Service performance in public healthcare system: data envelopment analysis - Núm. 30, Enero 2017 - Revista AD-minister - Libros y Revistas - VLEX 672314321

Service performance in public healthcare system: data envelopment analysis

AutorZahra Zare
CargoMA and BA in Industrial Engineering at the Faculty of Industrial Engineering
Páginas237-265
237
AD-MINISTER
AD-minister Nº. 30 january-june 2017 pp. 237 - 265 · ISSN 1692-0279 · eISSN 2256-4322
ZAHRA ZARE
JEL: C, I
Received: 5-09-2016
Modified: 14-11-2016
Accepted: 26-11-2016
DOI: 10.17230/ad-minister.30.12
www.eafit.edu.co/ad-minister
Creative Commons (CC BY-NC- SA)
SERVICE PERFORMANCE IN PUBLIC HEALTHCARE SYSTEM:
DATA ENVELOPMENT ANALYSIS
LA PRESTACIÓN DEL SERVICIO EN EL SISTEMA PÚBLICO DE SALUD: ANÁLISIS ENVOLVENTE DE DATOS
ZAHRA ZARE
ABSTRACT
As well as companies that compete in market, in public health system organizations compete to
satisfy customer’s need, and therefore identifying those needs and delivering the value is critical in
success. Return to Scale and Damage to Scale are measures. In this study data envelopment analysis
is developed to measure the Return to Scale and Damage to Scale in public health organization. Two
new assumptions for production possibility set are proposed as Weak Natural Disposability and weak
managerial disposability. Then three types of models including efficiency evaluation, Return to Scale
determination, and Damage to Scale determination are proposed based on radial and non-radial models.
A case study is handled using real data of 33 hospitals in Tehran. Each hospital is assumed as a decision-
making unit with 4 inputs, 2 desirable outputs, and 2 undesirable outputs. The proposed approaches are
straightforward and applicable for real world problems.
KEYWORDS
Scale Efficiency; Return to Scale; Damage to Scale; Healthcare performance; Hospital Performance.
RESUMEN
Al igual que las empresas que compiten en el mercado, las organizaciones del sistema público de salud
compiten para satisfacer las necesidades de los clientes y, por lo tanto, es fundamental identificar
dichas necesidades y entregar valor para alcanzar el éxito. Los Rendimiento de Escala y Daños de Escala
se utilizan como medidas. En este estudio, el análisis envolvente de datos se desarrolla para medir
los Rendimientos y Daños de Escala en una organización pública de salud. Se proponen dos nuevos
supuestos para la posibilidad de producción: Baja disponibilidad natural y baja disponibilidad de gestión.
Seguidamente, se proponen tres tipos de modelos basados en modelos radiales y no radiales que
incluyen la evaluación de la eficiencia, la determinación de los rendimientos de escala y la determinación
de los daños de escala. Se maneja un estudio de caso que utiliza datos reales de 33 hospitales de
Teherán, Irán. Cada hospital se asume como una unidad de toma de decisión de cuatro insumos (inputs),
dos productos (outputs) deseables y dos productos (outputs) indeseables. Los enfoques propuestos son
sencillos y aplicables a los problemas del mundo real.
PALABRAS CLAVE
Eficiencia de escala; Rendimientos de escala; daños de escala; desempeño del Sistema de salud.
INTRODUCTION
Data envelopment analysis (DEA), as a linear programming technique, serves
several benefits in comparison with the other techniques for performance
1 MA and BA in Industrial Engineeringat the Faculty ofIndustrial Engineering, Islamic Azad Univer-
sity (South Tehran Branch). Her main areas of interest are: Deterministic Models and Optimization,
Operation Research, Health systems, Economic and Financial Models. Institutional Email Address:
st_z_zare@azad.ac.ir
238
AD-MINISTER
Zahra Zare
Service performance in public healthcare system: data envelopment analysis
measurement. DEA requires no preference articulation on priority of inputs/
outputs, and can estimate the production function as a non-parametric approach.
DEA determines the ecient DMUs among others, and suggests the projection of
eciency for the inecient DMUs. Moreover, Return to Scale (RTS) issues can be
determined using an especial variants of DEA models. There are several successful
applications of DEA models in the healthcare systems (Chowdhury and Zelenyuk,
2015). Thanassoulisa, Portelab and Graveneyc (2016) identify the usefulness of the
length of stay of each episode and explores the dierences between hospitals and
between the care teams within the hospitals.
Thus, in this study DEA models are developed in order to measure the eciency
scores, RTS and Damage to Scale (DTS) issues of Iranian public health organizations
in Tehran. The main objectives of this research are:
1. The development of DEA models to measure the eciency scores of public health
organization with multiple inputs/outputs.
2. The development of mathematical models in order to measure the return/DTSs in
public health organizations.
3. And finally, the application of the proposed models in a real case study.
The structure of this paper is as follows. In Section 2, literature of past works is
reviewed. In Section 3 the proposed models are developed. In Section 3, new models
for assessing Tehran’s health systems are presented, decision-making departments,
factors would be defined. the solution algorithm that is applied for finding the
application of scale in radial and non-radial position is presented. The justification
of the application of such models will be discussed in Section 3. In Section 4, the
case study and data analysis are presented. The results and findings are presented
in Section 5. On the other hand, in Section 5, the Weak Natural Disposability (WND)
and weak managerial disposability (WMD) models’ results are presented in both
radial and non-radial status. The models are used for the evaluation of public health
organization of Medicinal Universities using desirable and undesirable outputs. And
also, the economics of scale of public health organization has been defined using
radial, non-radial models and the obtained results were compared using the collected
data. Finally, the paper will be summarized in Section 6 with concluding remarks and
future research directions.
LITERATURE OF PAST WORKS APPLICATION OF DEA MODELS IN
HEALTHCARE
Although hospital eciency analysis has attracted a large number of studies
(e.g., see Goldstein et. al., 2002; Hollingsworth, 2003; O’Neill et al., 2008; Garcia-
Lacalle and Martin, 2010; Rosko and Mutter, 2011; Mitropoulosa et al., 2015 and
Thanassoulisa et al., 2016), there are less research whose focal point is on analyzing
the determinants of hospital eciency (e.g., Grosskopf et al., 2004; Lee et al., 2008;
Blank and Valdmanis, 2010; Tsekouras et al., 2010; Cristian and Fannin, 2013; Ding,
2014). DEA is a method which evaluates service providers and defines a rate as the
ratio of perceived performance to its closed potential. Or it shows the amount of the

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