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Research
Jose M. Cordero
Corresponding Author
ORCiD: https://orcid.org/0000-0001-8783-6748
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
In Latin American and Caribbean countries the main concern of public health care managers has been traditionally placed on problems related to funding, payment mechanisms and equity of access. However, more recently, there is a growing interest in improving the levels of efficiency and reducing costs in the provision of health services. In this paper we focus on measuring the efficiency of public hospitals in Panama, where no such studies have been conducted so far. One of the most interesting features of the public hospital system in this country is that there are two different management schemes that coexist, thus we can make a distinction between hospitals operating under the Social Security Fund (SSF) and those belonging to the Ministry of Health (MoH).
Methods
Our dataset includes data about 22 public hospitals (11 for each model) during the period 2005–2015. We rely on the use of Data Envelopment Analysis and the Malmquist Productivity index to calculate technical efficiency and productivity change of hospitals. In addition, we also apply bootstrapping techniques to calculate confidence intervals for the obtained efficiency and productivity scores in order to obtain more robust results.
Results
We find that, until the period 2012–2013, the performance of hospitals belonging to different systems experienced a similar trend. However, during the last years of the evaluated period the hospitals operating under the Social Security Fund clearly outperformed Ministry´s hospitals. The main explanation for these divergences seems to be the growth of technological change. Nevertheless, the use of bootstrapping to make statistical inferences reveals that some differences detected may not be significant.
Conclusion
We demonstrate that the results of traditional DEA and Malmquist index analyses need to be tested for statistical significance. Otherwise, the conclusions reached could be wrong.
Keywords
Hospitals, Efficiency, Productivity change, Malmquist, DEA, Ownership
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This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research
Jose M. Cordero
Corresponding Author
ORCiD: https://orcid.org/0000-0001-8783-6748
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
View the published article at International Journal of Environmental Research and Public Health.
Version 1
Posted 16 Jul, 2020
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Food Science & Technology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at International Journal of Environmental Research and Public Health.
Background
In Latin American and Caribbean countries the main concern of public health care managers has been traditionally placed on problems related to funding, payment mechanisms and equity of access. However, more recently, there is a growing interest in improving the levels of efficiency and reducing costs in the provision of health services. In this paper we focus on measuring the efficiency of public hospitals in Panama, where no such studies have been conducted so far. One of the most interesting features of the public hospital system in this country is that there are two different management schemes that coexist, thus we can make a distinction between hospitals operating under the Social Security Fund (SSF) and those belonging to the Ministry of Health (MoH).
Methods
Our dataset includes data about 22 public hospitals (11 for each model) during the period 2005–2015. We rely on the use of Data Envelopment Analysis and the Malmquist Productivity index to calculate technical efficiency and productivity change of hospitals. In addition, we also apply bootstrapping techniques to calculate confidence intervals for the obtained efficiency and productivity scores in order to obtain more robust results.
Results
We find that, until the period 2012–2013, the performance of hospitals belonging to different systems experienced a similar trend. However, during the last years of the evaluated period the hospitals operating under the Social Security Fund clearly outperformed Ministry´s hospitals. The main explanation for these divergences seems to be the growth of technological change. Nevertheless, the use of bootstrapping to make statistical inferences reveals that some differences detected may not be significant.
Conclusion
We demonstrate that the results of traditional DEA and Malmquist index analyses need to be tested for statistical significance. Otherwise, the conclusions reached could be wrong.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
This preprint is available for download as a PDF.
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