicotte,et al.  Teaching hospital performance: towards a community of shared values? , 2014, Social science & medicine.

[43]  B. Silverman Density estimation for statistics and data analysis , 1986 .

[44]  J. Krüger The global trends of total factor productivity: evidence from the nonparametric Malmquist index approach , 2003 .

[45]  Gwyn Bevan,et al.  Modelling hospital costs to produce evidence for policies that promote equity and efficiency , 2008, Eur. J. Oper. Res..

[46]  J. Colin Glass,et al.  Best‐Practice Measures Of Resource Utilization For Hospitals: A Useful Complement In Performance Assessment , 1999 .

[47]  Lawrence M. Seiford,et al.  Recent developments in dea : the mathematical programming approach to frontier analysis , 1990 .

[48]  T. Klastorin,et al.  On the Measurement of Hospital Case Mix , 1980, Medical care.

[49]  I. Moscovice,et al.  A prognosis for the rural hospital. Part I: What is the role of the rural hospital? , 1985, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[50]  Mette Asmild,et al.  Slack free MEA and RDM with comprehensive efficiency measures , 2010 .

[51]  Léopold Simar,et al.  Local likelihood estimation of truncated regression and its partial derivatives: theory and application , 2008 .

[52]  Léopold Simar,et al.  On Testing Equality of Distributions of Technical Efficiency Scores , 2006 .

[53]  Jung-soo Lee,et al.  Reforming the hospital service structure to improve efficiency: urban hospital specialization. , 2008, Health policy.

[54]  David Xin Ding,et al.  The effect of experience, ownership and focus on productive efficiency: : A longitudinal study of U.S. hospitals , 2014 .

[55]  Jon A. Chilingerian,et al.  Exploring Why Some Physicians’ Hospital Practices are More Efficient: Taking DEA Inside the Hospital , 1994 .

[56]  D. Primont,et al.  Multi-Output Production and Duality: Theory and Applications , 1994 .

[57]  Marion S. Rauner,et al.  A cross-national comparison and taxonomy of DEA-based hospital efficiency studies , 2008 .

[58]  Joe Zhu,et al.  Data envelopment analysis: Prior to choosing a model , 2014 .

[59]  T. Nunnikhoven,et al.  Technical efficiency of for‐profit and non‐profit nursing homes , 1992 .

[60]  Joe Zhu,et al.  Evaluation of information technology investment: a data envelopment analysis approach , 2006, Comput. Oper. Res..

[61]  Hsihui Chang,et al.  Determinants of Hospital Efficiency: the Case of Central Government-owned Hospitals in Taiwan , 1998 .

[62]  R. Banker Maximum likelihood, consistency and data envelopment analysis: a statistical foundation , 1993 .

[63]  L. Iezzoni,et al.  Measuring hospital efficiency with frontier cost functions. , 1994, Journal of health economics.

[64]  P. McNamara Welfare Effects of Rural Hospitial Closures: A Nested Logit Analysis of the Demand for Rural Hospital Services , 1999 .

[65]  Pat Armstrong,et al.  Health Care in Canada , 1994 .

[66]  Victor V. Podinovski,et al.  Using data envelopment analysis for the assessment of technical efficiency of units with different specialisations: An application to agriculture ☆ , 2015 .

[67]  Valentin Zelenyuk,et al.  Corporate Governance and Firm’s Efficiency: The Case of a Transitional Country, Ukraine , 2006 .

[68]  J. Fannin,et al.  Analyzing cost efficiency of Critical Access Hospitals , 2013 .

[69]  R. Färe,et al.  Productivity Growth, Technical Progress, and Efficiency Change in Industrialized Countries , 1994 .

[70]  Shawna Grosskopf,et al.  Competitive effects on teaching hospitals , 2004, Eur. J. Oper. Res..

[71]  Bülent Sezen,et al.  Analyzing the ambiguous relationship between efficiency, quality and patient satisfaction in healthcare services: the case of public hospitals in Turkey. , 2013, Health policy.

[72]  Qi Li Nonparametric testing of closeness between two unknown distribution functions , 1996 .

[73]  Javier Garcia-Lacalle,et al.  Rural vs urban hospital performance in a 'competitive' public health service. , 2010, Social science & medicine.

[74]  Shawna Grosskopf,et al.  The effects of teaching on hospital productivity , 2001 .

[75]  L. Simar,et al.  Stochastic FDH/DEA estimators for frontier analysis , 2008 .

[76]  Kostantinos Kounetas,et al.  Does the adoption of new technology boost productive efficiency in the public sector? The case of ICUs system , 2010 .

[77]  Shawna Grosskopf,et al.  Comparing Teaching and Non-teaching Hospitals: A Frontier Approach (Teaching vs. Non-teaching Hospitals) , 2001, Health care management science.