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Assessing the impact of environmental factors on emergency healthcare quality: Implications for budget allocation

Author

Listed:
  • Marc Aliana

    (Department of Applied Economics, Universitat Autònoma de Barcelona, Spain)

  • Diego Prior

    (Department of Business, Universitat Autònoma de Barcelona, Spain)

  • Emili Tortosa-Ausina

    (IVIE, Valencia and IIDL and Department of Economics, Universitat Jaume I, Castellón, Spain)

Abstract

Evaluating the quality of emergency departments in hospitals is crucial for optimizing healthcare and allocating resources effectively. Existing metrics predominantly focus on internal variables (e.g., bed occupancy or time to treatment), neglecting external environmental factors, beyond their control. In response, the contributions of this paper are fourfold. First, we introduce a novel Quality Composite Indicator (QCI) for benchmarking emergency departments quality, considering the specific impact of demographic, socio-economic, patientspecific, and behavioral factors. This metric minimizes the influence of outliers, facilitating a comparison among emergency departments and enabling the identification of top performers based on quality indicators. Second, our study, conducted across 85 health trusts, reveals that emergency departments with higher population density, migration, average income, and deprived households tend to exhibit lower service quality. Moreover, critical patient conditions upon arrival and higher attendance rates exert additional negative influences, while higher obesity rates show a positive correlation with the quality of urgent healthcare services. Third, our analysis highlights differences in how environmental factors (e.g., age, education, or unemployment) affect overall hospital performance versus specialized units like emergency departments. These results suggest that the factors influencing emergency department performance may differ from those affecting broader healthcare institutions. Fourth, we examined the distribution of health budget funds and uncovered significant regional disparities in healthcare quality, contradicting the goal of nationwide uniformity. Furthermore, our study highlights the integration of emergency care funding with general hospital resources in the allocation model, despite being impacted differently by external factors.

Suggested Citation

  • Marc Aliana & Diego Prior & Emili Tortosa-Ausina, 2024. "Assessing the impact of environmental factors on emergency healthcare quality: Implications for budget allocation," Working Papers 2024/04, Economics Department, Universitat Jaume I, Castellón (Spain).
  • Handle: RePEc:jau:wpaper:2024/04
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    as
    1. Mª Isabel Ortega-Díaz & Ricardo Ocaña-Riola & Carmen Pérez-Romero & José Jesús Martín-Martín, 2020. "Multilevel Analysis of the Relationship between Ownership Structure and Technical Efficiency Frontier in the Spanish National Health System Hospitals," IJERPH, MDPI, vol. 17(16), pages 1-19, August.
    2. Andrés Rodríguez-Pose & Miquel Vidal-Bover, 2022. "Decentralisation, unfunded mandates, and the regional response to the covid-19 pandemic," Working Papers. Collection A: Public economics, governance and decentralization 2214, Universidade de Vigo, GEN - Governance and Economics research Network.
    3. 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.
    4. Cinzia Daraio & Léopold Simar & Paul W. Wilson, 2018. "Central limit theorems for conditional efficiency measures and tests of the ‘separability’ condition in non‐parametric, two‐stage models of production," Econometrics Journal, Royal Economic Society, vol. 21(2), pages 170-191, June.
    5. Racine, Jeff & Li, Qi, 2004. "Nonparametric estimation of regression functions with both categorical and continuous data," Journal of Econometrics, Elsevier, vol. 119(1), pages 99-130, March.
    6. Léopold Simar & Paul W. Wilson, 2020. "Hypothesis testing in nonparametric models of production using multiple sample splits," Journal of Productivity Analysis, Springer, vol. 53(3), pages 287-303, June.
    7. Cinzia Daraio & Léopold Simar, 2005. "Introducing Environmental Variables in Nonparametric Frontier Models: a Probabilistic Approach," Journal of Productivity Analysis, Springer, vol. 24(1), pages 93-121, September.
    8. Helen Barratt & Antonio Rojas-García & Katherine Clarke & Anna Moore & Craig Whittington & Sarah Stockton & James Thomas & Stephen Pilling & Rosalind Raine, 2016. "Epidemiology of Mental Health Attendances at Emergency Departments: Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 11(4), pages 1-14, April.
    9. Qi Li & Jeffrey Scott Racine, 2006. "Density Estimation, from Nonparametric Econometrics: Theory and Practice," Introductory Chapters, in: Nonparametric Econometrics: Theory and Practice, Princeton University Press.
    10. Daraio, Cinzia & Simar, Leopold & Wilson, Paul, 2018. "Central limit theorems for conditional efficiency measures and tests of the ‘separability’ condition in non-parametric, two-stage models of production," LIDAM Reprints ISBA 2018023, Université catholique de Louvain, Institute of Statistics, Biostatistics and Actuarial Sciences (ISBA).
    11. Rogge, Nicky & De Jaeger, Simon & Lavigne, Carolien, 2017. "Waste Performance of NUTS 2-regions in the EU: A Conditional Directional Distance Benefit-of-the-Doubt Model," Ecological Economics, Elsevier, vol. 139(C), pages 19-32.
    12. George Fragkiadakis & Michael Doumpos & Constantin Zopounidis & Christophe Germain, 2016. "Operational and economic efficiency analysis of public hospitals in Greece," Annals of Operations Research, Springer, vol. 247(2), pages 787-806, December.
    13. 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.
    14. 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.
    15. Cinzia Daraio & Léopold Simar, 2007. "Conditional nonparametric frontier models for convex and nonconvex technologies: a unifying approach," Journal of Productivity Analysis, Springer, vol. 28(1), pages 13-32, October.
    16. Peter Hall & Jeff Racine & Qi Li, 2004. "Cross-Validation and the Estimation of Conditional Probability Densities," Journal of the American Statistical Association, American Statistical Association, vol. 99, pages 1015-1026, December.
    17. Aragon, Y. & Daouia, A. & Thomas-Agnan, C., 2005. "Nonparametric Frontier Estimation: A Conditional Quantile-Based Approach," Econometric Theory, Cambridge University Press, vol. 21(2), pages 358-389, April.
    18. Kristof De Witte & Mika Kortelainen, 2013. "What explains the performance of students in a heterogeneous environment? Conditional efficiency estimation with continuous and discrete environmental variables," Applied Economics, Taylor & Francis Journals, vol. 45(17), pages 2401-2412, June.
    19. Li, Qi & Racine, Jeffrey S, 2008. "Nonparametric Estimation of Conditional CDF and Quantile Functions With Mixed Categorical and Continuous Data," Journal of Business & Economic Statistics, American Statistical Association, vol. 26, pages 423-434.
    20. Antony Andrews, 2021. "The Efficiency of New Zealand District Health Boards in Administrating Public Funds: An Application of Bootstrap DEA and Beta Regression," International Journal of Public Administration, Taylor & Francis Journals, vol. 44(14), pages 1297-1308, October.
    21. Rahab Mbau & Anita Musiega & Lizah Nyawira & Benjamin Tsofa & Andrew Mulwa & Sassy Molyneux & Isabel Maina & Julie Jemutai & Charles Normand & Kara Hanson & Edwine Barasa, 2023. "Analysing the Efficiency of Health Systems: A Systematic Review of the Literature," Applied Health Economics and Health Policy, Springer, vol. 21(2), pages 205-224, March.
    22. Léopold Simar, 2003. "Detecting Outliers in Frontier Models: A Simple Approach," Journal of Productivity Analysis, Springer, vol. 20(3), pages 391-424, November.
    23. Camilla Mastromarco & Lenka Stastna & Jana Votapkova, 2019. "Efficiency of hospitals in the Czech Republic: Conditional efficiency approach," Journal of Productivity Analysis, Springer, vol. 51(1), pages 73-89, February.
    24. Paul Fenn & Alastair Gray & Neil Rickman, 2004. "The Economics of Clinical Negligence Reform in England," Economic Journal, Royal Economic Society, vol. 114(496), pages 272-292, June.
    25. Qi Li & Jeffrey Scott Racine, 2006. "Nonparametric Econometrics: Theory and Practice," Economics Books, Princeton University Press, edition 1, volume 1, number 8355.
    26. Gearhart, Richard S. & Michieka, Nyakundi M., 2018. "A comparison of the robust conditional order-m estimation and two stage DEA in measuring healthcare efficiency among California counties," Economic Modelling, Elsevier, vol. 73(C), pages 395-406.
    27. Dyson, R. G. & Allen, R. & Camanho, A. S. & Podinovski, V. V. & Sarrico, C. S. & Shale, E. A., 2001. "Pitfalls and protocols in DEA," European Journal of Operational Research, Elsevier, vol. 132(2), pages 245-259, July.
    28. Seiford, Lawrence M. & Zhu, Joe, 2002. "Modeling undesirable factors in efficiency evaluation," European Journal of Operational Research, Elsevier, vol. 142(1), pages 16-20, October.
    29. Cazals, Catherine & Florens, Jean-Pierre & Simar, Leopold, 2002. "Nonparametric frontier estimation: a robust approach," Journal of Econometrics, Elsevier, vol. 106(1), pages 1-25, January.
    30. De Witte, Kristof & Schiltz, Fritz, 2018. "Measuring and explaining organizational effectiveness of school districts: Evidence from a robust and conditional Benefit-of-the-Doubt approach," European Journal of Operational Research, Elsevier, vol. 267(3), pages 1172-1181.
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    More about this item

    Keywords

    Budget allocation; emergency department; environmental factors; health policy; quality composite indicator;
    All these keywords.

    JEL classification:

    • C43 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods: Special Topics - - - Index Numbers and Aggregation
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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