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Eur J Health Econ (2013) 14:929938 DOI 10.1007/s10198-012-0437-0
ORIGINAL PAPER
Managing for efciency in health care: the case of Greek public hospitals
Panagiotis Mitropoulos Ioannis Mitropoulos
Aris Sissouras
Received: 14 May 2012 / Accepted: 4 October 2012 / Published online: 31 October 2012 Springer-Verlag Berlin Heidelberg 2012
Abstract This paper evaluates the efciency of public hospitals with two alternative conceptual models. One model targets resource usage directly to assess production efciency, while the other model incorporates nancial results to assess economic efciency. Performance analysis of these models was conducted in two stages. In stage one, we utilized data envelopment analysis to obtain the efciency score of each hospital, while in stage two we took into account the inuence of the operational environment on efciency by regressing those scores on explanatory variables that concern the performance of hospital services. We applied these methods to evaluate 96 general hospitals in the Greek national health system. The results indicate that, although the average efciency scores in both models have remained relatively stable compared to past assessments, internal changes in hospital performances do exist. This study provides a clear framework for policy implications to increase the overall efciency of general hospitals.
Keywords Hospital Efciency Bootstrap DEA
Truncated regression
JEL Classication C14 C51 I12 I18
Introduction
Efciency is a fundamental and at the same time elementary claim of every modern health system, regardless of any diversication or special issue that may occur due to specic funding or political-social characteristics. Efciency is the main target of every manager in any kind of healthcare institute, while effectiveness remains the respective concern of the medical professional. Restraint policies regarding health expenditure are applied worldwide, using methodologies and models aimed at rational and efcient use of scarce resources.
In OECD countries, hospital costs accounted for up to 35 % of total health expenditure in 2009 [1]. Cost containment in the hospital sector is therefore a key issue in stabilizing health-related expenditure at a sustainable level. Two of the main factors causing health care expenditure to grow uncontrollably are demographic change and technological progress. Both these factors are, however, difcult for policy-makers to control. As such, a third factor contributing to high costs can be introduced: inefciencies in the health-care production process. Hence, quantication...