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Hong Kong Hospital Authority resource efficiency evaluation: Via a novel DEA-Malmquist model and Tobit regression model.

ABSTRACT: The Hospital Authority (HA) is a statutory body managing all the public hospitals and institutes in Hong Kong (HK). In recent decades, Hong Kong Hospital Authority (HKHA) has been making efforts to improve the healthcare services, but there still exist some problems like unfair resource allocation and poor management, as reported by the Hong Kong medical legislative committee. One critical consequence of these problems is low healthcare efficiency of hospitals, leading to low satisfaction among patients. Moreover, HKHA also suffers from the conflict between limited resource and growing demand. An effective evaluation of HA is important for resource planning and healthcare decision making. In this paper, we propose a two-phase method to evaluate HA efficiency for reducing healthcare expenditure and improving healthcare service. Specifically, in Phase I, we measure the HKHA efficiency changes from 2000 to 2013 by applying a novel DEA-Malmquist index with undesirable factors. In Phase II, we further explore the impact of some exogenous factors (e.g., population density) on HKHA efficiency by Tobit regression model. Empirical results show that there are significant differences between the efficiencies of different hospitals and clusters. In particular, it is found that the public hospital serving in a richer district has a relatively lower efficiency. To a certain extent, this reflects the socioeconomic reality in HK that people with better economic condition prefers receiving higher quality service from the private hospitals.

SUBMITTER: Guo H

PROVIDER: S-EPMC5590922 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:In the recent years, the burgeoning non-performing assets (NPAs) have become a matter of concern and scrutiny in India as the surge in NPAs impinge on the credit services of the banks, make the banks vulnerable to external shocks, leave them with less cushion in case of idiosyncratic shocks and thus, leading to the abrasion of their productive capital. In this backdrop, some very normative questions become inevitable. How has the technical efficiency of the banks in India changed over time especially after the asset quality review, 2016? How does undesirable output like non-performing assets (NPA) impact the technical efficiency of banks in India? Does technical efficiency have anything to do with the ownership of banks? These are some of the questions we endeavour to answer through our study by employing three cornerstone methodologies namely DEA, Malmquist productivity index and SFA in the banking sector for the period 2014-2020.The results obtained from employing DEA and SFA both points toward the heterogeneity in the technical efficiency of public sector banks and private sectors banks operating in India. The results obtained from DEA are majorly three-fold. Firstly, private sector banks have fared better than the public sector banks, while the SFA scores show that the public sector ownership promotes efficiency. Secondly, the technical efficiency of public sector banks has consistently been falling from 2014 to 2017 only to rise in the later years, evidence corroborated by the SFA scores also. This trend is in line with the slew of measures adopted by the government and RBI like AQR and mergers of banks subsequently. Although according to the Malmquist productivity decomposition results, we find that productivity of banks have been falling for the period 2014-2020. Thirdly, the non-performing assets are detrimental for the efficiency of the banks. Like DEA, the SFA results also shows the presence of technical inefficiency in the Indian banking sector and a similar trend in the technical efficiency wherein the scores decline from 2014 through 2017 and then they rise subsequently.Supplementary informationThe online version contains supplementary material available at 10.1007/s40953-021-00247-x.

Project description:BackgroundThe pursuit of efficiency and productivity is one of the goals of health systems. In the era of Sustainable Development Goals and particularly the move towards universal health coverage, it is imperative to curb wastage of resources to ensure sustainable access of the population to needed and effective health services without enduring financial hardship. This study aims to assess total factor productivity change of national health systems of 20 countries in the WHO's Eastern Mediterranean Region.MethodsData Envelopment Analysis (DEA)-based Malmquist index is used to assess total factor productivity change and its components - efficiency change and technical change. To assess the robustness of the Malmquist index estimates, bootstrapping was performed. Outputs used are life expectancy at birth for both sexes and infant mortality; while total expenditure on health per capita in international dollars (PPP) is used as a measure of input. Panel data for the period 2003-2014 was extracted from databases of the WHO and the World Bank.ResultsIn all but five countries covered in the study, a decline in the mean total factor productivity is observed during the period 2003-2014. The decline is driven by technical regress. In all countries, the technical change component of the Malmquist TFP index is less than unity (range: 0.896 to 0.945). All countries exhibited growth in efficiency (efficiency change exceeding one) except two countries (Djibouti and Iraq). The growth in efficiency was mainly due to change in scale efficiency. Overall, total factor productivity in the region declined by 3.8%. This was due to a 9.1% decline in technical change, which overshadowed the 5.8% increase in efficiency. Three countries - Libya, Qatar and Yemen - showed a marginal growth in total factor productivity. There was no change in total factor productivity in Kuwait and Lebanon.ConclusionThe decline in total factor productivity over the study period is likely to hamper achieving the targets of Sustainable Development Goal 3 of ensuring healthy lives and promoting well-being for all at all ages. It is recommended that country-level studies on efficiency and productivity of health systems be conducted in order to intensively examine the determinants of inefficiency and productivity decline and implement appropriate interventions that could enhance efficiency and productivity.

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Hong Kong Hospital Authority resource efficiency evaluation: Via a novel DEA-Malmquist model and Tobit regression model.

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