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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:IntroductionMost cases of neonatal mortality are preventable but a substantial number of cases get complicated and become irreversible not only due to scarcity but also due to inefficient utilization of available resources in the health service. However, limited evidence shows the efficiency level of health facilities in Ethiopia. Therefore, this study aimed to assess the technical efficiency of neonatal health service and its associated factors among primary hospitals in three zones of Northwest Ethiopia.MethodsA facility-based cross-sectional study was conducted among fifteen randomly selected primary hospitals from March 17 to April 17, 2021. Input data on non-salary recurrent costs, salary costs, and the number of beds, and output data on neonatal admissions, outpatient visits, and referrals for the 2019/20 fiscal year were collected using a document review. In the first stage of analysis, input-oriented data envelopment analysis with a variable return-to-scale assumption was employed to estimate the efficiency scores using DEAP 2.1. A Tobit regression model was fitted in the second stage to identify the associated factors with technical efficiency. Variables with a p-value <0.05 were declared as statistically associated factors.ResultsIn this study, 80% of the primary hospitals were pure technical efficient whereas 46.67% of the facilities were scale efficient with all of the scale inefficient hospitals operating below their scale. The mean pure technical and scale efficiency score of primary hospitals was 0.948±0.113 and 0.887±0.143, respectively. Total catchment population, incentive packages for the clinical staff, and the educational status of the manager were positively associated with the technical efficiency of hospitals. On the other hand, technical efficiency was negatively associated with the presence of a health facility that provides neonatal health services near the hospital and the distance of the manager's residence.ConclusionThough most of the primary hospitals in Northwest Ethiopia were technical efficient, more than half of them were working below their scale of operation. Our results also indicated that introducing the performance-based provision of incentive packages for clinical staff and employing master's and above-educated health professionals as a manager might improve the efficient utilization of resources in primary hospitals.

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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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