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Peykani P, Memar-Masjed E, Arabjazi N, Mirmozaffari M. Dynamic Performance Assessment of Hospitals by Applying Credibility-Based Fuzzy Window Data Envelopment Analysis. Healthcare (Basel) 2022; 10:healthcare10050876. [PMID: 35628013 PMCID: PMC9141957 DOI: 10.3390/healthcare10050876] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2022] Open
Abstract
The goal of the current research is to propose the credibility-based fuzzy window data envelopment analysis (CFWDEA) approach as a novel method for the dynamic performance evaluation of hospitals during different periods under data ambiguity and linguistic variables. To reach this goal, a data envelopment analysis (DEA) method, a window analysis technique, a possibilistic programming approach, credibility theory, and chance-constrained programming (CCP) are employed. In addition, the applicability and efficacy of the proposed CFWDEA approach are illustrated utilizing a real data set to evaluate the performance of hospitals in the USA. It should be explained that three inputs including the number of beds, labor-related expenses, patient care supplies, and other expenses as well as three outputs including the number of outpatient department visits, the number of inpatient department admissions, and overall patient satisfaction level, are considered for the dynamic performance appraisal of hospitals. The experimental results show the usefulness of the CFWDEA method for the evaluation and ranking of hospitals in the presence of fuzzy data, linguistic variables, and epistemic uncertainty.
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Affiliation(s)
- Pejman Peykani
- School of Industrial Engineering, Iran University of Science and Technology, Tehran 1684613114, Iran;
| | - Elaheh Memar-Masjed
- Department of Industrial Engineering, Faculty of Engineering, Ferdowsi University of Mashhad, Mashhad 9177948974, Iran;
| | - Nasim Arabjazi
- Department of Mathematics, Faculty of Science, Science and Research Branch, Islamic Azad University, Tehran 1477893855, Iran;
| | - Mirpouya Mirmozaffari
- Department of Industrial Engineering, Dalhousie University, 5269 Morris Street, Halifax, NS B3H 4R2, Canada
- Correspondence:
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Yan C, Liao H, Ma Y, Wang J. The Impact of Health Care Reform Since 2009 on the Efficiency of Primary Health Services: A Provincial Panel Data Study in China. Front Public Health 2021; 9:735654. [PMID: 34746081 PMCID: PMC8569255 DOI: 10.3389/fpubh.2021.735654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 09/23/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Primary health care (PHC) is an important part of health systems in the world and in China. To improve the efficiency of PHC institutions (PHCIs), many countries have implemented reforms, including China's health care reform since 2009. This study aims to evaluate the impact of this reform on the efficiency of PHCIs from the perspective of the whole health system. Methods: Data were collected from China Health Statistical Yearbooks and China Statistical Yearbooks published from 2005 to 2019. By taking the number of beds, health technicians and PHCIs as inputs and the proportion of diagnosis, treatment and admission in PHCIs as outputs, Malmquist DEA was used to evaluate the efficiency change of PHCIs, and panel data regression was performed to analyze the impact of the reform and other factors on such efficiency. The interaction between reform and economic level was also estimated. Results: The MPI in Beijing, Tianjin, Shanghai, Hunan, and Guangdong improved after the reform. The efficiency improvement in Beijing, Tianjin and Shanghai is mainly reflected in the growth of TC, whereas the efficiency improvement in Guangdong and Hunan is mainly reflected in the growth of EC. Meanwhile, the EC and TC in Hebei, Heilongjiang, Shandong, and other provinces deteriorated. The deterioration of MPI in Shanxi, Inner Mongolia and Jilin was mainly attributed to EC. while the deterioration of MPI in Liaoning, Anhui, and Fujian provinces is mainly attributed to TC. Since 2009, the reform exerted a negative impact on MPI (β = -0.06; P < 0.01), TC (β = -0.048; P < 0.01) and EC (β = -0.03; P < 0.01). And such negative impact was weaker in economically developed areas (β = 0.076; P < 0.01). Conclusions: Attention should be paid to future reforms: China should continue investing in PHCIs, establish a structurally integrated and functionally complementary delivery system and promote the coordination of reform policies to avoid the adverse impacts of other reform policies on PHCIs.
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Affiliation(s)
- Chaoyang Yan
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Liao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Ma
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Wang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,The Key Research Institute of Humanities and Social Science of Hubei Province, Huazhong University of Science and Technology, Wuhan, China.,Health Poverty Alleviation Center, Institute for Poverty Reduction and Development, Huazhong University of Science and Technology, Wuhan, China
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Fene F, Serván-Mori E, Ángel Mendoza M, Chivardi C, Reyes-Morales H, Nigenda G. Measuring and analysing social efficiency in the production of maternal health services in Mexico, 2008-15. Health Policy Plan 2021; 35:889-899. [PMID: 32588053 DOI: 10.1093/heapol/czaa055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 11/12/2022] Open
Abstract
'Social efficiency' (SE) denotes the capacity of health systems to ensure equitable access to quality health services at no financial risk to users. Mexico and other low- and middle-income countries have rarely studied the performance of their health systems from an SE perspective. We propose a metric for assessing SE in the production of maternal health services in the public sector among populations without social security, analysing contextual correlates of the demand for these services. Analysis was based on administrative data collected from the 243 health jurisdictions (HJs) in Mexico for the period 2008-15. We defined production inputs as the availability of physical and human resources and social product as the unweighted sum of social sub-products, including an equitable distribution of maternal health resources, the provision of quality maternal health care and financial protection for users. We described the SE scores, the main contextual characteristics as well as those related to the demand for maternal health services. We then performed a variance decomposition analysis of the SE score by component and estimated the SE territorial concentration patterns. Finally, we identified the structural characteristics modelling SE by means of a spatial autoregressive panel data model with fixed effects by year. The SE score rose from 57.7% in 2008 to 71.9% in 2015 (P < 0.01), with its quality component accounting for the largest proportion of variance (30%). SE peaked in HJs with low social marginalization and rurality, and with service demand characterized by low parity and older populations. Different SE levels demonstrated territorial concentration patterns. Analysing SE as a metric for health system performance offers elements that contribute to the achievement of UHC as well as to the design and implementation of effective maternal health interventions intended particularly for the most socially vulnerable sectors of the population.
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Affiliation(s)
- Fato Fene
- School of Public Health of Mexico at the National Institute of Public Health of Mexico, Av. Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico
| | - Edson Serván-Mori
- Center for Health System Research, National Institute of Public Health of Mexico, Av. Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico
| | - Miguel Ángel Mendoza
- School of Economics, National Autonomous University of Mexico, Interior S/N, C.U., Coyoacán, 04510 Mexico City, Mexico
| | - Carlos Chivardi
- Center for Health System Research, National Institute of Public Health of Mexico, Av. Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico
| | - Hortensia Reyes-Morales
- Center for Health System Research, National Institute of Public Health of Mexico, Av. Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico
| | - Gustavo Nigenda
- National School of Nursing and Obstetrics, National Autonomous University of Mexico, Camino Viejo to Xochimilco and, Viad. Tlalpan, Huipulco, 14370 Mexico City, Mexico
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Serván-Mori E, Chivardi C, Fene F, Heredia-Pi I, Mendoza MÁ, Nigenda G. Tackling maternal mortality by improving technical efficiency in the production of primary health services: longitudinal evidence from the Mexican case. Health Care Manag Sci 2020; 23:571-584. [PMID: 32720200 DOI: 10.1007/s10729-020-09503-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 02/06/2020] [Indexed: 10/23/2022]
Abstract
Ensuring regular and timely access to efficient and quality health services reduces the risk of maternal mortality. Specifically, improving technical efficiency (TE) can result in improved health outcomes. To date, no studies in Mexico have explored the connection of TE with either the production of maternal health services at the primary-care level or the maternal-mortality ratio (MMR) in populations without social security coverage. The present study combined data envelopment analysis (DEA), longitudinal data and selection bias correction methods with the purpose of obtaining original evidence on the impact of TE on the MMR during the period 2008-2015. The results revealed that MMR fell 0.36% (P < 0.01) for every percentage point increase in TE at the jurisdictional level or elasticity TE-MMR. This effect proved lower in highly marginalized jurisdictions and disappeared entirely in those with low- or medium-marginalization levels. Our findings also highlighted the relevance of certain social and economic aspects in the attainment of TE by jurisdictions. This clearly demonstrates the need for comprehensive, cross-cutting policies capable of modifying the structural conditions that generate vulnerability in specific population groups. In other words, achieving an effective and sustainable reduction in the MMR requires, inter alia, that the Mexican government review and update two essential elements: the criteria behind resource allocation and distribution, and the control mechanisms currently in place for executing and ensuring accountability in these two functions.
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Affiliation(s)
- Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Carlos Chivardi
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Fato Fene
- School of Public Health, National Institute of Public Health of Mexico, Cuernavaca, Morelos, Mexico
| | - Ileana Heredia-Pi
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Miguel Ángel Mendoza
- School of Economics, National Autonomous University of Mexico, Mexico City, Mexico
| | - Gustavo Nigenda
- National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico.
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