Inefficiency of public hospitals: a multistage data envelopment analysis in an Italian region

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...

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Autores principales:	Luca Piubello Orsini, Chiara Leardini, Silvia Vernizzi, Bettina Campedelli
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Data envelopment analysis Efficiency Quality Public hospitals Tobit Malmquist productivity index Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/59655f497c854687b93065461dc1a2ab
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spelling	oai:doaj.org-article:59655f497c854687b93065461dc1a2ab2021-11-28T12:07:45ZInefficiency of public hospitals: a multistage data envelopment analysis in an Italian region10.1186/s12913-021-07276-51472-6963https://doaj.org/article/59655f497c854687b93065461dc1a2ab2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12913-021-07276-5https://doaj.org/toc/1472-6963Abstract 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.Luca Piubello OrsiniChiara LeardiniSilvia VernizziBettina CampedelliBMCarticleData envelopment analysisEfficiencyQualityPublic hospitalsTobitMalmquist productivity indexPublic aspects of medicineRA1-1270ENBMC Health Services Research, Vol 21, Iss 1, Pp 1-15 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Data envelopment analysis Efficiency Quality Public hospitals Tobit Malmquist productivity index Public aspects of medicine RA1-1270
spellingShingle	Data envelopment analysis Efficiency Quality Public hospitals Tobit Malmquist productivity index Public aspects of medicine RA1-1270 Luca Piubello Orsini Chiara Leardini Silvia Vernizzi Bettina Campedelli Inefficiency of public hospitals: a multistage data envelopment analysis in an Italian region
description	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.
format	article
author	Luca Piubello Orsini Chiara Leardini Silvia Vernizzi Bettina Campedelli
author_facet	Luca Piubello Orsini Chiara Leardini Silvia Vernizzi Bettina Campedelli
author_sort	Luca Piubello Orsini
title	Inefficiency of public hospitals: a multistage data envelopment analysis in an Italian region
title_short	Inefficiency of public hospitals: a multistage data envelopment analysis in an Italian region
title_full	Inefficiency of public hospitals: a multistage data envelopment analysis in an Italian region
title_fullStr	Inefficiency of public hospitals: a multistage data envelopment analysis in an Italian region
title_full_unstemmed	Inefficiency of public hospitals: a multistage data envelopment analysis in an Italian region
title_sort	inefficiency of public hospitals: a multistage data envelopment analysis in an italian region
publisher	BMC
publishDate	2021
url	https://doaj.org/article/59655f497c854687b93065461dc1a2ab
work_keys_str_mv	AT lucapiubelloorsini inefficiencyofpublichospitalsamultistagedataenvelopmentanalysisinanitalianregion AT chiaraleardini inefficiencyofpublichospitalsamultistagedataenvelopmentanalysisinanitalianregion AT silviavernizzi inefficiencyofpublichospitalsamultistagedataenvelopmentanalysisinanitalianregion AT bettinacampedelli inefficiencyofpublichospitalsamultistagedataenvelopmentanalysisinanitalianregion
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Inefficiency of public hospitals: a multistage data envelopment analysis in an Italian region

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