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Moreno-Domínguez MJ, Escobar-Rodríguez T, Pelayo-Díaz YM. [Influence of leadership style on knowledge management and hospital efficiency]. GACETA SANITARIA 2023; 37:102342. [PMID: 37992459 DOI: 10.1016/j.gaceta.2023.102342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To analyse the effect of leadership style on knowledge management in hospitals and hospital efficiency based on the opinion of experts in hospital management, applying fuzzy cognitive maps (FCM). METHOD FCM are relational models that can be used to graphically represent expert opinion and knowledge to infer cause-effect relationships between different concepts. The use of FCM as a simulation tool allows the evaluation of possible scenarios based on different leadership styles in hospitals. RESULTS In the resulting augmented matrix, standardized effects range from 0.02 to 0.84, with the highest value representing the strongest relationship between knowledge exploitation and hospital efficiency. From the viewpoint of experts, knowledge creation within the hospital also influences hospital efficiency. Regarding variables reflecting leadership characteristics, positive effects have been identified, though with varying intensities, between authority, benevolence, and charisma, both in terms of knowledge creation and exploitation, as well as hospital efficiency. The transformational leadership style is associated with coefficients having higher values for knowledge management and hospital efficiency. CONCLUSIONS Experts suggest that hospitals with authoritarian leadership styles would exhibit lower levels of knowledge creation and management, as well as lower hospital efficiency. On the other hand, they associate hospitals managed with a paternalistic leadership style with better values in both knowledge creation and exploitation, as well as hospital efficiency, compared to the authoritarian leadership style. Finally, they attribute the highest levels in aspects related to knowledge management and hospital efficiency to the transformational leadership style.
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Affiliation(s)
| | - Tomás Escobar-Rodríguez
- Departamento de Economía Financiera, Contabilidad y Dirección de Operaciones, Universidad de Huelva, Huelva, España
| | - Yolanda M Pelayo-Díaz
- Departamento de Dirección de Empresas y Marketing, Universidad de Huelva, Huelva, España
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Gorgemans S, Comendeiro-Maaløe M, Ridao-López M, Bernal-Delgado E. Comparing Hospital Efficiency: An Illustrative Study of Knee and Hip Replacement Surgeries in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3389. [PMID: 36834085 PMCID: PMC9963384 DOI: 10.3390/ijerph20043389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
WHO's Health Systems Performance Assessment framework suggests monitoring a set of dimensions. This study aims to jointly assess productivity and quality using a treatment-based approach, specifically analyzing knee and hip replacement, two prevalent surgical procedures performed with consolidated technology and run in most acute-care hospitals. Focusing on the analysis of these procedures sets out a novel approach providing clues for hospital management improvements, covering an existing gap in the literature. The Malmquist index under the metafrontier context was used to estimate the productivity in both procedures and its decomposition in terms of efficiency, technical and quality change. A multilevel logistic regression was specified to obtain the in-hospital mortality as a quality factor. All Spanish public acute-care hospitals were classified according to their average severity attended, dividing them into three groups. Our study revealed a decrease in productivity mainly due to a decrease in the technological change. Quality change remained constant during the period with highest variations observed between one period to the next according to the hospital classification. The improvement in the technological gap between different levels was due to an improvement in quality. These results provide new insights of operational efficiency after incorporating the quality dimension, specifically highlighting a decreasing operational performance, confirming that the technological heterogeneity is a critical question when measuring hospital performance.
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Affiliation(s)
- Sophie Gorgemans
- Department of Business Management and Organization, School of Engineering and Architecture, University of Zaragoza, 50009 Zaragoza, Spain
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Mohamadi E, Kiani MM, Olyaeemanesh A, Takian A, Majdzadeh R, Hosseinzadeh Lotfi F, Sharafi H, Sajadi HS, Goodarzi Z, Noori Hekmat S. Two-Step Estimation of the Impact of Contextual Variables on Technical Efficiency of Hospitals: The Case Study of Public Hospitals in Iran. Front Public Health 2022; 9:785489. [PMID: 35071166 PMCID: PMC8770937 DOI: 10.3389/fpubh.2021.785489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Measuring the efficiency and productivity of hospitals is a key tool to cost contamination and management that is very important for any healthcare system for having an efficient system. Objective: The purpose of this study is to examine the effects of contextual factors on hospital efficiency in Iranian public hospitals. Methods: This was a quantitative and descriptive-analytical study conducted in two steps. First, we measured the efficiency score of teaching and non-teaching hospitals by using the Data Envelopment Analysis (DEA) method. Second, the relationship between efficiency score and contextual factors was analyzed. We used median statistics (first and third quarters) to describe the concentration and distribution of each variable in teaching and non-teaching hospitals, then the Wilcoxon test was used to compare them. The Spearman test was used to evaluate the correlation between the efficiency of hospitals and contextual variables (province area, province population, population density, and the number of beds per hospital). Results: On average, the efficiency score in non-teaching hospitals in 31 provinces was 0.67 and for teaching hospitals was 0.54. Results showed that there is no significant relationship between the efficiency score and the number of hospitals in the provinces (p = 0.1 and 0.15, respectively). The relationship between the number of hospitals and the population of the province was significant and positive. Also, there was a positive relationship between the number of beds and the area of the province in both types of teaching and non-teaching hospitals. Conclusion: Multilateral factors influence the efficiency of hospitals and to address hospital inefficiency multi-intervention packages focusing on the hospital and its context should be developed. It is necessary to pay attention to contextual factors and organizational architecture to improve efficiency.
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Affiliation(s)
- Efat Mohamadi
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mohammad Mehdi Kiani
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Alireza Olyaeemanesh
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.,National Institute of Health Research, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Amirhossein Takian
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Reza Majdzadeh
- Community Based Participatory Research Centre and Knowledge Utilization Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Hamid Sharafi
- Department of Mathematics, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Haniye Sadat Sajadi
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.,University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Goodarzi
- National Institute of Health Research, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Somayeh Noori Hekmat
- Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Sánchez-Bayón A, González-Arnedo E, Andreu-Escario Á. Spanish Healthcare Sector Management in the COVID-19 Crisis Under the Perspective of Austrian Economics and New-Institutional Economics. Front Public Health 2022; 10:801525. [PMID: 35372254 PMCID: PMC8971546 DOI: 10.3389/fpubh.2022.801525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/09/2022] [Indexed: 11/30/2022] Open
Abstract
This is a study of Political Economy, Law & Economics, and Public Choice, applied to COVID-19 crisis management, and how the Spanish healthcare sector has operated under stressful conditions. Market and state failures are evaluated and some improvements are offered, according to the theories of Austrian Economics and New-Institutional Economics. At the macro level, the premise is the decentralization of the Spanish healthcare system a long time ago, to provide a better service to citizens, according to the idiosyncrasies of the Autonomous Communities (similar to federal states). The crisis has evidenced the failures of the Spanish system and its semi-federal model, without coordination to manage the trouble. Also, the General Government's recentralization attempt has failed too, proving Mises's theorem on the impossibility of economic calculation in intervened and coactive systems, with problems of shortages, lack of coordination, etc.; Buchanan-Tullock's theorem on the unfinished agenda of state interventionist and it suppression of private sector was also proven. At the micro level, health institutions (hospitals and health centers) have fallen into the paradox of media overexposure and the fake-news risk, because the more information they have tried to transmit, the more confusion they have caused, reducing the value of the supposed transparency and accountability, in addition to decreasing citizen wellbeing, giving way to a higher level of dissatisfaction and more risk of a syndemic. To perform the analysis of accountability and wellbeing perceived, this paper has used quantitative contrast techniques on secondary sources, such as the surveys of Centro de Investigaciones Sociológicas (part of the Public Sector) or Merco rankings (independent institution).
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Affiliation(s)
- Antonio Sánchez-Bayón
- Applied Economics II Department, Legal and Social Sciences School, Universidad Rey Juan Carlos, Madrid, Spain
- *Correspondence: Antonio Sánchez-Bayón
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Evaluation of Spanish Health System during the COVID-19 Pandemic: Accountability and Wellbeing Results. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412907. [PMID: 34948518 PMCID: PMC8701968 DOI: 10.3390/ijerph182412907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 01/31/2023]
Abstract
The COVID-19 pandemic poses a challenge for health systems. For this reason, it is essential to evaluate the management of health systems in the face of the pandemic, identifying the factors that may contribute to its failure or success. This management is more difficult in decentralized countries, since in them, health competencies are distributed among different levels of government. This is the case in Spain, one of the countries most affected by the pandemic. Therefore, the aim of this article is to evaluate how the Spanish health system has managed the COVID-19 pandemic. Four factors related to health management are analyzed: transparency, communication, reputation and well-being generated. For this purpose, a quantitative analysis is used with the contrast of secondary sources, such as the Merco rankings or survey data from the Centro de Investigaciones Sociológicas (Sociological Research Center). The results show that although the flow of communication about the health system increases considerably, such information comes mainly from the media, with a deficit in the transparency of health management. Likewise, although the reputation of the health system increases at the beginning of the pandemic, as it progresses, there is a deterioration in citizen satisfaction with the healthcare management and the services provided, as well as in the well-being generated by them. This study may have implications for decision making by public authorities regarding the different factors of health management.
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Multilevel Zero-One Inflated Beta Regression Model for the Analysis of the Relationship between Exogenous Health Variables and Technical Efficiency in the Spanish National Health System Hospitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910166. [PMID: 34639468 PMCID: PMC8508497 DOI: 10.3390/ijerph181910166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022]
Abstract
Background: This article proposes a methodological innovation in health economics for the second stage analysis of technical efficiency in hospitals. It investigates the relationship between the installed capacity in regions and hospitals and their ownership structure. Methods: A multilevel zero-one inflated beta regression model is employed to model pure technical efficiency more adequately than other models frequently used in econometrics. Results: Compared to publicly managed hospitals, the mean efficiency index of hospitals with public-private partnership (PPP) formulas was 4.27-fold. This figure was 1.90-fold for private hospitals. Concerning the efficiency frontier, the odds ratio (OR) of PPP models vs. public hospitals was 42.06. The OR of private hospitals vs. public hospitals was 8.17. A one standard deviation increase in the percentage of beds in intensive care units increases the odds of being situated on the efficiency frontier by 50%. Conclusions: The proportion of hospital beds in intensive care units relates to a higher chance of being on the efficiency frontier. Hospital ownership structure is related to the mean efficiency index of Spanish National Health Service hospitals, as well as the odds of being situated on the efficiency frontier.
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Silva LAJ, Pacahuala ER. [The Spanish crisis and nursing services during COVID-19]. GACETA SANITARIA 2021; 35:599. [PMID: 33750596 PMCID: PMC7885666 DOI: 10.1016/j.gaceta.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 11/23/2022]
Affiliation(s)
| | - Emilio Rosario Pacahuala
- Departamento de Humanidades, Facultat de Estudios Generales, Universidad Privada del Norte, Lima, Perú
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Data Envelopment Analysis Applications on Primary Health Care Using Exogenous Variables and Health Outcomes. SUSTAINABILITY 2021. [DOI: 10.3390/su13031337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A data envelopment analysis was used to evaluate the efficiency of 18 primary healthcare centres in a health district of the Valencian Community, Spain. Factor analysis was used as a first step in order to identify the most explanatory variables to be incorporated in the models. Included as variable inputs were the ratios of general practitioners, nurses, and costs; as output variables, those included were consultations, emergencies, avoidable hospitalisations, and prescription efficiency; as exogenous variables, those included were the percentage of population over 65 and a multimorbidity index. Confidence intervals were calculated using bootstrapping to correct possible biases. Efficient organisations within the set were identified, although the results depend on the models used and the introduction of exogenous variables. Pharmaceutical expenditure showed the greatest slack and room for improvement in its management. Data envelopment analysis allows an evaluation of efficiency that is focussed on achieving better results and a proper distribution and use of healthcare resources, although it needs the desired goals of the healthcare managers to be clearly identified, as the perspective of the analysis influences the results, as does including variables that measure the achievements and outcomes of the healthcare services.
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Franco Miguel JL, Fullana Belda C, Cordero Ferrera JM, Polo C, Nuño-Solinís R. Efficiency in chronic illness care coordination: public-private collaboration models vs. traditional management. BMC Health Serv Res 2020; 20:1044. [PMID: 33198716 PMCID: PMC7667775 DOI: 10.1186/s12913-020-05894-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this paper is to analyze the differences in the coordination of chronic illness care between the different public hospital management models coexisting in the Spanish region of Madrid (25 hospitals) during the period 2013–2017. Methods The performance of hospitals might be affected by the characteristics of the population they serve and, therefore, this information should be taken into account when estimating efficiency measures. For this purpose, we apply the nonparametric Data Envelopment Analysis (DEA) conditioned to some contextual variables and adapted to a dynamic framework, so that we can assess hospitals during a five-year period. The outputs considered are preventable hospitalizations, readmissions for heart failure and readmissions for chronic obstructive pulmonary disease, whereas the inputs considered are the number of beds, personnel (physicians and other healthcare professionals) and total expenditure on goods and services. Results The results suggest that the level of efficiency demonstrated by the public-private collaboration models of hospital management is higher than traditionally managed hospitals throughout the analyzed period. Nevertheless, we notice that efficiency differences among hospitals are significantly reduced when contextual factors were taken into account. Conclusions Hospitals managed under public-private collaboration models are more efficient than those under traditional management in terms of chronic illness care coordination, being this difference attributable to more agile and flexible management under the collaborative models. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12913-020-05894-z.
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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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Arango-Lasprilla JC, Zeldovich M, Olabarrieta-Landa L, Forslund MV, Núñez-Fernández S, von Steinbuechel N, Howe EI, Røe C, Andelic N. Early Predictors of Employment Status One Year Post Injury in Individuals with Traumatic Brain Injury in Europe. J Clin Med 2020; 9:jcm9062007. [PMID: 32604823 PMCID: PMC7355447 DOI: 10.3390/jcm9062007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022] Open
Abstract
Sustaining a traumatic brain injury (TBI) often affects the individual’s ability to work, reducing employment rates post-injury across all severities of TBI. The objective of this multi-country study was to assess the most relevant early predictors of employment status in individuals after TBI at one-year post-injury in European countries. Using a prospective longitudinal non-randomized observational cohort (The Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) project), data was collected between December 2014–2019 from 63 trauma centers in 18 European countries. The 1015 individuals who took part in this study were potential labor market participants, admitted to a hospital and enrolled within 24 h of injury with a clinical TBI diagnosis and indication for a computed tomography (CT) scan, and followed up at one year. Results from a binomial logistic regression showed that older age, status of part-time employment or unemployment at time of injury, premorbid psychiatric problems, and higher injury severity (as measured with higher Injury severity score (ISS), lower Glasgow Coma Scale (GCS), and longer length of stay (LOS) in hospital) were associated with higher unemployment probability at one-year after injury. The study strengthens evidence for age, employment at time of injury, premorbid psychiatric problems, ISS, GCS, and LOS as important predictors for employment status one-year post-TBI across Europe.
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Affiliation(s)
- Juan Carlos Arango-Lasprilla
- Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain;
- IKERBASQUE Basque Foundation for Science, 48013 Bilbao, Spain
- Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
- Correspondence: (J.C.A.-L.); (M.Z.); Tel.: +34-946-006-000 (J.C.A.-L.) (ext. 7963); +49-551-398-195 (M.Z.)
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany;
- Correspondence: (J.C.A.-L.); (M.Z.); Tel.: +34-946-006-000 (J.C.A.-L.) (ext. 7963); +49-551-398-195 (M.Z.)
| | | | - Marit Vindal Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (M.V.F.); (E.I.H.); (C.R.); (N.A.)
| | | | - Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany;
| | - Emilie Isager Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (M.V.F.); (E.I.H.); (C.R.); (N.A.)
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (M.V.F.); (E.I.H.); (C.R.); (N.A.)
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (M.V.F.); (E.I.H.); (C.R.); (N.A.)
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
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Ghafari Someh N, Pishvaee MS, Sadjadi SJ, Soltani R. Sustainable efficiency assessment of private diagnostic laboratories under uncertainty. JOURNAL OF MODELLING IN MANAGEMENT 2020. [DOI: 10.1108/jm2-05-2019-0117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Assessing the performance of medical laboratories plays an important role in the quality of health services. However, because of imprecise data, reliable results from laboratory performance cannot be obtained easily. The purpose of this paper is to illustrate the use of interval network data envelopment analysis (INDEA) based on sustainable development indicators under uncertainty.
Design/methodology/approach
In this study, each medical diagnostic laboratory is considered as a decision-making unit (DMU) and an INDEA model is used for calculating the efficiency of each medical diagnostic laboratory under imprecise inputs and outputs. The proposed model helps provide managers with effective performance scores for deficiencies and business improvements. The proposed model with realistic efficiency scores can help administrators manage their deficiencies and ultimately improve their business.
Findings
The results indicate that uncertainty can lead to changes in performance scores, rankings and performance classifications. Therefore, the use of DEA models under certainty can be potentially misleading.
Originality/value
The contribution of this study provides useful insights into the use of INDEA as a modeling tool to aid managerial decision-making in assessing efficiency of medical diagnostic laboratories based on sustainable development indicators under uncertainty.
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San-Jose L, Retolaza JL, Bernal R. [Social value added index: a proposal for analyzing hospital efficiency]. GACETA SANITARIA 2019; 35:21-27. [PMID: 31776045 DOI: 10.1016/j.gaceta.2019.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 07/06/2019] [Accepted: 08/02/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objective of this paper is to demonstrate that it is possible to monetize the social value generated by a hospital and use it to establish a different perspective to analyze the efficiency of public spending. METHOD A public hospital in Spain was selected using the case method. It is suitable for two reasons; first, the hospital activity is small and therefore dialogue with stakeholders is easy; and second, as it is a hospital of a residential nature, it allows an easy, modifiable and testable approximation of social accounting in hospitals. RESULTS It establishes the monetary translation of the activity of a hospital, including the social part of the economic transactions (market), the variables that have not been created based on economic transaction, but have been perceived and valued by the stakeholders (not market), and the satisfaction of the stakeholders (emotional). This socio-emotional value amounts to approximately 60 million Euros per year from 2013 to 2017. CONCLUSIONS The social value generated for the stakeholders, and its monetization, allows more efficient management of decisions towards the social purpose of public hospitals. In particular, the social value added index can be a tool for the social-efficiency of hospitals, as it establishes how much social value it generates from the public funding allocated to it. Thus, the decline in this value in recent years denotes a problem that, without this analysis with a social perspective and from the stakeholders, could not have been detected.
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Affiliation(s)
- Leire San-Jose
- Universidad del País Vasco, UPV/EHU, Grupo ECRI, Bilbao, España; Universidad de Huddersfield, United Kingdom.
| | | | - Ramon Bernal
- Universidad del País Vasco, UPV/EHU, Grupo ECRI, Bilbao, España
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Martín Cervantes PA, Rueda López N, Cruz Rambaud S. A Causal Analysis of Life Expectancy at Birth. Evidence from Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2367. [PMID: 31277340 PMCID: PMC6650812 DOI: 10.3390/ijerph16132367] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 06/26/2019] [Accepted: 06/30/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND From a causal point of view, there exists a set of socioeconomic indicators concerning life expectancy. The objective of this paper is to determine the indicators which exhibit a relation of causality with life expectancy at birth. METHODS Our analysis applies the Granger causality test, more specifically its version by Dumitrescu-Hurlin, starting from the information concerning life expectancy at birth and a set of socioeconomic variables corresponding to 17 Spanish regions, throughout the period 2006-2016. To do this, we used the panel data involving the information provided by the Spanish Ministry of Health, Consumer Affairs and Social Welfare (MHCSW) and the National Institute of Statistics (NIS). RESULTS Per capita income, and the rate of hospital beds, medical staff and nurses Granger-cause the variable "life expectancy at birth", according to the Granger causality test applied to panel data (Dumitrescu-Hurlin's version). CONCLUSIONS Life expectancy at birth has become one of the main indicators able to measure the performance of a country's health system. This analysis facilitates the identification of those factors which exhibit a unidirectional Granger-causality relationship with life expectancy at birth. Therefore, this paper provides useful information for the management of public health resources from the point of view of the maximization of social benefits.
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Affiliation(s)
| | - Nuria Rueda López
- Department of Economics and Business, Universidad de Almería, 04120 Almería, Spain
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Franco Miguel JL, Fullana Belda C. [New hospital management models as an alternative for the sustainability of public hospital system: An analysis of efficiency in health expenditure]. J Healthc Qual Res 2019; 34:131-147. [PMID: 30982705 DOI: 10.1016/j.jhqr.2019.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/09/2018] [Accepted: 01/25/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyse the efficiency in health expenditure of the new hospital management models (Private Finance Initiative [PFI], Public Private Partnership [PPP] and other new management models) compared to the traditional management, with the objective of determining which is the more sustainable and efficient. MATERIAL AND METHODS The efficiency was measured in health expenditure terms of the different general hospitals management models in the period 2009-2016, using data envelopment analysis (DEA). The study included a population of 7 hospitals with a PFI model, a population of 3 hospitals with a PPP model, a population of 4 hospitals with other new management models, and a population of 11 public hospitals with direct public management by the Madrid Health Service (SERMAS). RESULTS The highest mean health expenditure efficiency corresponded to the PPP model (85.8%), followed by the PFI model (73.5%), and the other new management models (56.6%). The lowest mean health expenditure efficiency corresponded to the direct public management model, with 53.3%. As regards changes in productivity, measured by the Malmquist Index, there were increases amounting to 1.1% in the PPP model, 1% in the PFI model, 1.8% in traditional management, and a decrease of 3.8% in the other new management models. CONCLUSIONS Hospitals governed by new management models had a higher health expenditure efficiency, and from the health expenditure point of view they are an alternative to be considered in the planning of new health infrastructures.
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Serván-Mori E, Chivardi C, Mendoza MÁ, Nigenda G. A longitudinal assessment of technical efficiency in the outpatient production of maternal health services in México. Health Policy Plan 2018; 33:888-897. [PMID: 30137317 DOI: 10.1093/heapol/czy074] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2018] [Indexed: 11/14/2022] Open
Abstract
We assess technical efficiency (TE) level for Mexican Ministry of Health (MoH) primary care units. Assessment was focused on the production of adequate maternal health services defined as the coverage level of women who received timely and frequent antenatal care, and institutional and medical care during childbirth. We conducted a longitudinal analysis of administrative and socio-demographic information concerning 233 health jurisdictions for the period 2008-15. Crude TE was calculated using window data envelopment analysis (Windows-DEA). Empirical analysis included the description of several factors affecting the production of maternal health services, including the heterogeneity and trends assessment of TE among health jurisdictions. We estimated a pooled regression model with robust standard errors to identify correlates of TE and estimated adjusted performance scores. Results indicate that while the production of adequate maternal-health services and TE in health jurisdictions proved insufficient, they rose by 22% (from 40.9% to 49.8%) and 14% (from 54.3% to 62%), respectively, over time. Furthermore, variance in efficiency among production units diminished and persistent regularities were observed. Performance was highest in the Northern as opposed to the Southern and Southeastern health jurisdictions, but lowest in the most marginalized zones of the country marked by economic inequality and the presence of indigenous populations. The Mexican Health System has reached a paradoxical situation: the steady escalation of financial resources in the public health subsystem over the past 15 years has yielded sub-optimal results as regards coverage for essential maternal health interventions among the poorest. Mexican government must put in place a set of measures to guarantee efficiency in the system's performance without affecting equity gains. This necessarily involves reconsidering, and where necessary replacing, the criteria behind the allocation and distribution of resources, as well as the mechanisms for controlling how resources are used and accountability is fulfilled.
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Affiliation(s)
| | | | - Miguel Ángel Mendoza
- School of Economics, National Autonomous University of México, México City, México
| | - Gustavo Nigenda
- National School of Nursing and Obstetrics, National Autonomous University of México, México City, México
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Franco Miguel JL, Fullana Belda C, Rúa Vieites A. Analysis of the technical efficiency of the forms of hospital management based on public-private collaboration of the Madrid Health Service, as compared with traditional management. Int J Health Plann Manage 2018; 34:414-442. [PMID: 30303272 DOI: 10.1002/hpm.2678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 11/07/2022] Open
Abstract
FUNDAMENTALS The study aims to carry out a comparative analysis of the technical efficiency of hospital management based on public-private collaboration, as compared with traditional management. Specifically, we compare traditionally managed public hospitals, public hospitals managed by a private finance initiative (PFI), public hospitals managed through a public-private partnership (PPP), and hospitals managed through other forms of management, during the period 2009 to 2014, in the hospitals dependent on the Madrid Health Service (SERMAS). METHODS The study covers all publicly owned general hospitals under SERMAS, consisting of seven PFI hospitals, three PPP hospitals, 11 traditionally managed public hospitals (with the category of general hospital), and four hospitals managed through other forms of hospital management. The technical efficiency indices of the hospitals were calculated using the data envelopment analysis technique. Subsequently, a sensitivity analysis was performed by bootstrapping and variation of model variables to verify their impact on efficiency. Finally, an analysis of the evolution of efficiency in the analyzed period was carried out using the Malmquist Index. RESULTS In all the analysis models carried out in the analyzed period, the hospitals managed based on public-private collaboration were more efficient than the hospitals under traditional management. CONCLUSIONS The greater efficiency of hospitals managed based on public-private collaboration, as compared with traditional management, could be attributed to greater organizational and management flexibility.
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Gorgemans S, Comendeiro-Maaløe M, Ridao-López M, Bernal-Delgado E. Quality and technical efficiency do not evolve hand in hand in Spanish hospitals: Observational study with administrative data. PLoS One 2018; 13:e0201466. [PMID: 30071062 PMCID: PMC6072019 DOI: 10.1371/journal.pone.0201466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/15/2018] [Indexed: 11/18/2022] Open
Abstract
Objective Recent evidence on the Spanish National Health System (SNHS) reveals a considerable margin for hospital efficiency and quality improvement. However, those studies do not consider both dimensions together. This study aims at jointly studying both technical efficiency (TE) and quality, classifying the public SNHS hospitals according to their joint performance. Methods Stochastic frontier analysis is used to estimate TE and multilevel logistic regressions to build a low-quality composite measure (LQ), which considers in-hospital mortality and safety events. All hospitalizations discharged in Spain in 2003 and 2013, in 179 acute-care general hospitals, were studied. Four scenarios of resulting performance were built setting yearly medians as thresholds for the overall sample, and according to hospital-complexity strata. Results Overall, since 2003, median TE improved and LQ reduced -from TE2003:0.89 to TE2013:0.93 and, from LQ2003:42.6 to LQ2013:27.7 per 1,000 treated patients. The time estimated coefficient showed technical progress over the period. TE across hospitals showed scarce variability (CV2003:0.08 vs. CV2013:0.07), not so the rates of LQ (CV2003:0.64 vs. CV2013:0.76). No correlation was found between TE values and LQ rates. When jointly considering technical efficiency and quality, hospitals dealing with the highest clinical complexity showed the highest chance to be placed in optimal scenarios, also showing lesser variability between hospitals. Conclusions Efficiency and quality have improved in Spanish public hospitals. Not all hospitals experiencing improvements in efficiency equally improved their quality. The joint analysis of both dimensions allowed identifying those optimal hospitals according to this trade-off.
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Affiliation(s)
- Sophie Gorgemans
- Department of Management, School of Engineering and Architecture, University of Zaragoza, Zaragoza, Spain
- * E-mail:
| | - Micaela Comendeiro-Maaløe
- Institute for Health Sciences in Aragon (IACS), Zaragoza, Spain
- REDISSEC–Research Network for Health Services on Chronic Patients, Galdakao, Spain
| | - Manuel Ridao-López
- Institute for Health Sciences in Aragon (IACS), Zaragoza, Spain
- REDISSEC–Research Network for Health Services on Chronic Patients, Galdakao, Spain
| | - Enrique Bernal-Delgado
- Institute for Health Sciences in Aragon (IACS), Zaragoza, Spain
- REDISSEC–Research Network for Health Services on Chronic Patients, Galdakao, Spain
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Pérez-Romero C, Ortega-Díaz MI, Ocaña-Riola R, Martín-Martín JJ. [Multilevel analysis of the technical efficiency of hospitals in the Spanish National Health System by property and type of management]. GACETA SANITARIA 2018; 33:325-332. [PMID: 29759305 DOI: 10.1016/j.gaceta.2018.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 02/01/2018] [Accepted: 02/05/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze technical efficiency by type of property and management of general hospitals in the Spanish National Health System (2010-2012) and identify hospital and regional explanatory variables. METHOD 230 hospitals were analyzed combining data envelopment analysis and fixed effects multilevel linear models. Data envelopment analysis measured overall, technical and scale efficiency, and the analysis of explanatory factors was performed using multilevel models. RESULTS The average rate of overall technical efficiency of hospitals without legal personality is lower than hospitals with legal personality (0.691 and 0.876 in 2012). There is a significant variability in efficiency under variable returns (TE) by direct, indirect and mixed forms of management. The 29% of the variability in TE es attributable to the Region. Legal personality increased the TE of the hospitals by 11.14 points. On the other hand, most of the forms of management (different to those of the traditional hospitals) increased TE in varying percentages. At regional level, according to the model considered, insularity and average annual income per household are explanatory variables of TE. DISCUSSION Having legal personality favours technical efficiency. The regulatory and management framework of hospitals, more than public or private ownership, seem to explain technical efficiency. Regional characteristics explain the variability in TE.
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Affiliation(s)
| | | | - Ricardo Ocaña-Riola
- Escuela Andaluza de Salud Pública, Granada, España; Instituto de Investigación Biosanitaria de Granada, Granada, España
| | - José Jesús Martín-Martín
- Instituto de Investigación Biosanitaria de Granada, Granada, España; Departamento de Economía Aplicada, Universidad de Granada, Granada, España
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Relación entre sistemas de costes y gasto hospitalario. GACETA SANITARIA 2018; 32:158-165. [DOI: 10.1016/j.gaceta.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 11/19/2022]
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