Efficiency and Productivity of Public Hospitals in Serbia Using DEA-Malmquist Model and Tobit Regression Model, 2015-2019

Overview

Journal Int J Environ Res Public Health

Publisher MDPI

Specialties Environmental Health
Public Health

Date 2021 Dec 10

PMID 34886202

Citations 15

Authors

Aleksandar Medarevic

Dejana Vukovic

Affiliations

Soon will be listed here.

Abstract

Improving productivity within health systems using limited resources is a matter of great concern. The objectives of the paper were to evaluate the productivity, efficiency, and impact of environmental factors on efficiency in Serbian hospitals from 2015-2019. Data envelopment analysis, Malmquist index and Tobit regression were applied to hospital data from this period, and public hospitals in Serbia exhibited a great variation regarding their capacity and performance. Between five and eight hospitals ran efficiently from 2015 to 2019, and the productivity of public hospitals increased whereas technical efficiency decreased in the same period. Tobit regression indicated that the proportion of elderly patients and small hospital size (below 200 beds) had a negative correlation with technical efficiency, while large hospital size (between 400 and 600 beds), the ratio of outpatient episodes to inpatient days, bed turnover rate and the bed occupation rate had a positive correlation with technical efficiency. Serbian public hospitals have considerable space for technical efficiency improvement and public action must be taken to improve resource utilization.

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References

Hibbard J, Greene J, Sofaer S, Firminger K, Hirsh J . An experiment shows that a well-designed report on costs and quality can help consumers choose high-value health care. Health Aff (Millwood). 2012; 31(3):560-8. DOI: 10.1377/hlthaff.2011.1168. View

Sarabi Asiabar A, Sharifi T, Rezapour A, Khatami Firouzabadi S, Haghighat-Fard P, Mohammad-Pour S . Technical efficiency and its affecting factors in Tehran's public hospitals: DEA approach and Tobit regression. Med J Islam Repub Iran. 2021; 34:176. PMC: 8004568. DOI: 10.47176/mjiri.34.176. View

Pilyavsky A, Aaronson W, Bernet P, Rosko M, Valdmanis V, Golubchikov M . East-west: does it make a difference to hospital efficiencies in Ukraine?. Health Econ. 2006; 15(11):1173-86. DOI: 10.1002/hec.1120. View

Hollingsworth B . Non-parametric and parametric applications measuring efficiency in health care. Health Care Manag Sci. 2003; 6(4):203-18. DOI: 10.1023/a:1026255523228. View

Madsen F, Ladelund S, Linneberg A . High levels of bed occupancy associated with increased inpatient and thirty-day hospital mortality in Denmark. Health Aff (Millwood). 2014; 33(7):1236-44. DOI: 10.1377/hlthaff.2013.1303. View

Kim Y, Lee K, Choi S . Multifaced Evidence of Hospital Performance in Pennsylvania. Healthcare (Basel). 2021; 9(6). PMC: 8228833. DOI: 10.3390/healthcare9060670. View

Cao P, Toyabe S, Abe T, Akazawa K . Profit and loss analysis for an intensive care unit (ICU) in Japan: a tool for strategic management. BMC Health Serv Res. 2006; 6:1. PMC: 1395358. DOI: 10.1186/1472-6963-6-1. View

Kakemam E, Dargahi H . The Health Sector Evolution Plan and the Technical Efficiency of Public Hospitals in Iran. Iran J Public Health. 2019; 48(9):1681-1689. PMC: 6825684. View

Stefko R, Gavurova B, Kocisova K . Healthcare efficiency assessment using DEA analysis in the Slovak Republic. Health Econ Rev. 2018; 8(1):6. PMC: 5845086. DOI: 10.1186/s13561-018-0191-9. View

10.

Kjekshus L, Hagen T . Do hospital mergers increase hospital efficiency? Evidence from a National Health Service country. J Health Serv Res Policy. 2007; 12(4):230-5. DOI: 10.1258/135581907782101561. View

11.

Kirigia J, Asbu E . Technical and scale efficiency of public community hospitals in Eritrea: an exploratory study. Health Econ Rev. 2013; 3(1):6. PMC: 3605339. DOI: 10.1186/2191-1991-3-6. View

12.

Hsiao B, Chen L, Wu H . Assessing performance of Taiwan hospitals using data envelopment analysis: In view of ownership. Int J Health Plann Manage. 2018; 34(1):e602-e616. DOI: 10.1002/hpm.2676. View

13.

Hollingsworth B . The measurement of efficiency and productivity of health care delivery. Health Econ. 2008; 17(10):1107-28. DOI: 10.1002/hec.1391. View

14.

Guo H, Zhao Y, Niu T, Tsui K . Hong Kong Hospital Authority resource efficiency evaluation: Via a novel DEA-Malmquist model and Tobit regression model. PLoS One. 2017; 12(9):e0184211. PMC: 5590922. DOI: 10.1371/journal.pone.0184211. View

15.

Cheng Z, Tao H, Cai M, Lin H, Lin X, Shu Q . Technical efficiency and productivity of Chinese county hospitals: an exploratory study in Henan province, China. BMJ Open. 2015; 5(9):e007267. PMC: 4567660. DOI: 10.1136/bmjopen-2014-007267. View

16.

Han A, Lee K . The Impact of Public Reporting Schemes and Market Competition on Hospital Efficiency. Healthcare (Basel). 2021; 9(8). PMC: 8391365. DOI: 10.3390/healthcare9081031. View

17.

Tierney L, Conroy K . Optimal occupancy in the ICU: a literature review. Aust Crit Care. 2013; 27(2):77-84. DOI: 10.1016/j.aucc.2013.11.003. View

18.

Giancotti M, Guglielmo A, Mauro M . Efficiency and optimal size of hospitals: Results of a systematic search. PLoS One. 2017; 12(3):e0174533. PMC: 5371367. DOI: 10.1371/journal.pone.0174533. View

19.

Jiang S, Min R, Fang P . The impact of healthcare reform on the efficiency of public county hospitals in China. BMC Health Serv Res. 2017; 17(1):838. PMC: 5738802. DOI: 10.1186/s12913-017-2780-4. View

20.

Sultan W, Crispim J . Measuring the efficiency of Palestinian public hospitals during 2010-2015: an application of a two-stage DEA method. BMC Health Serv Res. 2018; 18(1):381. PMC: 5975658. DOI: 10.1186/s12913-018-3228-1. View