Leleu Herve, Al-Amin Mona, Rosko Michael, Valdmanis Vivian G
1 CNRS-LEM (UMR 9221), 55080 IESEG School of Management , Lille, France.
2 Suffolk University, Boston, MA, USA.
Health Serv Manage Res. 2018 Feb;31(1):33-42. doi: 10.1177/0951484817730537. Epub 2017 Oct 9.
The objectives of this paper are to use data envelopment analysis to measure hospital inefficiency in a way that accounts for patient outcomes and to study the association between organizational factors, such as hospital-physicians integration level and teaching status, and market competition with hospital inefficiency. We apply the robust data envelopment analysis approach to a sample of private (both not-for-profit and for-profit) hospitals operating in the United States. Our data envelopment analysis model includes mortality and readmission rates as bad outputs and admissions, surgeries, emergency room, and other visits as good outputs. Therefore, our measurement of hospital inefficiency accounts for quality. We then use a subsampling regression analysis to determine the predictors of hospital inefficiency. For-profit, fully integrated and teaching hospitals were more efficient than their counterparts. Also hospitals located in more competitive markets were more efficient than those located in less competitive markets. Incorporating quality in the measurement of hospital efficiency is key for producing valid efficiency scores. Hospitals in less competitive markets need to improve their efficiency levels. Moreover, high levels of hospital physician integration might be instrumental in ensuring that hospitals achieve their efficiency goals.
本文的目标是使用数据包络分析，以一种考虑患者结果的方式来衡量医院的无效率，并研究组织因素（如医院与医生的整合水平和教学地位）与医院无效率之间的市场竞争关系。我们将稳健数据包络分析方法应用于在美国运营的私立（包括非营利性和营利性）医院样本。我们的数据包络分析模型将死亡率和再入院率作为不良产出，将入院人数、手术量、急诊室就诊量和其他就诊量作为良好产出。因此，我们对医院无效率的衡量考虑了质量因素。然后，我们使用子样本回归分析来确定医院无效率的预测因素。营利性、完全整合型和教学型医院比其同类医院更有效率。此外，位于竞争更激烈市场的医院比位于竞争不太激烈市场的医院更有效率。在医院效率衡量中纳入质量因素是产生有效效率得分的关键。位于竞争不太激烈市场的医院需要提高其效率水平。此外，高水平的医院与医生整合可能有助于确保医院实现其效率目标。
