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Investigating the link between medical urgency and hospital efficiency – Insights from the German hospital market

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  • Annika Maren Schneider

    (University of Hamburg)

  • Eva-Maria Oppel

    (University of Hamburg)

  • Jonas Schreyögg

    (University of Hamburg)

Abstract

With hospital budgets remaining tight and healthcare expenditure rising due to demographic change and advances in technology, hospitals continue to face calls to contain costs and allocate their resources more efficiently. In this context, efficiency has emerged as an increasingly important way for hospitals to withstand competitive pressures in the hospital market. Doing so, however, can be challenging given unpredictable fluctuations in demand, a prime example of which are emergencies, i.e. urgent medical cases. The link between medical urgency and hospitals’ efficiency, however, has been neglected in the literature to date. This study therefore aims to investigate the relationship between hospitals’ urgency characteristics and their efficiency. Our analyses are based on 4094 observations from 1428 hospitals throughout Germany for the years 2015, 2016, and 2017. We calculate an average urgency score for each hospital based on all cases treated in that hospital per year and also investigate the within-hospital dispersion of medical urgency. To analyze the association of these urgency measures with hospitals’ efficiency we use a two-stage double bootstrap data envelopment analysis approach with truncated regression. We find a negative relationship between the urgency score and hospital efficiency. When testing for non-linear effects, the results reveal a u-shaped association, indicating that having either a high or low overall urgency score is beneficial in terms of efficiency. Finally, our results reveal that higher within-hospital urgency dispersion is negatively related to efficiency.

Suggested Citation

  • Annika Maren Schneider & Eva-Maria Oppel & Jonas Schreyögg, 2020. "Investigating the link between medical urgency and hospital efficiency – Insights from the German hospital market," Health Care Management Science, Springer, vol. 23(4), pages 649-660, December.
    • Handle: RePEc:kap:hcarem:v:23:y:2020:i:4:d:10.1007_s10729-020-09520-6
    DOI: 10.1007/s10729-020-09520-6
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    as
    1. Yauheniya Varabyova & Jonas Schreyögg, 2018. "Integrating quality into the nonparametric analysis of efficiency: a simulation comparison of popular methods," Annals of Operations Research, Springer, vol. 261(1), pages 365-392, February.
    2. Grosskopf, Shawna & Margaritis, Dimitri & Valdmanis, Vivian, 2004. "Competitive effects on teaching hospitals," European Journal of Operational Research, Elsevier, vol. 154(2), pages 515-525, April.
    3. Sebastian McRae & Jens O. Brunner & Jonathan F. Bard, 2020. "Analyzing economies of scale and scope in hospitals by use of case mix planning," Health Care Management Science, Springer, vol. 23(1), pages 80-101, March.
    4. Shiovan Ni Luasa & Declan Dineen & Marta Zieba, 2018. "Technical and scale efficiency in public and private Irish nursing homes – a bootstrap DEA approach," Health Care Management Science, Springer, vol. 21(3), pages 326-347, September.
    5. Martinussen, Pal E. & Midttun, Linda, 2004. "Day surgery and hospital efficiency: empirical analysis of Norwegian hospitals, 1999-2001," Health Policy, Elsevier, vol. 68(2), pages 183-196, May.
    6. Robert G. Chambers & Teresa Serra, 2018. "The social dimension of firm performance: a data envelopment approach," Empirical Economics, Springer, vol. 54(1), pages 189-206, February.
    7. Wilson, Paul W., 2018. "Dimension reduction in nonparametric models of production," European Journal of Operational Research, Elsevier, vol. 267(1), pages 349-367.
    8. Yauheniya Varabyova & Carl Rudolf Blankart & Aleksandra Torbica & Jonas Schreyögg, 2017. "Comparing the Efficiency of Hospitals in Italy and Germany: Nonparametric Conditional Approach Based on Partial Frontier," Health Care Management Science, Springer, vol. 20(3), pages 379-394, September.
    9. Iustin Nedelea & James Fannin, 2013. "Technical efficiency of Critical Access Hospitals: an application of the two-stage approach with double bootstrap," Health Care Management Science, Springer, vol. 16(1), pages 27-36, March.
    10. Oleg Badunenko & Harald Tauchmann, 2019. "Simar and Wilson two-stage efficiency analysis for Stata," Stata Journal, StataCorp LP, vol. 19(4), pages 950-988, December.
    11. Yauheniya Varabyova & Carl Rudolf Blankart & Jonas Schreyögg, 2017. "Using nonparametric conditional approach to integrate quality into efficiency analysis: empirical evidence from cardiology departments," Health Care Management Science, Springer, vol. 20(4), pages 565-576, December.
    12. Lindlbauer, Ivonne & Schreyögg, Jonas & Winter, Vera, 2016. "Changes in technical efficiency after quality management certification: A DEA approach using difference-in-difference estimation with genetic matching in the hospital industry," European Journal of Operational Research, Elsevier, vol. 250(3), pages 1026-1036.
    13. 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.
    14. Lee, Kwang-soo & Chun, Ki-hong & Lee, Jung-soo, 2008. "Reforming the hospital service structure to improve efficiency: Urban hospital specialization," Health Policy, Elsevier, vol. 87(1), pages 41-49, July.
    15. Annika Herr, 2008. "Cost and technical efficiency of German hospitals: does ownership matter?," Health Economics, John Wiley & Sons, Ltd., vol. 17(9), pages 1057-1071, September.
    16. Ross, Stephen A, 1973. "The Economic Theory of Agency: The Principal's Problem," American Economic Review, American Economic Association, vol. 63(2), pages 134-139, May.
    17. Adriana Castelli & Andrew Street & Rossella Verzulli & Padraic Ward, 2015. "Examining variations in hospital productivity in the English NHS," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(3), pages 243-254, April.
    18. Cláudia Araújo & Carlos Barros & Peter Wanke, 2014. "Efficiency determinants and capacity issues in Brazilian for-profit hospitals," Health Care Management Science, Springer, vol. 17(2), pages 126-138, June.
    19. Ivonne Lindlbauer & Jonas Schreyögg, 2014. "The relationship between hospital specialization and hospital efficiency: do different measures of specialization lead to different results?," Health Care Management Science, Springer, vol. 17(4), pages 365-378, December.
    20. Léopold Simar & Paul Wilson, 2011. "Inference by the m out of n bootstrap in nonparametric frontier models," Journal of Productivity Analysis, Springer, vol. 36(1), pages 33-53, August.
    21. Simar, Leopold & Wilson, Paul W., 2007. "Estimation and inference in two-stage, semi-parametric models of production processes," Journal of Econometrics, Elsevier, vol. 136(1), pages 31-64, January.
    22. Nurhafiza Md Hamzah & Kok Fong See, 2019. "Technical efficiency and its influencing factors in Malaysian hospital pharmacy services," Health Care Management Science, Springer, vol. 22(3), pages 462-474, September.
    23. Daniel M. Walker, 2018. "Does participation in health information exchange improve hospital efficiency?," Health Care Management Science, Springer, vol. 21(3), pages 426-438, September.
    24. Yasar A. Ozcan, 2014. "Evaluation of Performance in Health Care," International Series in Operations Research & Management Science, in: Health Care Benchmarking and Performance Evaluation, edition 2, chapter 0, pages 3-14, Springer.
    25. Banker, Rajiv D. & Chang, Hsihui, 2006. "The super-efficiency procedure for outlier identification, not for ranking efficient units," European Journal of Operational Research, Elsevier, vol. 175(2), pages 1311-1320, December.
    26. Carlos Pestana Barros & Silvestre Dumbo & Peter Wanke, 2014. "Efficiency Determinants and Capacity Issues in Angolan Insurance Companies," South African Journal of Economics, Economic Society of South Africa, vol. 82(3), pages 455-467, September.
    27. 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.
    28. Helmut Herwartz & Christoph Strumann, 2012. "On the effect of prospective payment on local hospital competition in Germany," Health Care Management Science, Springer, vol. 15(1), pages 48-62, March.
    29. Meliyanni Johar & Glenn Stewart Jones & Elizabeth Savage, 2013. "Emergency Admissions And Elective Surgery Waiting Times," Health Economics, John Wiley & Sons, Ltd., vol. 22(6), pages 749-756, June.
    30. Hughes, David & McGuire, Alistair, 2003. "Stochastic demand, production responses and hospital costs," Journal of Health Economics, Elsevier, vol. 22(6), pages 999-1010, November.
    31. Varabyova, Yauheniya & Schreyögg, Jonas, 2013. "International comparisons of the technical efficiency of the hospital sector: Panel data analysis of OECD countries using parametric and non-parametric approaches," Health Policy, Elsevier, vol. 112(1), pages 70-79.
    32. Jonas Krämer & Jonas Schreyögg & Reinhard Busse, 2019. "Classification of hospital admissions into emergency and elective care: a machine learning approach," Health Care Management Science, Springer, vol. 22(1), pages 85-105, March.
    33. Silvio Daidone & Francesco D’Amico, 2009. "Technical efficiency, specialization and ownership form: evidences from a pooling of Italian hospitals," Journal of Productivity Analysis, Springer, vol. 32(3), pages 203-216, December.
    34. 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.
    35. Chowdhury, Hedayet & Zelenyuk, Valentin, 2016. "Performance of hospital services in Ontario: DEA with truncated regression approach," Omega, Elsevier, vol. 63(C), pages 111-122.
    36. Gaynor, Martin & Anderson, Gerard F., 1995. "Uncertain demand, the structure of hospital costs, and the cost of empty hospital beds," Journal of Health Economics, Elsevier, vol. 14(3), pages 291-317, August.
    37. Manhal Ali & Reza Salehnejad & Mohaimen Mansur, 2019. "Hospital productivity: The role of efficiency drivers," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(2), pages 806-823, April.
    38. Yauheniya Varabyova & Carl Rudolf Blankart & Jonas Schreyögg, 2017. "Erratum to: Using nonparametric conditional approach to integrate quality into efficiency analysis: empirical evidence from cardiology departments," Health Care Management Science, Springer, vol. 20(4), pages 577-577, December.
    39. Jonathan R. Clark & Robert S. Huckman, 2012. "Broadening Focus: Spillovers, Complementarities, and Specialization in the Hospital Industry," Management Science, INFORMS, vol. 58(4), pages 708-722, April.
    40. Alvaro Almeida & Joana Cima, 2015. "Demand uncertainty and hospital costs: an application to Portuguese public hospitals," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(1), pages 35-45, January.
    41. Peter Bogetoft & Lars Otto, 2011. "Benchmarking with DEA, SFA, and R," International Series in Operations Research and Management Science, Springer, number 978-1-4419-7961-2, January.
    42. William W. Cooper & Lawrence M. Seiford & Kaoru Tone, 2007. "Data Envelopment Analysis," Springer Books, Springer, edition 0, number 978-0-387-45283-8, June.
    43. Yasar A. Ozcan, 2014. "Health Care Benchmarking and Performance Evaluation," International Series in Operations Research and Management Science, Springer, edition 2, number 978-1-4899-7472-3, January.
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    5. Iveta Vrabková & Sabrina Lee, 2023. "Approximating the influence of external factors on the technical efficiency score of hospital care: evidence from the federal states of Germany," Health Economics Review, Springer, vol. 13(1), pages 1-14, December.

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