Assessment of the Efficiency of Public Hospitals in Romania
DOI:
https://doi.org/10.47743/saeb-2023-0027Keywords:
hospital efficiency, healthcare, Data Envelopment AnalysisAbstract
Considering the high pressure on the healthcare limited resources, mainly on hospitals, determined by the population ageing, and the increased incidence of chronic and infectious diseases, it is essential to both decrease expenditures and provide good quality healthcare. In this paper we focus on the efficiency of Romanian public hospitals. Our research goals are to identify and examine the inefficient public hospitals in Romania; to determine sources of inefficiency in Romanian public hospitals; to describe a potential reduction in all inputs on average to rationalize hospital resources; and recommend that hospital management be improved. We propose an approach that contains preliminary data analyses to obtain homogeneous distributions, then we use Data Envelopment Analysis to estimate the technical efficiency scores for the hospitals in the sample. The results showed that more than half of the examined small hospitals were technically inefficient and that they could have produced a larger number of discharges and consequently an increased number of inpatient days. Possible reductions in inputs were also indicated. These results suggest ways of improving hospital management and restructuring and reorganizing decisions that can be implemented in the hospital network.
References
Ahamed, S. K., Naidu, M. M., & Subba Rami Reddy, C. (2016). Outliers/Most Influential Observations in Variable Returns to Scale Data Envelopment Analysis. Indian Journal of Science and Technology, 9(2), 1-7. http://dx.doi.org/10.17485/ijst/2016/v9i2/80361
Alatawi, A. D., Niessen, L. W., & Khan, J. A. M. (2020). Efficiency Evaluation of Public Hospitals in Saudi Arabia: An Application of Data Envelopment Analysis. BMJ Open, 10(1), e031924. http://dx.doi.org/10.1136/bmjopen-2019-031924
Antohi, V. M. (2017). Romanian Healthcare Financing Based On The Diagnosis-Related Group Payment System (DRG). In A. Sandu, T. Ciulei, & A. Frunza (Eds.), Multidimensional Education and Professional Development: Ethical Values (Vol. 27, pp. 19-28): Future Academy. http://dx.doi.org/10.15405/epsbs.2017.07.03.4
Atılgan, E. (2016). The Technical Efficiency of Hospital Inpatient Care Services: An Application for Turkish Public Hospitals. Business and Economics Research Journal, 7(2), 203-214. http://dx.doi.org/10.20409/berj.2016217537
Björnberg, A., & Phang, A. Y. (2019). Euro Health Consumer Index 2018. Retrieved from https://healthpowerhouse.com/media/EHCI-2018/EHCI-2018-report.pdf
Bogetoft, P., & Otto, L. (2011). Benchmarking with DEA, SFA, and R (Vol. 157). New York: Springer http://dx.doi.org/10.1007/978-1-4419-7961-2
Carling, K. (2000). Resistant Outlier Rules and the Non-Gaussian Case. Computational Statistics & Data Analysis, 33(3), 249-258. http://dx.doi.org/10.1016/S0167-9473(99)00057-2
Caunic, R.-E. (2020). Technical and Scale Efficiency in Romanian Public Hospitals: Estimating with Data Envelopment Analysis. Proceedings of the International Conference on Applied Statistics, 2(1), 66-76. http://dx.doi.org/10.2478/icas-2021-0006
Caunic, R.-E., Asandului, L., & Bedrule-Grigoruță, M. V. (2021). A Data Envelopment Analysis of the Response of Healthcare Facilities to Coronavirus Pandemic: Evidence from Romania. EURINT 2021, 8(July), 23-40.
Charnes, A., Cooper, W. W., & Rhodes, E. (1978). Measuring the Efficiency of Decision Making Units. European Journal of Operational Research, 2(6), 429-444. http://dx.doi.org/10.1016/0377-2217(78)90138-8
Chisholm, D., & Evans, D. (2010). Improving Health System Efficiency as a Means of Moving towards Universal Coverage. Retrieved from https://www.who.int/publications/m/item/improving-health-system-efficiency-as-a-means-of-moving-towards-universal-coverage
Cinaroglu, S. (2021). Geographic Distribution of the Efficiency of Childbirth Services in Turkey. In Y. I. Topcu, O. Ozaydin, O. Kabak, & S. O. Ekici (Eds.), Multiple Criteria Decision Making (pp. 131-154). Cham: Springer. http://dx.doi.org/10.1007/978-3-030-52406-7_5
Donabedian, A., Wheeler, J. R. C., & Wyszewianski, L. (1982). Quality, Cost, and Health: An Integrative Model. Medical Care, 20(10), 975-992. http://dx.doi.org/10.1097/00005650-198210000-00001
Duran, A., Chanturidze, T., Gheorghe, A., & Moreno, A. (2019). Assessment of Public Hospital Governance in Romania: Lessons From 10 Case Studies. International Journal of Health Policy and Management, 8(4), 199-210. http://dx.doi.org/10.15171/ijhpm.2018.120
Duran, A., Chanturidze, T., Moreno, A., & Gheorghe, A. (2017). Performance Auditing of Selected Public Hospitals with Arrears. Retrieved from https://ms.ro/media/documents/A0775_-Final-Report_010517_updated-_ENG.pdf
Eurostat. (2018). Statistics explained - Glossary: Hospital discharge. Retrieved from https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Glossary:Hospital_discharge
Farrell, M. J. (1957). The Measurement of Productive Efficiency. Journal of the Royal Statistical Society. Series A (General), 120(3), 253-281. http://dx.doi.org/10.2307/2343100
Fatulescu, P. I. (2011). Romanian Health System: Lessons Still to Learn. Acta Universitatis Danubius. Œconomica, 7(3), 193-202.
Ferraz, D., Mariano, E. B., Manzine, P. R., Moralles, H. F., Morceiro, P. C., Torres, B. G., . . . Rebelatto, D. A. D. N. (2021). COVID Health Structure Index: The Vulnerability of Brazilian Microregions. Social Indicators Research, 158(1), 197-215. http://dx.doi.org/10.1007/s11205-021-02699-3
García-Cornejo, B., & Pérez-Méndez, J. A. (2020). Influence of Cost Systems on Efficiency. An Analysis of Spanish Hospitals Using Public National Databases. Revista de Contabilidad, 23(2), 249-262. http://dx.doi.org/10.6018/rcsar.365031
Golany, B., & Roll, Y. (1989). An Application Procedure for DEA. Omega, 17(3), 237-250. http://dx.doi.org/10.1016/0305-0483(89)90029-7
Guillon, M., Audibert, M., & Mathonnat, J. (2022). Efficiency of District Hospitals in Zimbabwe: Assessment, Drivers and Policy Implications. The International Journal of Health Planning and Management, 37(1), 271-280. http://dx.doi.org/10.1002/hpm.3337
Hollingsworth, B. (2008). The Measurement of Efficiency and Productivity of Health Care Delivery. Health Economics, 17(10), 1107-1128. http://dx.doi.org/10.1002/hec.1391
Hospitals Law No. 95, 95 C.F.R. (2006).
Institute of Medicine (US) Committee on Quality of Health Care in America. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press. http://dx.doi.org/10.17226/10027
Issue Monitoring. (2020). Health Care System in Romania. Retrieved from https://issuemonitoring.eu/sistemul-de-sanatate-din-romania-politici-publice/
Jones, R. (2011). Hospital Bed Occupancy Demystified. British Journal of Healthcare Management, 17(6), 242-248. http://dx.doi.org/10.12968/bjhc.2011.17.6.242
Kirigia, J. M., & Asbu, E. Z. (2013). Technical and Scale Efficiency of Public Community Hospitals in Eritrea: An Exploratory Study. Health Economics Review, 3(1), 6. http://dx.doi.org/10.1186/2191-1991-3-6
Kirigia, J. M., Emrouznejad, A., & Sambo, L. G. (2002). Measurement of Technical Efficiency of Public Hospitals in Kenya: Using Data Envelopment Analysis. Journal of Medical Systems, 26(1), 39-45. http://dx.doi.org/10.1023/A:1013090804067
Kocisova, K., Hass-Symotiuk, M., & Kludacz-Alessandri, M. (2018). Use of the DEA Method to Verify the Performance Model for Hospitals. E+M Ekonomie a Management, 21(4), 125-140. http://dx.doi.org/10.15240/tul/001/2018-4-009
Kohl, S., Schoenfelder, J., Fügener, A., & Brunner, J. O. (2019). The Use of Data Envelopment Analysis (DEA) in Healthcare with a Focus on Hospitals. Health Care Management Science, 22(2), 245-286. http://dx.doi.org/10.1007/s10729-018-9436-8
McKee, M., & Healy, J. (2002). The Significance of Hospitals: An Introduction. In M. McKee & J. Healy (Eds.), Hospitals in a changing Europe (pp. 3-14). Buckingham: Open University Press.
Ministry of Health. (2014). National Health Strategy 2014 - 2020Anexa 1(November), 1-76. Retrieved from https://old.ms.ro/upload/Anexa%201%20-%20Strategia%20Nationala%20de%20Sanatate%202014-2020.pdf
Mitropoulos, P., Mitropoulos, I., & Sissouras, A. (2013). Managing for Efficiency in Health Care: The Case of Greek Public Hospitals. The European Journal of Health Economics, 14(6), 929-938. http://dx.doi.org/10.1007/s10198-012-0437-0
National Institute for Health Services Management. (2022). Romanian Health Services Research and Evaluation Center. Retrieved from http://www.drg.ro/
National Institute of Statistics. (2020). Health Units Activity in 2019. Retrieved from https://insse.ro/cms/sites/default/files/field/publicatii/activitatea_unitatilor_sanitare_anul_2019.pdf
Nepomuceno, T. C. C., Silva, W. M. N., Nepomuceno, K. T. C., & Barros, I. K. F. (2020). A DEA-Based Complexity of Needs Approach for Hospital Beds Evacuation during the COVID-19 Outbreak. Journal of Healthcare Engineering, 2020(September), 1-9. http://dx.doi.org/10.1155/2020/8857553
Nistor, C. S., Ștefănescu, C. A., Sîntejudeanu, M. A., & Crișan, A.-R. (2017). Performance Through Efficiency in the Public Healthcare System – A DEA Approach in an Emergent Country. Studia Universitatis Babes-Bolyai, Oeconomica, 62(1), 31-49.
O’Neill, L., Rauner, M., Heidenberger, K., & Kraus, M. (2008). A Cross-National Comparison and Taxonomy of DEA-Based Hospital Efficiency Studies. Socio-Economic Planning Sciences, 42(3), 158-189. http://dx.doi.org/10.1016/j.seps.2007.03.001
OECD. (2019). Romania: Country Health Profile 2019. Paris: OECD Publishing. http://dx.doi.org/10.1787/f345b1db-en
OECD. (2021). Romania: Country Health Profile 2021. Paris: OECD Publishing. http://dx.doi.org/10.1787/74ad9999-en
Ortega-Díaz, M. I., Ocaña-Riola, R., Pérez-Romero, C., & Martín-Martín, J. J. (2020). 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, 17(16), 1-19. http://dx.doi.org/10.3390/ijerph17165905
Ozcan, Y. A. (1992). Sensitivity Analysis of Hospital Efficiency under Alternative Output/Input and Peer Groups: A Review. Knowledge in Society, 5(4), 1-29. http://dx.doi.org/10.1007/BF02692773
Ozcan, Y. A. (2008). Hospital Applications. In Y. A. Ozcan (Ed.), Health Care Benchmarking and Performance Evaluation: An Assessment using Data Envelopment Analysis (DEA) (pp. 103-117). Boston, MA: Springer US. http://dx.doi.org/10.1007/978-0-387-75448-2_8
Pecoraro, F., Luzi, D., Cesarelli, M., & Clemente, F. (2015). A Methodology of Healthcare Quality Measurement: A Case Study. Journal of Physics: Conference Series, 588(1), 1-5. http://dx.doi.org/10.1088/1742-6596/588/1/012027
Radu, C. P., Chiriac, D. N., & Vladescu, C. (2010). Changing Patient Classification System for Hospital Reimbursement in Romania. Croatian Medical Journal, 51(3), 250-258. http://dx.doi.org/10.3325/cmj.2010.51.250
Radu, F., Radu, V., Turkeș, M. C., Ivan, O. R., & Tăbîrcă, A. I. (2022). A Research of Service Quality Perceptions and Patient Satisfaction: Case Study of Public Hospitals in Romania. The International Journal of Health Planning and Management, 37(2), 1018-1048. http://dx.doi.org/10.1002/hpm.3375
Radu, P. (2006). Introduction to the Diagnostic Reference Group (DRG) system Hospital Management (pp. 91-95): Public H Press.
Rotea, C. S., Logofatu, M., & Ploscaru, C. C. (2018). Quantitative Model for Assessing the Impact of Reward System Elements on Hospital Efficiency. International Journal of Academic Research in Business & Social Sciences, 8(8), 231-241. http://dx.doi.org/10.6007/IJARBSS/v8-i8/4461
Samoilenko, S., & Osei-Bryson, K. M. (2010). Determining Sources of Relative Inefficiency in Heterogeneous Samples: Methodology using Cluster Analysis, DEA and Neural Networks. European Journal of Operational Research, 206(2), 479-487. http://dx.doi.org/10.1016/j.ejor.2010.02.017
Shahhoseini, R., Tofighi, S., Jaafaripooyan, E., & Safiaryan, R. (2011). Efficiency Measurement in Developing Countries: Application of Data Envelopment Analysis for Iranian Hospitals. Health Services Management Research, 24(2), 75-80. http://dx.doi.org/10.1258/hsmr.2010.010017
Stefanescu, A. (2019). Designing the Smart Hospitals -Through Intelligently Integrated Tools of Quality and Cost Effectiveness. In D. Vrontis, Y. Weber, & E. Tsoukatos (Eds.), Business Management Theories and Practices in a Dynamic Competitive Environment (Vol. 12, pp. 1865-1867). Thessaloniki, Greece: EuroMed Press.
Talaghir, L.-G., Gheonea, V., Rus, C. M., Cretu, C.-M., & Iconomescu, T.-M. (2018). Statistical Analysis of Hospitalized Morbidity Indicators based on DRG in Romanian Public Hospitals. Revista de Cercetare si Interventie Sociala, 61(June), 163-186.
Tiemann, O., & Schreyögg, J. (2012). Changes in Hospital Efficiency after Privatization. Health Care Management Science, 15(4), 310-326. http://dx.doi.org/10.1007/s10729-012-9193-z
Tukey, J. W. (1977). Exploratory Data Analysis (Vol. 2): Addison-Wesley.
Voinea, L., & Pamfilie, R. (2009). Considerations Regarding the Performance Improvement of the Hospital Healthcare Services from Romania by the Implementation of an Integrated Management System. Amfiteatrul Economic, 11(26), 339-345.
Wilson, P. W. (2018). Dimension Reduction in Nonparametric Models of Production. European Journal of Operational Research, 267(1), 349-367. http://dx.doi.org/10.1016/j.ejor.2017.11.020
Zere, E., Mbeeli, T., Shangula, K., Mandlhate, C., Mutirua, K., Tjivambi, B., & Kapenambili, W. (2006). Technical Efficiency of District Hospitals: Evidence from Namibia using Data Envelopment Analysis. Cost Effectiveness and Resource Allocation, 4(1), 1-9. http://dx.doi.org/10.1186/1478-7547-4-5
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Copyright (c) 2022 Laura Asandului, Raluca-Elena Caunic, Paul Coţofrei
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