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Efficiency and Productivity of Public Hospitals in Serbia Using DEA-Malmquist Model and Tobit Regression Model, 2015–2019

Author

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  • Aleksandar Medarević

    (Institute of Public Health of Serbia, 11000 Belgrade, Serbia
    Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia)

  • Dejana Vuković

    (Centre-School of Public Health and Health Management, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
    Institute of Social Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia)

Abstract

Improving productivity within health systems using limited resources is a matter of great concern. The objectives of the paper were to evaluate the productivity, efficiency, and impact of environmental factors on efficiency in Serbian hospitals from 2015–2019. Data envelopment analysis, Malmquist index and Tobit regression were applied to hospital data from this period, and public hospitals in Serbia exhibited a great variation regarding their capacity and performance. Between five and eight hospitals ran efficiently from 2015 to 2019, and the productivity of public hospitals increased whereas technical efficiency decreased in the same period. Tobit regression indicated that the proportion of elderly patients and small hospital size (below 200 beds) had a negative correlation with technical efficiency, while large hospital size (between 400 and 600 beds), the ratio of outpatient episodes to inpatient days, bed turnover rate and the bed occupation rate had a positive correlation with technical efficiency. Serbian public hospitals have considerable space for technical efficiency improvement and public action must be taken to improve resource utilization.

Suggested Citation

  • Aleksandar Medarević & Dejana Vuković, 2021. "Efficiency and Productivity of Public Hospitals in Serbia Using DEA-Malmquist Model and Tobit Regression Model, 2015–2019," IJERPH, MDPI, vol. 18(23), pages 1-22, November.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:23:p:12475-:d:689046
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    1. William W. Cooper & Lawrence M. Seiford & Joe Zhu (ed.), 2011. "Handbook on Data Envelopment Analysis," International Series in Operations Research and Management Science, Springer, number 978-1-4419-6151-8.
    2. O'Neill, Liam & Rauner, Marion & Heidenberger, Kurt & Kraus, Markus, 2008. "A cross-national comparison and taxonomy of DEA-based hospital efficiency studies," Socio-Economic Planning Sciences, Elsevier, vol. 42(3), pages 158-189, September.
    3. Elizabeth Adamson & Janette Pow & Fiona Houston & Pamela Redpath, 2017. "Exploring the experiences of patients attending day hospitals in the rural Scotland: capturing the patient's voice," Journal of Clinical Nursing, John Wiley & Sons, vol. 26(19-20), pages 3044-3055, October.
    4. Agata Sielskas, 2021. "Determinants of hospital inefficiency. The case of Polish county hospitals," PLOS ONE, Public Library of Science, vol. 16(8), pages 1-23, August.
    5. Sebastian Kohl & Jan Schoenfelder & Andreas Fügener & Jens O. Brunner, 2019. "The use of Data Envelopment Analysis (DEA) in healthcare with a focus on hospitals," Health Care Management Science, Springer, vol. 22(2), pages 245-286, June.
    6. Charnes, A. & Cooper, W. W. & Rhodes, E., 1978. "Measuring the efficiency of decision making units," European Journal of Operational Research, Elsevier, vol. 2(6), pages 429-444, November.
    7. Berta, Paolo & Callea, Giuditta & Martini, Gianmaria & Vittadini, Giorgio, 2010. "The effects of upcoding, cream skimming and readmissions on the Italian hospitals efficiency: A population-based investigation," Economic Modelling, Elsevier, vol. 27(4), pages 812-821, July.
    8. William W. Cooper & Lawrence M. Seiford & Joe Zhu, 2011. "Data Envelopment Analysis: History, Models, and Interpretations," International Series in Operations Research & Management Science, in: William W. Cooper & Lawrence M. Seiford & Joe Zhu (ed.), Handbook on Data Envelopment Analysis, chapter 0, pages 1-39, Springer.
    9. Zack Cooper & Stephen Gibbons & Simon Jones & Alistair McGuire, 2012. "Does Competition Improve Public Hospitals' Efficiency? Evidence from a Quasi-Experiment in the English National Health Service," CEP Discussion Papers dp1125, Centre for Economic Performance, LSE.
    10. Thomas Czypionka & Markus Kraus & Susanne Mayer & Gerald Röhrling, 2014. "Efficiency, ownership, and financing of hospitals: The case of Austria," Health Care Management Science, Springer, vol. 17(4), pages 331-347, December.
    11. Monica Giancotti & Annamaria Guglielmo & Marianna Mauro, 2017. "Efficiency and optimal size of hospitals: Results of a systematic search," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-40, March.
    12. Anatoly I. Pilyavsky & William E. Aaronson & Patrick M. Bernet & Michael D. Rosko & Vivian G. Valdmanis & Mikhail V. Golubchikov, 2006. "East–west: does it make a difference to hospital efficiencies in Ukraine?," Health Economics, John Wiley & Sons, Ltd., vol. 15(11), pages 1173-1186, November.
    13. Rize Jing & Tingting Xu & Xiaozhen Lai & Elham Mahmoudi & Hai Fang, 2019. "Technical Efficiency of Public and Private Hospitals in Beijing, China: A Comparative Study," IJERPH, MDPI, vol. 17(1), pages 1-18, December.
    14. Chilingerian, Jon A., 1995. "Evaluating physician efficiency in hospitals: A multivariate analysis of best practices," European Journal of Operational Research, Elsevier, vol. 80(3), pages 548-574, February.
    15. Bo Hsiao & Li‐Hsueh Chen & Huei‐Ting Wu, 2019. "Assessing performance of Taiwan hospitals using data envelopment analysis: In view of ownership," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 602-616, January.
    16. Hoff, Ayoe, 2007. "Second stage DEA: Comparison of approaches for modelling the DEA score," European Journal of Operational Research, Elsevier, vol. 181(1), pages 425-435, August.
    17. Rolf Färe & Shawna Grosskopf & Dimitris Margaritis, 2011. "Malmquist Productivity Indexes and DEA," International Series in Operations Research & Management Science, in: William W. Cooper & Lawrence M. Seiford & Joe Zhu (ed.), Handbook on Data Envelopment Analysis, chapter 0, pages 127-149, Springer.
    18. Hacer Özgen Narcı & Yasar A. Ozcan & İsmet Şahin & Menderes Tarcan & Mustafa Narcı, 2015. "An examination of competition and efficiency for hospital industry in Turkey," Health Care Management Science, Springer, vol. 18(4), pages 407-418, December.
    19. Maddala,G. S., 1986. "Limited-Dependent and Qualitative Variables in Econometrics," Cambridge Books, Cambridge University Press, number 9780521338257, January.
    20. Bruce Hollingsworth, 2008. "The measurement of efficiency and productivity of health care delivery," Health Economics, John Wiley & Sons, Ltd., vol. 17(10), pages 1107-1128, October.
    21. Martinussen, Pål E. & Hagen, Terje P., 2009. "Reimbursement systems, organisational forms and patient selection: Evidence from day surgery in Norway," Health Economics, Policy and Law, Cambridge University Press, vol. 4(2), pages 139-158, April.
    22. repec:cai:poeine:pope_1101_0009 is not listed on IDEAS
    23. Hainan Guo & Yang Zhao & Tie Niu & Kwok-Leung Tsui, 2017. "Hong Kong Hospital Authority resource efficiency evaluation: Via a novel DEA-Malmquist model and Tobit regression model," PLOS ONE, Public Library of Science, vol. 12(9), pages 1-24, September.
    24. Iveta Vrabková & Ivana Vaňková, 2021. "Efficiency of Human Resources in Public Hospitals: An Example from the Czech Republic," IJERPH, MDPI, vol. 18(9), pages 1-14, April.
    25. Yasar A. Ozcan, 2008. "Health Care Benchmarking and Performance Evaluation," International Series in Operations Research and Management Science, Springer, number 978-0-387-75448-2.
    26. Robert Stefko & Beata Gavurova & Kristina Kocisova, 2018. "Healthcare efficiency assessment using DEA analysis in the Slovak Republic," Health Economics Review, Springer, vol. 8(1), pages 1-12, December.
    27. Jos Blank & Vivian Valdmanis, 2010. "Environmental factors and productivity on Dutch hospitals: a semi-parametric approach," Health Care Management Science, Springer, vol. 13(1), pages 27-34, March.
    28. R. D. Banker & A. Charnes & W. W. Cooper, 1984. "Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis," Management Science, INFORMS, vol. 30(9), pages 1078-1092, September.
    29. Angeliki Flokou & Vassilis Aletras & Dimitris Niakas, 2017. "A window-DEA based efficiency evaluation of the public hospital sector in Greece during the 5-year economic crisis," PLOS ONE, Public Library of Science, vol. 12(5), pages 1-26, May.
    30. Victor Ngobeni & Marthinus C. Breitenbach & Goodness C. Aye, 2020. "Technical Efficiency of Provincial Public Healthcare in South Africa," Working Papers 202013, University of Pretoria, Department of Economics.
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