Evaluating Colombian public hospitals productivity during 2004-2015. A Luenberger-Indicator approach
Published
Oct 2, 2020
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Antonio José Orozco Gallo
https://orcid.org/0000-0002-2666-3617
Camilo Almanza Ramírez
https://orcid.org/0000-0003-3934-5578
https://orcid.org/0000-0002-2666-3617
Camilo Almanza Ramírez
https://orcid.org/0000-0003-3934-5578
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Abstract
Background: In Colombia, public policy has encouraged hospital efficiency and sustainability since 1993, when its health system underwent a profound change with the Law 100. Method: We estimate the efficiency and productivity of Colombian public hospitals using the Luenberger productivity indicator. This less restrictive indicator allows for a disaggregated regional analysis and does not overestimate the change in productivity when compared to other measures. It was made an empirical application to a sample of 260 hospitals during the 2004-2015 period. Results: The results show a productivity decline for Colombian public hospitals, explained mainly by the decrease in technological change as a result of low investment in technology. In fact, one out of every eighty-seven hospitals reached an improvement in efficiency and technological change simultaneously, while, one out of every two experienced the opposite. On average, hospitals in all regions showed a productivity decrease, in particular those in the Eastern region, an area that accounted, with the Central region, three-fifths of the overall decline. Discussion and conclusion: The efficiency and productivity that was sought to be achieved through the profound change in the health system were insufficient. Thus, governmental measures should: encourage managers to modernize their administrative and organizational factors, promote the development of technology and research in health by greater investments, and foster complementary and non-competitive relationships among hospitals.
Keywords
References
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3. Toro E, Mutis G. Medición de la eficiencia de las instituciones prestadoras de servicios de salud públicas mediante técnicas multivariadas y análisis envolvente de datos. Bogotá: Universidad de los Andes; 2006. https://repositorio.uniandes.edu.co/handle/1992/9379? locale-attribute=en
4. Pinzón M. Medición de eficiencia técnica relativa en hospitales públicos de baja complejidad mediante la metodología Data Envelopment Analysis (DEA). Archivos de Economía, Bogotá: DNP; 2003. https://colaboracion.dnp.gov.co/CDT/Estudios%20Econmicos/245.pdf
5. Barros C, Menezes A, Peypoch N, Solonandrasana B, Vieira J. An analysis of hospital efficiency and productivity growth using the Luenberger indicator. Health Care Manag Sci. 2008 Jan;11(4): 373-381. https://doi.org/10.1007/s10729-007-9043-6
6. Worthington A. Frontier efficiency measurement in healthcare: a review of empirical techniques and selected applications. Med Care Res Rev. 2004;61(2): 1-36. https://doi.org/10.1177/1077558704263796
7. Charnes A, Cooper W, Lewin A, Seiford L. Data envelopment analysis: theory, methodology and application. Boston: Kluwer; 1994.
8. Chambers RG, Chung Y, Färe R. Benefit and distance functions. J Econ Theory. 1996;70(2): 407-419. https://doi.org/10.1006/jeth.1996.0096
9. Shephard RW. Theory of cost and production function. New Jersey: Princeton University Press; 1970.
10. Williams J, Peypoch N, Barros C. The Luenberger indicator and productivity growth: a note on the European savings banks sector. Appl Econ. 2011;43(6): 747-755. https://doi.org/10.1080/00036840802599859
11. Peñaloza MC. Evaluación de la Eficiencia en instituciones hospitalarias públicas y privadas con Data Envelopment Analysis (DEA). Archivos de Economía, Departamento Nacional de Planeación. Bogotá: DNP; 2003. https://colaboracion.dnp.gov.co/CDT/Estudios%20Econmicos/244.pdf
12. Reina M, Yanovich D. Proyecto Agenda Colombia. Cuadernos de Fedesarrollo, vol. I: Salud, educación y desempleo diagnóstico y recomendaciones. Bogotá: Tercer Mundo Editores; 1998.
13. Tinbergen J. Zur Theorie Der Langfristigen Wirtschaftsentwicklung. Weltwirtschaftliches Archiv. 1942;55: 511-549. https://www.jstor.org/stable/i40019409
14. Kittelsen SAC, Winsnes BA, Anthum KS, Goude F, Hope Ø, Häkkinen U, et al. Decomposing the productivity differences between hospitals in the Nordic countries. J Prod Anal. 2015;43: 281-293. https://www.frisch.uio.no/publikasjoner/pdf/1201.pdf
15. Nghiem S, Coelli T, Barber S. Sources of productivity growth in health services: a case study of Queensland public hospitals. Economic Analysis and Policy. 2011;41(1): 37-48. https://doi.org/10.1016/S0313-5926(11)50003-7
16. Linna M. Measuring hospital cost efficiency with panel data models. Health Econ. 1998;7(5): 415-427. https://doi.org/10.1002/SICI1099-10501998087:5415::AID-HEC3573.0.CO2-9
17. Gabbitas O, Jeffs C. Assessing productivity in the delivery of public hospital services in Australia: some experimental estimates. Paper presented at: The 30th Australian Health Economics Conference; 2008 Oct 2-3; Adelaide, Australia.
18. Granderson G, Tauchen H. The impacts of membership in multi-hospital systems on cost, productivity growth and technical change. Appl Econ. 2016;48(18): 1633-1646. https://doi.org/10.1080/00036846.2015.1105922
19. Chowdhury H, Zelenyuk V, Laporte A, Wodchis WP. Analysis of productivity, efficiency and technological changes in hospital services in Ontario: How does case-mix matter? Int J Prod Econ. 2014;150: 74-82. https://doi.org/10.1016/j.ijpe.2013.12.003
20. Wu CH, Chang CC, Chen PC, Kuo KN. Efficiency and productivity change in Taiwan’s hospitals: a non-radial quality-adjusted measurement. CEJOR. 2013;21: 431-453. http://hdl.handle.net/10.1007/s10100-012-0238-7
21. Burgess JF, Wilson PW. Decomposing hospital productivity changes, 1985-1988: A nonparametric Malmquist approach. J Prod Anal. 1995;6: 343-363. https://doi.org/10.1007/BF01073525
22. McCallion G, Glass C, Jackson R, Kerr C, McKillop D. Investigating productivity change and hospital size: a nonparametric frontier approach. Appl Econ. 2000;32(2): 161-174. https://doi.org/10.1080/000368400322859
23. Färe R, Grosskopf S, Lindgren B, Roos P. Productivity developments in Swedish hospitals: a Malmquist output index approach. In: Charnes A et al. (eds). Data Envelopment Analysis: Theory, Methodology, and Applications. Boston: Kluwer; 1994. p.253-272.
24. Kirigia J, Emrouznejad A, Cassoma B, Asbu E, Barry S. A performance assessment method for hospitals: the case of municipal hospitals in Angola. J Med Syst. 2008;32: 509-519. https://doi.org/10.1007/s10916-008-9157-5
25. Tlotlego N, Nonvignon J, Sambo LG, Asbu EZ, Kirigia JM. Assessment of productivity of hospitals in Botswana: a DEA application. Int Arch Med. 2010;3: 14. https://doi.org/10.1186/1755-7682-3-27
26. Gok S, Sezen B. Capacity inefficiencies of teaching and non-teaching hospitals. Serv Ind J. 2012;32(14): 2307-2328. https://doi.org/10.1080/02642069.2011.582495
27. De Castro MS, Ozcan YA, Da Silva ACM, Estellita MP, Fiszman R. Financing reform and productivity change in Brazilian teaching hospitals: Malmquist approach. CEJOR. 2010;18: 141-152. https://doi.org/10.1007/s10100-009-0097-z
28. Wei CK. Measuring efficiency and productivity change in Taiwan hospitals: a nonparametric frontier approach. J Am Acad Business. 2006;10(1): 317-323. https://doi.org/10.1177/097206341101300201
29. Dimas G, Goula A, Soulis S. Productive performance and its components in Greek public hospitals. Oper Res Int J. 2012;12: 15-27. https://doi.org/10.1007/s12351-010-0082-2.
30. Karagiannis R, Velentzas K. Productivity and quality changes in Greek public hospitals. Oper Res Int J. 2012;12: 69-81. https://doi.org/10.1007/s12351-010-0080-4
31. Huerta T, Ford E, Ford W, Thompson M. Realizing the value proposition: A longitudinal assessment of hospitals’ total factor productivity. J Health Eng. 2011;2(3): 285-302. https://doi.org/10.1260/2040-2295.2.3.285.
32. Li H, Dong S, Liu T. Relative efficiency and productivity: a preliminary exploration of public hospitals in Beijing, China. BMC Health Serv Res. 2014;14: 158. https://doi.org/10.1186/1472-6963-14-158.
33. Mogha S, Yadav S, Singh S. Technical efficiency and productivity growth in public sector hospitals of Uttarakhand (India). Int J Syst Assur Eng Manag. 2015;6: 390-406. https://www.infona.pl/resource/bwmeta1.element.springer-doi-10_1007-S13198-014-0270-1
34. Sulku SN. The health sector reforms and the efficiency of public hospitals in Turkey: provincial markets. Eur J Public Health. 2011;22(5): 634-638. https://doi.org/10.1093/eurpub/ckr163
35. NG YC. The productivity efficiency of Chinese hospitals. China Econ Rev. 2011;22(3): 428-439. https://doi.org/10.1016/j.chieco.2011.06.001
36. Ferrier GD, Valdmanis VG. Do mergers improve hospital productivity? J Oper Res Soc. 2004;50(10): 1071-1080. https://doi.org/10.1186/2191-1991-3-3
37. Roh CY, Moon MJ, Park C. Economic performance of U.S. non-profit hospitals using the Malmquist productivity change index. Journal of Management and Marketing Research. 2011. http://www.aabri.com/manuscripts/11869.pdf
38. Roh CY, Moon MJ, Park C. Measuring economic performance of Colorado community hospitals using the Malmquist productivity change index. Int Rev Publ Adm. 2011;16(1): 91-111. https://doi.org/10.1080/12264431.2011.10805187
39. Chu CL, Chiang TL, Chang RE. Hospital competition and inpatient services efficiency in Taiwan: a longitudinal study. Health Econ. 2011;20(1): 1268-1280. https://doi.org/10.1002/hec.1676.
40. Chen SN. Productivity changes in Taiwanese hospitals and the national health insurance. Serv Ind J. 2006;26(4): 459-477. https://doi.org/10.1080/02642060600622355
41. Chang SJ, Hsiao HC, Huang LH, Chang H. Taiwan quality indicator project and hospital productivity growth. Int J Manag Sci. 2011;39(1):14-22. https://doi.org/10.1016/j.omega.2010.01.006
42. Arocena P, García-Prado A. Accounting for quality in the measurement of hospital performance: evidence from Costa Rica. Health Econ. 2007 Jul;16(7): 667-685. https://doi.org/10.1002/hec.1204
43. Pham TL. Efficiency and productivity of hospitals in Vietnam. J Health Organ Manag. 2011;25(2): 195-213. https://doi.org/10.1108/14777261111134428
44. Sommersguter-Reichmann M. The impact of the Austrian hospital financing reform on hospital productivity: empirical evidence on efficiency and technology changes using a non-parametric input-based Malmquist approach. Health Care Manag Sci. 2000;3(4): 309-321. https://doi.org/10.1023/a:1019022230731
45. Maniadakis N, Thanassoulis E. Assessing productivity changes in UK hospitals reflecting technology and input prices. Appl Econ. 2000;32(12): 1575-1589. https://doi.org/10.1080/000368400418970
46. Zere E, McIntyre D, Addison T. Technical efficiency and productivity of public sector hospitals in three South African provinces. S Afr J Econ. 2001;69(2): 336-358. https://doi.org/10.1111/j.1813-6982.2001.tb00016.x
47. Sola M, Prior D. Measuring productivity and quality changes using data envelopment analysis: an application to Catalan hospitals. Financial Accountability & Management. 2001;17(3): 219-245. https://doi.org/10.1111/1468-0408.00129
48. Gannon B. Total factor productivity growth of hospitals in Ireland: A nonparametric approach. Appl Econ Lett. 2008;15(2): 131-135. https://doi.org/10.1080/13504850600706115
49. Nabilou B, Yusefzadeh H, Rezapour A, Fard AF, Safi P, Asiabar A, Ahmadzadeh N. The productivity and its barriers in public hospitals: case study of Iran. Med J Islam Repub Iran. 2016;30(1): 36-43. http://mjiri.iums.ac.ir/article-1-3431-en
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How to Cite
Orozco Gallo, A. J., & Almanza Ramírez, C. (2020). Evaluating Colombian public hospitals productivity during 2004-2015. A Luenberger-Indicator approach. Gerencia Y Políticas De Salud, 19, 1–23. https://doi.org/10.11144/Javeriana.rgps19.ecph
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Artículos