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Peng Z, Laporte A, Wei X, Sha X, Coyte PC. Does hospital competition improve the quality of outpatient care? - empirical evidence from a quasi-experiment in a Chinese city. HEALTH ECONOMICS REVIEW 2024; 14:39. [PMID: 38850390 PMCID: PMC11162028 DOI: 10.1186/s13561-024-00516-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 06/02/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Although countries worldwide have launched a series of pro-competition reforms, the literature on the impacts of hospital competition has produced a complex and contradictory picture. This study examined whether hospital competition contributed to an increase in the quality of outpatient care. METHODS The dataset comprises encounter data on 406,664 outpatients with influenza between 2015 and 2019 in China. Competition was measured using the Herfindahl-Hirschman index (HHI). Whether patients had 14-day follow-up encounter for influenza at any healthcare facility, outpatient facility, and hospital outpatient department were the three quality outcomes assessed. Binary regression models with crossed random intercepts were constructed to estimate the impacts of the HHI on the quality of outpatient care. The intensity of nighttime lights was employed as an instrumental variable to address the endogenous relationship between the HHI and the quality of outpatient care. RESULTS We demonstrated that an increase in the degree of hospital competition was associated with improved quality of outpatient care. For each 1% increase in the degree of hospital competition, an individual's risk of having a 14-day follow-up encounter for influenza at any healthcare facility, outpatient facility, and hospital outpatient department fell by 34.9%, 18.3%, and 20.8%, respectively. The impacts of hospital competition on improving the quality of outpatient care were more substantial among females, individuals who used the Urban and Rural Residents Basic Medical Insurance to pay for their medical costs, individuals who visited accredited hospitals, and adults aged 25 to 64 years when compared with their counterparts. CONCLUSION This study demonstrated that hospital competition contributed to better quality of outpatient care under a regime with a regulated ceiling price. Competition is suggested to be promoted in the outpatient care market where hospitals have control over quality and government sets a limit on the prices that hospitals may charge.
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Affiliation(s)
- Zixuan Peng
- School of Public Health, Southeast University, Suite 137, Kangjian Building, 87 Dingjiaqiao, Nanjing, Jiangsu, 210009, China
| | - Audrey Laporte
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Xiaolin Wei
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Xinping Sha
- Xiangya School of Medicine, Central South University, 172 Tongzipo Rd, Yuelu District, Changsha, Hunan, 410013, China.
| | - Peter C Coyte
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Pai DR, Pakdil F, Azadeh-Fard N. Applications of data envelopment analysis in acute care hospitals: a systematic literature review, 1984-2022. Health Care Manag Sci 2024; 27:284-312. [PMID: 38438649 DOI: 10.1007/s10729-024-09669-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/20/2024] [Indexed: 03/06/2024]
Abstract
This study reviews scholarly publications on data envelopment analysis (DEA) studies on acute care hospital (ACH) efficiency published between 1984 and 2022 in scholarly peer-reviewed journals. We employ systematic literature review (SLR) method to identify and analyze pertinent past research using predetermined steps. The SLR offers a comprehensive resource that meticulously analyzes DEA methodology for practitioners and researchers focusing on ACH efficiency measurement. The articles reviewed in the SLR are analyzed and synthesized based on the nature of the DEA modelling process and the key findings from the DEA models. The key findings from the DEA models are presented under the following sections: effects of different ownership structures; impacts of specific healthcare reforms or other policy interventions; international and multi-state comparisons; effects of changes in competitive environment; impacts of new technology implementations; effects of hospital location; impacts of quality management interventions; impact of COVID-19 on hospital performance; impact of teaching status, and impact of merger. Furthermore, the nature of DEA modelling process focuses on use of sensitivity analysis; choice of inputs and outputs; comparison with Stochastic Frontier Analysis; use of congestion analysis; use of bootstrapping; imposition of weight restrictions; use of DEA window analysis; and exogenous factors. The findings demonstrate that, despite several innovative DEA extensions and hospital applications, over half of the research used the conventional DEA models. The findings also show that the most often used inputs in the DEA models were labor-oriented inputs and hospital beds, whereas the most frequently used outputs were outpatient visits, followed by surgeries, admissions, and inpatient days. Further research on the impact of healthcare reforms and health information technology (HIT) on hospital performance is required, given the number of reforms being implemented in many countries and the role HIT plays in enhancing care quality and lowering costs. We conclude by offering several new research directions for future studies.
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Affiliation(s)
- Dinesh R Pai
- School of Business Administration, Penn State Harrisburg, 777 West Harrisburg Pike, Middletown, PA, 17057, USA
| | - Fatma Pakdil
- College of Business, Eastern Connecticut State University, 83 Windham St, Willimantic, CT, 06226, USA.
| | - Nasibeh Azadeh-Fard
- Rochester Institute of Technology, Kate Gleason College of Engineering, Rochester, NY, 14623, USA
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Piedra-Peña J, Prior D. Analyzing the effect of health reforms on the efficiency of Ecuadorian public hospitals. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2023; 23:361-392. [PMID: 36929472 PMCID: PMC10462564 DOI: 10.1007/s10754-023-09346-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 03/04/2023] [Indexed: 06/18/2023]
Abstract
This study aims to assess whether Ecuadorian health reforms carried out since 2008 have affected the efficiency performance of public hospitals in the country. We contribute to the literature by shedding new light on the effects on public healthcare efficiency for developing countries when policies move toward health equity and universal coverage. We follow a two-stage approach, wherein the first stage we make use of factor and cluster analysis to obtain three clusters of public hospitals based on their technological endowment; we exploit Data Envelopment Analysis for panel data in the second stage to estimate robust efficiency measures over time. Our innovative empirical strategy considers the heterogeneity of healthcare institutions in the analysis of their efficiency performance. The results show a significant decrease in the average efficiency of low and intermediate technology hospitals after the new constitution was adopted in 2008. The decline in efficiency coincides with the two reforms of 2010 and 2011 that brought on higher social security coverage.
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Affiliation(s)
- Juan Piedra-Peña
- Department of Applied Economics, Universitat Autònoma de Barcelona, Campus Bellaterra, Barcelona, Spain.
| | - Diego Prior
- Department of Business, Universitat Autònoma de Barcelona, Campus Bellaterra, Barcelona, Spain
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Chang WF, Yan XY, Ling H, Liu T, Luo AJ. A study of the types and manifestations of physicians' unintended behaviors in the DRG payment system. Front Public Health 2023; 11:1141981. [PMID: 37441652 PMCID: PMC10333571 DOI: 10.3389/fpubh.2023.1141981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction In recent years, China has implemented the Diagnosis Related Groups (DRG) payment system as part of its healthcare insurance reimbursement policy. Numerous studies have focused on the effectiveness of DRG payment system in controlling unreasonable growth in medical expenses. However, there has been no systematic report on the types of unintended behaviors exhibited by doctors under the DRG payment system. Methods The study first utilized interrupted time series analysis to analyze medical records and insurance data from eight hospitals. It investigated the data changes in MDC and ADRG groups before and after the implementation of the DRG payment system. Subsequently, a semi-structured interview method was employed to conduct qualitative research on the unintended behaviors of physicians, aiming to gain a more accurate understanding of specific changes in physician behavior after the implementation of the DRG payment system. Results This study discovered that doctors engage in unintended behaviors within the framework of the DRG payment system. Discussion In the early implementation of the DRG payment system in China, the contradictions between the flawed DRG payment methods and supporting systems and the actual diagnostic and treatment work manifested in the form of unintended doctor behaviors. Most of these unintended behaviors can be considered reasonable feedback from doctors to cope with the existing system flaws. They are conducive to identifying the deficiencies in China's DRG payment system and suggesting directions for improvement.
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Affiliation(s)
- Wei-Fu Chang
- Department of Medical Administration, The Third Xiangya Hospital of Central South University, Changsha, China
- Xiangya School of Public Health, Central South University, Changsha, China
- Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China
| | - Xin-Yu Yan
- Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China
- School of Life Sciences, Central South University, Changsha, China
| | - Hao Ling
- Department of Medical Administration, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Ting Liu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Ai-Jing Luo
- Information Network Center, The Second Xiangya Hospital of Central South University, Changsha, China
- Clinical Research Center for Cardiovascular Intelligent Healthcare in Hunan Province, Changsha, China
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5
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Wang M, Chen X, Sun Y, Wang Q, Liu G. Functions, advantages and challenges facing private healthcare organisations in China's healthcare system: a qualitative analysis through open-ended questionnaires. BMJ Open 2023; 13:e069381. [PMID: 37336542 DOI: 10.1136/bmjopen-2022-069381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVES The medical reform in 2009 stimulated the growth of private healthcare organisations in China, but there is still room for their further development in the healthcare market. The objectives of the study were to provide more information about the healthcare market in China and to explore the challenges private healthcare organisations faced. DESIGN Qualitative descriptive study using a web-based open-ended questionnaire and thematic content analysis. Data were collected between 12 February and 20 February 2020. SETTING This study was conducted in China. PARTICIPANTS 124 respondents from private healthcare organisations across 20 provinces in China. RESULTS Our content analysis identified three themes: (1) functioning and positioning of the healthcare institutions: current private healthcare organisations generally serve as a supplement to public hospitals and focus more on specialised medical and high-end services; (2) institutions' advantages: private healthcare organisations can flexibly respond to market demands, formulate effective strategies, introduce advanced management concepts and methods, provide personalised and diversified services, and introduce new technologies which can stimulate market vitality and promote healthy competition; and (3) institutions' challenges: private healthcare organisations face difficulties in professional development and talent cultivation, branding and establishing a reputation, and the policies for institution establishment, tax and medical insurance pose drawbacks to their development. CONCLUSION This study illustrates that private healthcare organisations need more government support for further development, such as providing a fairer insurance strategy and taxation policy, affording ground for a more equitable scientific research environment and promotion opportunities, and evaluating reputation score for healthcare institutions.
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Affiliation(s)
- Meijiao Wang
- College of Public Administration and Humanities, Dalian Maritime University, Dalian, China
| | - Xiaotong Chen
- China Center for Health Economic Research, Peking University, Beijing, China
| | - Yu Sun
- China Center for Health Economic Research, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Qi Wang
- College of Public Administration and Humanities, Dalian Maritime University, Dalian, China
| | - Gordon Liu
- China Center for Health Economic Research, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
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Strumann C, Geissler A, Busse R, Pross C. Can competition improve hospital quality of care? A difference-in-differences approach to evaluate the effect of increasing quality transparency on hospital quality. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1229-1242. [PMID: 34997865 PMCID: PMC9395484 DOI: 10.1007/s10198-021-01423-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
Public reporting on the quality of care is intended to guide patients to the provider with the highest quality and to stimulate a fair competition on quality. We apply a difference-in-differences design to test whether hospital quality has improved more in markets that are more competitive after the first public release of performance data in Germany in 2008. Panel data from 947 hospitals from 2006 to 2010 are used. Due to the high complexity of the treatment of stroke patients, we approximate general hospital quality by the 30-day risk-adjusted mortality rate for stroke treatment. Market structure is measured (comparatively) by the Herfindahl-Hirschman index (HHI) and by the number of hospitals in the relevant market. Predicted market shares based on exogenous variables only are used to compute the HHI to allow a causal interpretation of the reform effect. A homogenous positive effect of competition on quality of care is found. This effect is mainly driven by the response of non-profit hospitals that have a narrow range of services and private for-profit hospitals with a medium range of services. The results highlight the relevance of outcome transparency to enhance hospital quality competition.
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Affiliation(s)
- Christoph Strumann
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
| | | | - Reinhard Busse
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany
| | - Christoph Pross
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany
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Piubello Orsini L, Leardini C, Vernizzi S, Campedelli B. Inefficiency of public hospitals: a multistage data envelopment analysis in an Italian region. BMC Health Serv Res 2021; 21:1281. [PMID: 34838006 PMCID: PMC8627633 DOI: 10.1186/s12913-021-07276-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background The objective of this study was to assess public hospital efficiency, including quality outputs, inefficiency determinants, and changes to efficiency over time, in an Italian region. To achieve this aim, the study used secondary data from the Veneto region for the years 2018 and 2019. Methods A nonparametric approach—that is, multistage data envelopment analysis (DEA)—was applied to a sample of 43 hospitals. We identified three categories of input: capital investments (Beds), labor (FTE), operating expenses. We selected five efficiency outputs (outpatient visits, inpatients, outpatient visit revenue, inpatient revenue, bed occupancy rate) and two quality outputs (mortality rate and inappropriate admission rate). Efficiency scores were estimated and decomposed into two components. Slack analysis was then conducted. Further, DEA efficiency scores were regressed on internal and external variables using a Tobit model. Finally, the Malmquist Productivity Index was applied. Results On average, the hospitals in the Veneto region operated at more than 95% efficiency. Technical and scale inefficiencies often occurred jointly, with 77% of inefficient hospitals needing a downsizing strategy to gain efficiency. The inputs identified as needing significant reductions were full-time employee (FTE) administrative staff and technicians. The size of the hospital in relation to the size of the population served and the length of patient stay were important factors for the efficiency score. The major cause of decreased efficiency over time was technical change (0.908) rather than efficiency change (0.974). Conclusions The study reveals improvements that should be made from both the policy and managerial perspectives. Hospital size is an important feature of inefficiency. On average, the results show that it is advisable for hospitals to reorganize nonmedical staff to enhance efficiency. Further, increasing technology investment could enable higher efficiency levels.
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Affiliation(s)
- Luca Piubello Orsini
- Department of Business Administration, University of Verona, Via Cantarane 24, 37129, Verona, Italy.
| | - Chiara Leardini
- Department of Business Administration, University of Verona, Via Cantarane 24, 37129, Verona, Italy
| | - Silvia Vernizzi
- Department of Business Administration, University of Verona, Via Cantarane 24, 37129, Verona, Italy
| | - Bettina Campedelli
- Department of Business Administration, University of Verona, Via Cantarane 24, 37129, Verona, Italy
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Does hospital competition lead to medical equipment expansion? Evidence on the medical arms race. Health Care Manag Sci 2021; 24:582-596. [PMID: 33411086 DOI: 10.1007/s10729-020-09529-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/27/2020] [Indexed: 12/13/2022]
Abstract
With the implementation of a series of pro-competition policies in China, the hospital market competition has been intensified dramatically over the past decade. Based on previous literature, such competition is very much likely to bring about an upgoing trend in the promotion and expansion of medical facilities among hospitals as an essential strategy for attracting patients, which is known as Medical Arms Race (MAR). Comprehensive evaluations have been conducted by previous studies on the consequences of the MAR, which, however, merely provided inadequate empirical evidence on the relationship between hospital competition and MAR. Utilizing the variations in hospital competition across various regions and through different time periods in Sichuan Province as a prototype representative of the nationwide situation, a dynamic panel data model was established and adopted in this study for investigating whether intensified hospital competition had resulted in the expansion of medical facilities in China during the corresponding time period. The geopolitical boundaries and Herfindahl-Hirschman Index (HHI) were respectively employed to define the hospital market and measure the competition degree. We found that a 10% reduction in HHI is associated with an 8.79% increase in regional total costs of advanced medical equipment per capita, suggesting that hospital competition would lead to medical equipment expansion. Our results provide novel evidence on MAR which is particularly applicable for the healthcare system in China, providing suggestions for nationwide healthcare reform in order to mitigate potential negative outcomes induced by the implementation of pro-competition policies.
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9
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Does neighbours' grass matter? Testing spatial dependent heterogeneity in technical efficiency of Italian hospitals. Soc Sci Med 2020; 265:113506. [DOI: 10.1016/j.socscimed.2020.113506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/26/2020] [Accepted: 11/05/2020] [Indexed: 11/21/2022]
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Investigating the link between medical urgency and hospital efficiency - Insights from the German hospital market. Health Care Manag Sci 2020; 23:649-660. [PMID: 32936387 PMCID: PMC7674330 DOI: 10.1007/s10729-020-09520-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 08/06/2020] [Indexed: 10/27/2022]
Abstract
With hospital budgets remaining tight and healthcare expenditure rising due to demographic change and advances in technology, hospitals continue to face calls to contain costs and allocate their resources more efficiently. In this context, efficiency has emerged as an increasingly important way for hospitals to withstand competitive pressures in the hospital market. Doing so, however, can be challenging given unpredictable fluctuations in demand, a prime example of which are emergencies, i.e. urgent medical cases. The link between medical urgency and hospitals' efficiency, however, has been neglected in the literature to date. This study therefore aims to investigate the relationship between hospitals' urgency characteristics and their efficiency. Our analyses are based on 4094 observations from 1428 hospitals throughout Germany for the years 2015, 2016, and 2017. We calculate an average urgency score for each hospital based on all cases treated in that hospital per year and also investigate the within-hospital dispersion of medical urgency. To analyze the association of these urgency measures with hospitals' efficiency we use a two-stage double bootstrap data envelopment analysis approach with truncated regression. We find a negative relationship between the urgency score and hospital efficiency. When testing for non-linear effects, the results reveal a u-shaped association, indicating that having either a high or low overall urgency score is beneficial in terms of efficiency. Finally, our results reveal that higher within-hospital urgency dispersion is negatively related to efficiency.
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Ortega-Díaz MI, Ocaña-Riola R, Pérez-Romero C, Martín-Martín JJ. Multilevel Analysis of the Relationship between Ownership Structure and Technical Efficiency Frontier in the Spanish National Health System Hospitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165905. [PMID: 32823922 PMCID: PMC7459985 DOI: 10.3390/ijerph17165905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022]
Abstract
Objective: To evaluate the relationship between the ownership structure of hospitals and the possibility of their being positioned on the frontier of technical efficiency in the economic crisis period 2010–2012, adjusting for hospital variables and regional characteristics in the areas where the Spanish National Health System (SNHS) hospitals are located. Methods: 230 National Health System hospitals were studied over the two-year period 2010–2012 according to their ownership structure—public hospitals, private hospitals and public–private partnership (PPP)—data envelopment analysis orientated to inputs was used to measure the overall technical efficiency, pure efficiency and efficiency of scale. A generalised linear mixed model (GLMM) with binomial distribution and logit link function was used to analyse the hospital and regional variables associated with positioning on the frontier. Results: There are substantial differences between the average pure technical efficiency of public, private and PPP hospitals, as well as a greater number of PPP models being positioned on the efficiency frontier (91.67% in 2012). The odds of being positioned on the frontier are 41.7 times higher in PPP models than in public hospitals. The average annual household income per region is related to the greater odds of hospitals being positioned on the frontier of efficiency. Conclusions: During the most acute period of recession in the Spanish economy, PPP formulas favoured hospital efficiency, by increasing the odds of being positioned on the frontier of efficiency when compared to private and public hospitals. The position on the frontier of efficiency of a hospital is related to the wealth of its region.
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Affiliation(s)
- Mª Isabel Ortega-Díaz
- Departamento de Economía, Universidad de Jaén, Edificio D-3, Campus Las Lagunillas s/n, 23071 Jaén, Spain;
| | - Ricardo Ocaña-Riola
- Escuela Andaluza de Salud Pública, Cuesta del Observatorio 4, Campus Universitario de Cartuja, 18011 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, Doctor Azpitarte 4, 18012 Granada, Spain;
| | - Carmen Pérez-Romero
- Escuela Andaluza de Salud Pública, Cuesta del Observatorio 4, Campus Universitario de Cartuja, 18011 Granada, Spain;
- Correspondence: ; Tel.: +34-958-02-74-10
| | - José Jesús Martín-Martín
- Instituto de Investigación Biosanitaria ibs.GRANADA, Doctor Azpitarte 4, 18012 Granada, Spain;
- Departamento de Economía Aplicada, Universidad de Granada, Facultad de Ciencias Económicas y Empresariales, Campus Universitario de Cartuja s/n, 18071 Granada, Spain
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Ex P, Vogt V, Busse R, Henschke C. The reimbursement of new medical technologies in German inpatient care: What factors explain which hospitals receive innovation payments? HEALTH ECONOMICS, POLICY, AND LAW 2020; 15:355-369. [PMID: 31159902 DOI: 10.1017/s1744133119000124] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Most hospital payment systems based on diagnosis-related groups (DRGs) provide payments for newly approved technologies. In Germany, they are negotiated between individual hospitals and health insurances. The aim of our study is to assess the functioning of temporary reimbursement mechanisms. We used multilevel logistic regression to examine factors at the hospital and state levels that are associated with agreeing innovation payments. Dependent variable was whether or not a hospital had successfully negotiated innovation payments in 2013 (n = 1532). Using agreement data of the yearly budget negotiations between each German hospital and representatives of the health insurances, the study comprises all German acute hospitals and innovation payments on all diagnoses. In total, 32.9% of the hospitals successfully negotiated innovation payments in 2013. We found that the chance of receiving innovation payments increased if the hospital was located in areas with a high degree of competition and if they were large, had university status and were private for-profit entities. Our study shows an implicit self-controlled selection of hospitals receiving innovation payments. While implicitly encouraging safety of patient care, policy makers should favour a more direct and transparent process of distributing innovation payments in prospective payment systems.
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Affiliation(s)
- Patricia Ex
- TU Berlin, Department of Health Care Management, Technische Universität Berlin, 10623Berlin, Germany
| | - Verena Vogt
- TU Berlin, Department of Health Care Management, Technische Universität Berlin, 10623Berlin, Germany
| | - Reinhard Busse
- TU Berlin, Department of Health Care Management, Technische Universität Berlin, 10623Berlin, Germany
| | - Cornelia Henschke
- TU Berlin, Department of Health Care Management, Technische Universität Berlin, 10623Berlin, Germany
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Koné I, Maria Zimmermann B, Nordström K, Simone Elger B, Wangmo T. A scoping review of empirical evidence on the impacts of the DRG introduction in Germany and Switzerland. Int J Health Plann Manage 2018; 34:56-70. [PMID: 30426573 DOI: 10.1002/hpm.2669] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 11/09/2022] Open
Abstract
CONTEXT Germany and Switzerland have introduced diagnosis-related groups (DRGs) for hospital reimbursement. This scoping review aims to evaluate if empirical evidence exists on the effect of the DRG introduction. METHODS Medline via PubMed, Embase (Elsevier), CINAHL, PsychINFO, and Psyndex were systematically screened for studies from 2003 onwards using keywords-DRG, prospective payment system, and lump sum-in English, German, and French. Abstracts were screened for alignment with our inclusion criteria and classified as editorial/commentary, review, or empirical study. The full-text extraction included data on country, study design, collected data, study population, specialty, comparison group, and outcome measures. RESULTS Our literature search yielded 1944 references, of which 1405 references were included in the abstract screening after removal of duplicates. 135 articles were relevant to DRG, including 94 editorials/comments/reviews and 41 empirical articles from 36 different samples. The most frequently used outcome parameters were length of stay (12), reimbursement/cost (9), and case numbers (9). CONCLUSIONS Only a minority of identified articles (30.4%; 41 of 135) presented empirical data. This indicates that discussion on the topic is not totally evidence-based. The only common trend was a decrease in length of stay.
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Affiliation(s)
- Insa Koné
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | | | - Karin Nordström
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.,Theological Ethics and Social Ethics, University of Lucerne, Lucerne, Switzerland
| | | | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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Pross C, Strumann C, Geissler A, Herwartz H, Klein N. Quality and resource efficiency in hospital service provision: A geoadditive stochastic frontier analysis of stroke quality of care in Germany. PLoS One 2018; 13:e0203017. [PMID: 30188906 PMCID: PMC6126832 DOI: 10.1371/journal.pone.0203017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 08/14/2018] [Indexed: 02/07/2023] Open
Abstract
We specify a Bayesian, geoadditive Stochastic Frontier Analysis (SFA) model to assess hospital performance along the dimensions of resources and quality of stroke care in German hospitals. With 1,100 annual observations and data from 2006 to 2013 and risk-adjusted patient volume as output, we introduce a production function that captures quality, resource inputs, hospital inefficiency determinants and spatial patterns of inefficiencies. With high relevance for hospital management and health system regulators, we identify performance improvement mechanisms by considering marginal effects for the average hospital. Specialization and certification can substantially reduce mortality. Regional and hospital-level concentration can improve quality and resource efficiency. Finally, our results demonstrate a trade-off between quality improvement and resource reduction and substantial regional variation in efficiency.
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Affiliation(s)
- Christoph Pross
- Department of Healthcare Management, Berlin University of Technology, Straße des 17. Juni 135, 10623 Berlin, Germany
| | - Christoph Strumann
- Institute for Entrepreneurship and Business Development, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Alexander Geissler
- Department of Healthcare Management, Berlin University of Technology, Straße des 17. Juni 135, 10623 Berlin, Germany
| | - Helmut Herwartz
- Chair of Econometrics, Georg-August-University Göttingen, Humboldtallee 3, 37073 Göttingen, Germany
| | - Nadja Klein
- Melbourne Business School, University of Melbourne, 200 Leicester Street, Carlton VIC 3053, Australia
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Salloch S, Apitzsch B, Wilkesmann M, Ruiner C. Locum physicians' professional ethos: a qualitative interview study from Germany. BMC Health Serv Res 2018; 18:333. [PMID: 29739411 PMCID: PMC5941762 DOI: 10.1186/s12913-018-3118-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 04/12/2018] [Indexed: 12/03/2022] Open
Abstract
Background In contrast to other countries, the appearance of locum physicians as independent contractors constitutes a rather new phenomenon in the German health care system and emerged out of a growing economization and shortage of medical staff in the hospital sector. Locums are a special type of self-employed professionals who are only temporally embedded in organisational contexts of hospitals, and this might have consequences for their professional practice. Therefore, questions arise regarding how locums perceive their ethical duties as medical professionals. Methods In this first qualitative study on German locum physicians, the locums’ own perspective is complemented by the viewpoint of permanently employed physician colleagues. Eighteen semi-structured interviews were conducted in 2014 to explore the professional practice of locum physicians from both groups’ perspectives with respect to doctor-patient-relationship, cooperation with colleagues and physicians’ role in society. The data were analysed using qualitative content analysis, including a deductive application and an inductive development of codes. The results were related to key tenets of medical professionalism with respect to the question: how far do locums fulfil their ethical duties towards patients, colleagues and the society? Results The study indicates that although ethical requirements are met broadly, difficulties remain with respect to close doctor–patient contact and the sustainability of hiring locums as a remedy in times of staff shortage. Conclusions Further qualitative and quantitative research on locum physicians’ professional practice, including patient perspectives and economic health care system analyses, is needed to better understand the ethical impact of hiring independent contractors in the hospital sector. Electronic supplementary material The online version of this article (10.1186/s12913-018-3118-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sabine Salloch
- Institute of Ethics and History of Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17487, Greifswald, Germany.
| | - Birgit Apitzsch
- Sociological Research Institute (SOFI) Göttingen, 37085, Göttingen, Germany
| | - Maximiliane Wilkesmann
- Faculty of Business, Economics, and Social Sciences, TU Dortmund University, 44221, Dortmund, Germany
| | - Caroline Ruiner
- Institute of Work Science, Ruhr University Bochum, 44801, Bochum, Germany
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16
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Kruse FM, Stadhouders NW, Adang EM, Groenewoud S, Jeurissen PPT. Do private hospitals outperform public hospitals regarding efficiency, accessibility, and quality of care in the European Union? A literature review. Int J Health Plann Manage 2018; 33:e434-e453. [PMID: 29498430 PMCID: PMC6033142 DOI: 10.1002/hpm.2502] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/18/2018] [Indexed: 11/07/2022] Open
Abstract
European countries have enhanced the scope of private provision within their health care systems. Privatizing services have been suggested as a means to improve access, quality, and efficiency in health care. This raises questions about the relative performance of private hospitals compared with public hospitals. Most systematic reviews that scrutinize the performance of the private hospitals originate from the United States. A systematic overview for Europe is nonexisting. We fill this gap with a systematic realist review comparing the performance of public hospitals to private hospitals on efficiency, accessibility, and quality of care in the European Union. This review synthesizes evidence from Italy, Germany, the United Kingdom, France, Greece, Austria, Spain, and Portugal. Most evidence suggests that public hospitals are at least as efficient as or are more efficient than private hospitals. Accessibility to broader populations is often a matter of concern in private provision: Patients with higher social-economic backgrounds hold better access to private hospital provision, especially in private parallel systems such as the United Kingdom and Greece. The existing evidence on quality of care is often too diverse to make a conclusive statement. In conclusion, the growth in private hospital provision seems not related to improvements in performance in Europe. Our evidence further suggests that the private (for-profit) hospital sector seems to react more strongly to (financial) incentives than other provider types. In such cases, policymakers either should very carefully develop adequate incentive structures or be hesitant to accommodate the growth of the private hospital sector.
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Affiliation(s)
- Florien M Kruse
- Celsus Academy for Sustainable Healthcare, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Niek W Stadhouders
- Celsus Academy for Sustainable Healthcare, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eddy M Adang
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stef Groenewoud
- Celsus Academy for Sustainable Healthcare, IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Patrick P T Jeurissen
- Celsus Academy for Sustainable Healthcare, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.,Ministry of Health, Welfare, and Sport, The Hague, the Netherlands
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Kohl S, Schoenfelder J, Fügener A, Brunner JO. The use of Data Envelopment Analysis (DEA) in healthcare with a focus on hospitals. Health Care Manag Sci 2018; 22:245-286. [DOI: 10.1007/s10729-018-9436-8] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 01/29/2018] [Indexed: 12/21/2022]
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18
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Vuagnat A, Yilmaz E, Roussot A, Rodwin V, Gadreau M, Bernard A, Creuzot-Garcher C, Quantin C. Did case-based payment influence surgical readmission rates in France? A retrospective study. BMJ Open 2018; 8:e018164. [PMID: 29391376 PMCID: PMC5829593 DOI: 10.1136/bmjopen-2017-018164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To determine whether implementation of a case-based payment system changed all-cause readmission rates in the 30 days following discharge after surgery, we analysed all surgical procedures performed in all hospitals in France before (2002-2004), during (2005-2008) and after (2009-2012) its implementation. SETTING Our study is based on claims data for all surgical procedures performed in all acute care hospitals with >300 surgical admissions per year (740 hospitals) in France over 11 years (2002-2012; n=51.6 million admissions). INTERVENTIONS We analysed all-cause 30-day readmission rates after surgery using a logistic regression model and an interrupted time series analysis. RESULTS The overall 30-day all-cause readmission rate following discharge after surgery increased from 8.8% to 10.0% (P<0.001) for the public sector and from 5.9% to 8.6% (P<0.001) for the private sector. Interrupted time series models revealed a significant linear increase in readmission rates over the study period in all types of hospitals. However, the implementation of case-based payment was only associated with a significant increase in rehospitalisation rates for private hospitals (P<0.001). CONCLUSION In France, the increase in the readmission rate appears to be relatively steady in both the private and public sector but appears not to have been affected by the introduction of a case-based payment system after accounting for changes in care practices in the public sector.
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Affiliation(s)
- Albert Vuagnat
- Department of Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
- Division of Research and Statistics, Ministry of Health, Paris, France
| | - Engin Yilmaz
- Division of Research and Statistics, Ministry of Health, Paris, France
- School of Economics, University of Sorbonne, Paris, France
| | - Adrien Roussot
- Department of Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
| | - Victor Rodwin
- The Robert F. Wagner School of Public Service, New York University, New York, USA
| | - Maryse Gadreau
- Laboratoire d’Economie de Dijon, Université Bourgogne/Franche-Comté, Inserm U1200, CNRS UMR 6307, Dijon, France
| | - Alain Bernard
- Department of Thoracic Surgery, University Hospital, Dijon, France
| | - Catherine Creuzot-Garcher
- Department of Ophthalmology, University Hospital, Dijon, France
- Eye and Nutrition Research Group, Bourgogne Franche-Comté University, Dijon, France
| | - Catherine Quantin
- Department of Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
- Clinical Investigation Center, Dijon University Hospital, Dijon, France
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
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19
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Krämer J, Schreyögg J, Busse R. Classification of hospital admissions into emergency and elective care: a machine learning approach. Health Care Manag Sci 2017; 22:85-105. [PMID: 29177993 DOI: 10.1007/s10729-017-9423-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
Abstract
Rising admissions from emergency departments (EDs) to hospitals are a primary concern for many healthcare systems. The issue of how to differentiate urgent admissions from non-urgent or even elective admissions is crucial. We aim to develop a model for classifying inpatient admissions based on a patient's primary diagnosis as either emergency care or elective care and predicting urgency as a numerical value. We use supervised machine learning techniques and train the model with physician-expert judgments. Our model is accurate (96%) and has a high area under the ROC curve (>.99). We provide the first comprehensive classification and urgency categorization for inpatient emergency and elective care. This model assigns urgency values to every relevant diagnosis in the ICD catalog, and these values are easily applicable to existing hospital data. Our findings may provide a basis for policy makers to create incentives for hospitals to reduce the number of inappropriate ED admissions.
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Affiliation(s)
- Jonas Krämer
- Hamburg Center for Health Economics, Universität Hamburg, Esplanade 36, 20354, Hamburg, Germany
| | - Jonas Schreyögg
- Hamburg Center for Health Economics, Universität Hamburg, Esplanade 36, 20354, Hamburg, Germany.
| | - Reinhard Busse
- Department of Healthcare Management, Technische Universität Berlin, 10623, Berlin, Germany
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20
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Buczak-Stec E, Goryński P, Nitsch-Osuch A, Kanecki K, Tyszko P. The impact of introducing a new hospital financing system (DRGs) in Poland on hospitalisations for atherosclerosis: An interrupted time series analysis (2004–2012). Health Policy 2017; 121:1186-1193. [PMID: 28967491 DOI: 10.1016/j.healthpol.2017.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/14/2017] [Accepted: 09/12/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Elżbieta Buczak-Stec
- Department of Organization, Health Economics and Hospital Management. National Institute of Public Health - National Institute of Hygiene, Poland; Department of Social Medicine and Public Health, Medical University of Warsaw, Poland.
| | - Paweł Goryński
- Centre for Monitoring and Analyses of Population Health Status and Health Care System. National Institute of Public Health - National Institute of Hygiene, Poland
| | - Aneta Nitsch-Osuch
- Department of Social Medicine and Public Health, Medical University of Warsaw, Poland
| | - Krzysztof Kanecki
- Department of Social Medicine and Public Health, Medical University of Warsaw, Poland
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21
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Comparing the Efficiency of Hospitals in Italy and Germany: Nonparametric Conditional Approach Based on Partial Frontier. Health Care Manag Sci 2016; 20:379-394. [DOI: 10.1007/s10729-016-9359-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
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22
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Kim SJ, Park EC, Kim SJ, Han KT, Han E, Jang SI, Kim TH. The effect of competition on the relationship between the introduction of the DRG system and quality of care in Korea. Eur J Public Health 2015; 26:42-7. [DOI: 10.1093/eurpub/ckv162] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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23
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Rezaee MJ, Karimdadi A. Do Geographical Locations Affect in Hospitals Performance? A Multi-group Data Envelopment Analysis. J Med Syst 2015. [DOI: 10.1007/s10916-015-0278-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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24
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Pirozek P, Komarkova L, Leseticky O, Hajdikova T. Corporate governance in Czech hospitals after the transformation. Health Policy 2015; 119:1086-95. [PMID: 26001299 DOI: 10.1016/j.healthpol.2015.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 04/13/2015] [Accepted: 05/03/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND This contribution is a response to the current issue of corporate governance in hospitals in the Czech Republic, which draw a significant portion of funds from public health insurance. This not only has a significant impact on the economic efficiency of hospitals, but ultimately affects the whole system of healthcare provision in the Czech Republic. Therefore, the effectiveness of the corporate governance of hospitals might affect the fiscal stability of the health system and, indirectly, health policy for the whole country. OBJECTIVES The main objective of this paper is to evaluate the success of the transformation in connection with the performance of corporate governance in hospitals in the Czech Republic. Specifically, there was an examination of the management differences in various types of hospitals, which differed in their ownership structure and legal form. METHODOLOGY/APPROACH A sample of 100 hospitals was investigated in 2009, i.e., immediately after the transformation had been completed, and then three years later in 2012. With regard to the different public support of individual hospitals, the operating subsidies were removed from the economic results of the corporations in the sample. The adjusted economic results were first of all examined in relationship to the type of hospital (according to owner and legal form), and then in relation to its size, the size of the supervisory board and the education level of the senior hospital manager. A multiple median regression was used for the evaluation. FINDINGS One of the basic findings was the fact that the hospital's legal form had no influence on economic results. Successful management in the form of adjusted economic results is only associated with the private type of facility ownership. From the perspective of our concept of corporate governance other factors were under observation: the size of the hospital, the size of the supervisory board and the medical qualifications of the senior manager had no statistically verifiable influence on the efficiency of the hospital management, though we did record certain developments as a result of the transformation process. The economic results that were reported were significantly distorted by the operating subsidies from the founder. PRACTICAL IMPLICATIONS The results can be used immediately on several practical levels: on the macro level as part of the state's formulation of health policy, particularly in the optimization of the structure of healthcare providers, as well as for the completion of reforms in legal forms and hospital founders, and on the micro level as part of the effective administration and governance of hospitals through corporate governance regardless of the form of ownership.
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Affiliation(s)
- Petr Pirozek
- Masaryk University, Faculty of Economics and Administration, Lipova 41a, Brno, Czech Republic.
| | - Lenka Komarkova
- University of Economics Prague, Faculty of Management, Jarosovska 1117, Jindrichuv Hradec, Czech Republic.
| | - Ondrej Leseticky
- University of Economics Prague, Faculty of Management, Jarosovska 1117, Jindrichuv Hradec, Czech Republic.
| | - Tatana Hajdikova
- University of Economics Prague, Faculty of Management, Jarosovska 1117, Jindrichuv Hradec, Czech Republic.
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25
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Mateus C, Joaquim I, Nunes C. Measuring hospital efficiency—comparing four European countries. Eur J Public Health 2015; 25 Suppl 1:52-8. [DOI: 10.1093/eurpub/cku222] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Helmig B, Hinz V, Ingerfurth S. Extending Miles & Snow's strategy choice typology to the German hospital sector. Health Policy 2014; 118:363-76. [DOI: 10.1016/j.healthpol.2014.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 06/11/2014] [Accepted: 06/19/2014] [Indexed: 11/30/2022]
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Büchner VA, Hinz V, Schreyögg J. Health systems: changes in hospital efficiency and profitability. Health Care Manag Sci 2014; 19:130-43. [DOI: 10.1007/s10729-014-9303-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 09/28/2014] [Indexed: 11/30/2022]
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28
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The relationship between hospital specialization and hospital efficiency: do different measures of specialization lead to different results? Health Care Manag Sci 2014; 17:365-78. [PMID: 24595722 DOI: 10.1007/s10729-014-9275-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 02/21/2014] [Indexed: 10/25/2022]
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29
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Herwartz H, Strumann C. Hospital efficiency under prospective reimbursement schemes: an empirical assessment for the case of Germany. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2014; 15:175-186. [PMID: 23519432 DOI: 10.1007/s10198-013-0464-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 02/05/2013] [Indexed: 06/01/2023]
Abstract
The introduction of prospective hospital reimbursement based on diagnosis-related groups (DRG) has been a conspicuous attempt to decelerate the steady increase of hospital expenditures in the German health sector. In this work, the effect of the financial reform on hospital efficiency is subjected to empirical testing by means of two complementary testing approaches. On the one hand, we apply a two-stage procedure based on non-parametric efficiency measurement. On the other hand, a stochastic frontier model is employed that allows a one-step estimation of both production frontier parameters and inefficiency effects. To identify efficiency gains as a consequence of changes in the hospital incentive structure, we account for technological progress, spatial dependence and hospital heterogeneity. The results of both approaches do not reveal any increase in overall efficiency after the DRG reform. In contrast, a significant decline in overall hospital efficiency over time is observed.
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Affiliation(s)
- Helmut Herwartz
- Department VWL, Georg-August-Universität zu Göttingen, Platz der Göttinger Sieben 5, 37073, Gottingen, Germany,
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30
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Landais P, Boudemaghe T, Suehs C, Dedet G, Lebihan-Benjamin C. Computerized Medico-Economic Decision Making: An International Comparison. MEDICAL INFORMATICS, E-HEALTH 2014. [DOI: 10.1007/978-2-8178-0478-1_9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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31
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Costs analysis of laparoendoscopic, single-site laparoscopic and open surgery for cT1 renal masses in a European high-volume centre. World J Urol 2013; 32:1501-10. [DOI: 10.1007/s00345-013-1223-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/02/2013] [Indexed: 01/30/2023] Open
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32
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Efficiency, ownership, and financing of hospitals: the case of Austria. Health Care Manag Sci 2013; 17:331-47. [PMID: 24338279 DOI: 10.1007/s10729-013-9256-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 11/07/2013] [Indexed: 10/25/2022]
Abstract
While standard economic theory posits that privately owned hospitals are more efficient than their public counterparts, no clear conclusion can yet be drawn for Austria in this regard. As previous Austrian efficiency studies rely on data from the 1990s only and are based on small hospital samples, the generalizability of these results is questionable. To examine the impact of ownership type on efficiency, we apply a Data Envelopment Analysis which extends the existing literature in two respects: first, it evaluates the efficiency of the Austrian acute care sector, using data on 128 public and private non-profit hospitals from the year 2010; second, it additionally focusses on the inpatient sector alone, thus increasing the comparability between hospitals. Overall, the results show that in Austria, private non-profit hospitals outperform public hospitals in terms of technical efficiency. A multiple regression analysis confirms the significant association between efficiency and ownership type. This conclusive result contrasts some international evidence and can most likely be attributed to differences in financial incentives for public and private non-profit hospitals in Austria. Therefore, by drawing on the example of the Austrian acute care hospital sector and existing literature on the German acute care hospital sector, we also discuss the impact of hospital financing systems and their incentives on efficiency. This paper thus also aims at providing a proof of principle, pointing out the importance of the respective market conditions when internationally comparing hospital efficiency by ownership type.
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Seidel RP, Lux MP, Hoellthaler J, Beckmann MW, Voigt W. Economic constraints - the growing challenge for Western breast cancer centers. Breast Care (Basel) 2013; 8:41-7. [PMID: 24715842 PMCID: PMC3971806 DOI: 10.1159/000348356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Breast cancer care in Western countries has reached a considerable level of quality and standardization, which has contributed to the decline in breast cancer mortality. Certified Breast Cancer Centers (BCC) represent an important element of this development. Related to changes in reimbursement and growing costs, BCC face economic constraints which ultimately could endanger the achievements of the past. Thus, BCC have to optimize their care strategies from an economic perspective, particularly by increasing efficiency but also by adapting their service portfolio. This could result in competitive advantages and additional revenue by increasing case numbers and extra charges to patients. Furthermore, an intensification of collaboration with the outpatient sector resulting in an integrated and managed 'trans-sectoral' care approach which could allow to shift unprofitable procedures to the outpatient sector - in the sense of a win-win situation for both sectors and without loss of care quality - seems reasonable. Structured and specialized consulting approaches can further be a lever to fulfill economic requirements in order to avoid cuts in medical care quality for the sake of a balanced budget. In this review, economic constraints of BCC with a focus on the German healthcare system and potential approaches to ameliorate these financial burdens are being discussed.
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Affiliation(s)
- Rene P. Seidel
- Siemens AG, Healthcare Sector, Customer Solutions Division, H CX CRM-VA HCC ONC, Friedrich Alexander University, Erlangen, Germany
| | - Michael P. Lux
- University Breast Centre Franconia, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Josef Hoellthaler
- Siemens AG, Healthcare Sector, Customer Solutions Division, H CX CRM-VA HCC ONC, Friedrich Alexander University, Erlangen, Germany
| | - Matthias W. Beckmann
- University Breast Centre Franconia, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Wieland Voigt
- Siemens AG, Healthcare Sector, Customer Solutions Division, H CX CRM-VA HCC ONC, Friedrich Alexander University, Erlangen, Germany
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Vogl M. Improving patient-level costing in the English and the German 'DRG' system. Health Policy 2012; 109:290-300. [PMID: 23069132 DOI: 10.1016/j.healthpol.2012.09.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 09/03/2012] [Accepted: 09/21/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this paper is to develop ways to improve patient-level cost apportioning (PLCA) in the English and German inpatient 'DRG' cost accounting systems, to support regulators in improving costing schemes, and to give clinicians and hospital management sophisticated tools to measure and link their management. METHODS The paper analyzes and evaluates the PLCA step in the cost accounting schemes of both countries according to the impact on the key aspects of DRG introduction: transparency and efficiency. The goal is to generate a best available PLCA standard with enhanced accuracy and managerial relevance, the main requirements of cost accounting. RESULTS A best available PLCA standard in 'DRG' cost accounting uses: (1) the cost-matrix from the German system; (2) a third axis in this matrix, representing service-lines or clinical pathways; (3) a scoring system for key cost drivers with the long-term objective of time-driven activity-based costing and (4) a point of delivery separation. CONCLUSION Both systems have elements that the other system can learn from. By combining their strengths, regulators are supported in enhancing PLCA systems, improving the accuracy of national reimbursement and the managerial relevance of inpatient cost accounting systems, in order to reduce costs in health care.
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Affiliation(s)
- Matthias Vogl
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Munich, Germany.
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Vogl M. Assessing DRG cost accounting with respect to resource allocation and tariff calculation: the case of Germany. HEALTH ECONOMICS REVIEW 2012; 2:15. [PMID: 22935314 PMCID: PMC3504509 DOI: 10.1186/2191-1991-2-15] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 08/15/2012] [Indexed: 05/24/2023]
Abstract
The purpose of this paper is to analyze the German diagnosis related groups (G-DRG) cost accounting scheme by assessing its resource allocation at hospital level and its tariff calculation at national level. First, the paper reviews and assesses the three steps in the G-DRG resource allocation scheme at hospital level: (1) the groundwork; (2) cost-center accounting; and (3) patient-level costing. Second, the paper reviews and assesses the three steps in G-DRG national tariff calculation: (1) plausibility checks; (2) inlier calculation; and (3) the "one hospital" approach. The assessment is based on the two main goals of G-DRG introduction: improving transparency and efficiency. A further empirical assessment attests high costing quality. The G-DRG cost accounting scheme shows high system quality in resource allocation at hospital level, with limitations concerning a managerially relevant full cost approach and limitations in terms of advanced activity-based costing at patient-level. However, the scheme has serious flaws in national tariff calculation: inlier calculation is normative, and the "one hospital" model causes cost bias, adjustment and representativeness issues. The G-DRG system was designed for reimbursement calculation, but developed to a standard with strategic management implications, generalized by the idea of adapting a hospital's cost structures to DRG revenues. This combination causes problems in actual hospital financing, although resource allocation is advanced at hospital level.
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Affiliation(s)
- Matthias Vogl
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764 , Neuherberg, Germany.
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