Evaluation of efficiency in Colombian hospitals: An analysis for the post-reform period

In this study we analyze the performance of 602 level 1 Colombian hospitals for the period 2009–2013. The analysis is carried out from both static and temporal perspectives in order to evaluate the evolution of total factor productivity (change in hospital performance) and its components throughout the period. The study also explores a question relevant not only to the Colombian health system, but to many others around the world, of whether primary care centers excessively refer patients to high-level hospitals, thereby negatively affecting the quality, efficiency, and effectiveness of all healthcare service provision. The results demonstrated that adjusted production (service provision) and levels of quality and referrals to higher-level hospitals could be improved, on average, by 44%. This increase in health service provision levels and their quality can be achieved by reducing personnel expenditure (by an average of 22%), expenditure on medicines (by 20%), and purchasing expenses (by 11%). The temporal analysis shows that total factor productivity (hospital performance change) worsened by 1% during the period, mainly due to the technological backlash experienced despite a slightly positive evolution in efficiency.     

Are we operating effectively? A lean analysis of operating theatre changeovers

Hospital operating theatres are a critical but costly resource in healthcare processes. Their efficiency and utilisation impact upon hospital finances, clinical effectiveness and patient outcomes. Operations management techniques have now been applied widely to optimise flow. An important challenge is to balance the needs of process flexibility, efficiency and work standardisation with clinical requirements. This paper applies operations management methods to analyse elective orthopaedic surgery at five international hospitals to describe the issues that affect operating theatre productivity. It utilises an innovative method of video analysis to observe patient changeovers over 29 days of surgery and data is analysed to understand the causes of variability and waste. The findings suggest that processes which are standardised via operations management methodologies can improve productivity in a process that exhibits wide variation in practice. There are apparent trade-offs associated with efficiency and clinical concerns such infection control, that lead to different standard process archetypes being utilised. Recommendations for standardising patient changeovers are provided.     

Workforce churning,human capital disruption,and organisational performance in different technological contexts

We assess the influence of workforce churning on the relationship between organisational human capital and labour productivity. Building on collective turnover research and human capital theory, we examine how the components of workforce churning (i.e., voluntary turnover, involuntary turnover, and new hires) influence the relationship between existing human capital and labour productivity. Further, we examine how this influence varies according to a firm's technological intensity. Our data come from 1,911 Italian manufacturing firms and reveals that collective voluntary turnover negatively affects the relationship between organisational human capital and labour productivity regardless of an organisation's level of technological intensity. In contrast, collective involuntary turnover enhances the relationship between human capital and labour productivity, and its effect is even stronger for organisations with more technologically intensive operations. Finally, our results suggest that the integration of new hires disrupts the relationship between human capital and productivity, particularly for firms with technologically intensive operations.     

ECONOMIC WELFARE ANALYSIS OF THE LEGALIZATION OF DRUGS: A CGE MICROSIMULATION MODEL FOR COLOMBIA

In this paper, a computable general equilibrium (CGE) microsimulation model is used to analyze the effects of an ex ante legalization of drugs on the Colombian economy. The model consists of 11 productive sectors, 3 different labor force categories with unemployment, and 20 households divided by income and location. Changes in wages and migration are estimated using a labor participation model, and a NIDS estimates the demands of the households. Changes in household economic welfare, measured by changes in income and prices (CV and EV measurements), are very sensitive to the reinvestments that the government makes in the economy. By analyzing six different scenarios with different assumptions about changes in drug prices, investments of the government, and the termination of the armed conflict, the results suggest that economic welfare improves when the government reinvests military expenditures in other productive sectors or when the ‘economy of war’ continues and the legalization does not end the armed conflict.     

资本市场扭曲对城市全要素生产率的影响研究——基于规模和技术视角

在创新驱动发展的背景下,资本市场化改革有助于提高资本配置效率,进而对全要素生产率产生影响。基于中国城市相关数据,利用生产函数法和随机前沿估计法测算资本市场扭曲,并利用DEA-Malmquist指数法对城市全要素生产率进行分解,从规模和技术视角切入,实证分析了资本市场扭曲对城市规模效率、技术效率和全要素生产率的影响。研究发现,资本市场扭曲增加对规模效率具有正向影响,对技术效率和全要生产率具有负向影响。反事实分析结果显示,当消除资本市场扭曲后,从全国层面看,规模效率平均下降0.54%,技术效率平均上升4.25%,全要素生产率平均上升1.54%。     

Examining the impact of information technology and patient flow on healthcare performance: A Theory of Swift and Even Flow (TSEF) perspective

The impact of information technologies on manufacturing operations and performance is well established. However, scant research has been devoted to examining information technology (IT) investment among hospitals and how it influences patient care and financial performance. Using the lens of the Theory of Swift Even Flow (TSEF), we present an operations management-based perspective on the effect of IT in streamlining hospital operations. Specifically, we examined the role of IT on patient flow and its consequences for improved hospital efficiency and performance.     

基于环境负产出的能效动态Malmquist模型研究

本文旨在研究环境效率—能源效率—经济效率的"三位一体动态全要素生产率"。首先基于数据包络分析建立了环境约束下的能效动态Malmquist模型,定义了能效效率改变指数、污效效率改变指数和动态进步指数。通过对中国18个行业2000～2007年的数据分析,指出未考虑环境效应、动态效应的Malmquist模型会带来误判,进而揭示出在中国能效全要素生产率改变过程中,能源环境效应起到了不可忽略的作用,而动态效应则是最大的瓶颈,却没得到应有的重视。     

A Decomposition of Total Factor Productivity Growth in Korean Manufacturing Industries: A Stochastic Frontier Approach

This paper applies a stochastic frontier production model to Korean manufacturing industries, to decompose the sources of total factor productivity (TFP) growth into technical progress, changes in technical efficiency, changes in allocative efficiency, and scale effects. Empirical results based on data from 1980–1994 show that productivity growth was driven mainly by technical progress, that changes in technical efficiency had a significant positive effect, and that allocative efficiency had a negative effect. This study suggests that specific guidelines are required to promote productivity in each industry, and provides additional insight into understanding the recent debate on TFP growth in Korean manufacturing.     

The diffusion of medical technology: a "prisoner's dilemma" trap?

Medical technology diffusion and its effect on the modern hospital and on the rising costs of medical care is an issue which receives considerable attention from economists and policy analysts. In this paper a different approach is used to understand this phenomenon. We present the decision of a single hospital, whether or not to adopt an advanced technology system, using the concept of a noncooperative, nonzero sum game. Such presentation provides us with more insight on the conflict in which hospitals find themselves; the "catch" which pushes them to purchase more and more sophisticated and expensive technology in the hope that they will be able to successfully compete with other hospitals. The situation is further complicated by the existence of another "hidden" player--society, whose goals may differ from those of any individual hospital and even from the collective interests of the hospital sector. Possible conflicts that may exist and suggested solutions for each participant are presented and their policy implication are discussed.     

Changes in hospital efficiency and size: An integrated propensity score matching with data envelopment analysis

Turkey has made huge investments in city hospitals. The distinguishing feature of these hospitals is that they are physically large. Although many studies have investigated the efficiency of public hospitals, there are a few studies on the effect of hospital size on efficiency. This study examines the effect of hospital size on changes in public hospital efficiencies. The analysis is made up of three steps. First, using a bootstrap data envelopment analysis (DEA), the pure efficiency scores of each hospital were calculated. Second, propensity score matching (PSM) was used to ensure that any differences could be attributed to a particular class of hospital size, and not be due to differences in sample characteristics between the intervention and control groups. To highlight a potential time difference between small and large hospitals, the efficiencies of hospitals were examined from 2014 to 2017. Third, the Mann–Whitney U test was used to conduct a robustness check of the DEA and PSM results. Fourth, logistic regression was used on balanced data to examine the determinants of the efficiency of public hospitals. There are remarkable differences in the results obtained before and after matching the groups based on the bed-occupancy rate. Additionally, urban location is a key predictor of efficient and inefficient hospitals. This study also highlights that integrating DEA and PSM is a useful strategy in accurately identifying predictors of efficiencies of hospitals by creating balanced groups. Health policymakers should consider the efficiency advantages of high workload and service burden in the planning of public hospitals.     

Efficiency of U.S. hospitals between 2001 and 2011

This study focuses on finding the trend of efficiency in the healthcare industry in recent years. We applied stochastic frontier analysis and data envelopment analysis methods to capture the efficiency of 1,471 hospitals and found a sign of the Baumol effect, which is detected by the decreasing trend of hospital efficiency with increasing trend of labor costs. Furthermore, we compared the results of both approaches (stochastic frontier and data envelope analyses) in capturing efficiency scores and suggest the U‐shaped curve of the size effect may indicate the practice of “cream skimming” by some small hospitals.     

Exploratory analyses of relief and development operations using social networks

We use social networks to explore how structural factors affect humanitarian organizations’ performance in relief and development operations. Analyses of two recent humanitarian disasters show that having pre-established partnerships among implementers, a central coordinator, high connectivity, and few structural holes facilitates coordination and improves performance. Similarly, cost efficiency analyses of 757 development programs reveal that (i) high performance of donors and beneficiaries is positively related to the amount of implementers they interact with, and (ii) programs connected by common actors are more cost efficient. Finally, short path lengths and frequent connections among actors or programs improve performance in humanitarian operations.     

最低工资与全要素生产率：机制讨论与经验证据

最低工资标准逐年上调导致企业劳动力成本不断上升,其对我国企业全要素生产率影响存在争议。将2012—2019年全国405个地级市最低工资标准数据和中国上市公司数据匹配,从要素替代和技术替代效应两个视角探讨其内在影响机制。研究发现：最低工资上调会降低企业的全要素生产率;最低工资对企业全要素生产率挤出效应表现为国有企业和融资约束程度越高的企业挤出效应更强,中部地区的挤出效应强于东部地区;最低工资标准越高,企业越倾向于通过要素替代和技术替代来改变生产效率。研究对提高全要素生产率和实现经济高质量发展具有重要参考意义。     

数字经济对全要素生产率的影响研究——来自国家级大数据综合试验区的证据

基于国家级大数据综合试验区的准自然实验，运用2014—2019年280个地级市的面板数据，采用多期双重差分法实证检验数字经济对全要素生产率的影响。研究结果表明：数字经济显著提升了全要素生产率，这一结论在经过多种稳健性检验后仍然成立；中介效应检验表明，数字经济通过提高资源配置效率和促进技术创新来提升全要素生产率；异质性分析表明，数字经济对低资源禀赋城市、低数字经济发展水平城市以及智慧城市的全要素生产率具有促进作用，抑制高资源禀赋、高数字经济城市的全要素生产率，而对非智慧城市的作用则不明显。因此，应基于大数据综合试验区深度挖掘数字经济的直接作用与间接作用，同时采取差异化发展战略，培育壮大全要素生产率增长新动能。     

The impact of strategic operations management decisions on community hospital performance

Over the past decade, 10% of community hospitals have closed. In this challenging time, our study presents hospital administrators with some valuable information that can help improve community hospitals’ performance. The purpose of this paper is to develop a strategic operations management model that links long-term service choices, intermediate operations decisions, and hospital performance given the structural constraints of location, size, and medical teaching status. Data collected from 151 community hospitals are used to test the model. The research identifies strategic operations management decisions in the US community hospitals, shows their causal relationships, and identifies their effects on hospital performance. Specifically, we find that intermediate infrastructural operations decisions affect a community hospital’s cost, quality, and financial performance after the structural decisions of location and size have set the stage. Our study also reveals that community hospitals have adopted new staff and demand management decisions in response to the market needs.     

Productivity Growth in the UK Regions, 1968–1991

This paper provides estimates of total factor productivity growth for the regions of the UK. It shows that the peripheral regions generally performed better than the national average in the 1980's. A model to explain TFP growth found that much of this increase can be attributed to a general upskilling of a more flexible workforce, falling plant sizes, and a 'catch-up' effect in the unionized sector.     

Developing economic measures of hospital productivity

This study presents a methodology for measuring hospital output and estimating hospital productivity. A productivity index is developed for a sample of hospitals in New York City for which information was far more detailed than in systematic national sources, and sources of differences among hospitals in productivity are investigated. Internal consistencies in the productivity relationships are examined, and the findings are compared with cost relationships derived from the same data base. The analysis suggests that much better measures for a number of service areas and improved methods for dealing with variations in quality of care will be needed before reasonably accurate hospital-wide measures of output and productivity can be attained.     

Explaining Bank Productivity in Ghana

The objective of this paper is to examine productivity changes among Ghanaian banks. The Malmquist productivity index is employed to estimate total factor productivity changes and its components on a panel of 18 banks from 2003 to 2011. The results indicate that productivity growth was attributable to the catch‐up effect of efficiency changes. We also find productivity growth across three categories of bank size to be driven by efficiency changes. From a panel regression analysis, we identify size, concentration, income diversification and risk as the factors that explain productivity differences among Ghanaian banks. Recommendations for improving bank productivity are derived from the results. Copyright © 2015 John Wiley & Sons, Ltd.     

金融发展对环境规制提升工业绿色全要素生产率的创新补偿效应

以金融发展为切入点,探讨环境规制对工业绿色全要素生产率的影响。研究结果显示,不同融资模式的金融发展对环境规制提升工业绿色全要素生产率均存在创新补偿效应,且股票市场的创新补偿效应最大,银行部门次之,民间金融最小。分区域的估计结果显示,东部地区银行部门不存在创新补偿效应,其余地区的估计结果与整体一致。进一步的门槛检验结果显示,银行部门和民间金融均存在单一门槛,且呈现正向边际效率递增的非线性规律。     

中国农业生产率的变动与分解分析:1978～2004年--基于非参数的HMB生产率指数的实证研究

本文使用非参数的HMB生产率指数方法，考察了中国农村改革以来农业全要素生产率（TFP）的变动趋势，并把TFP的增长构成分解为技术进步、技术效率变化、规模效应和投入产出混合效应四个部分。结果表明，改革开放以来我国农业TFP的增长主要是由技术进步推动的，技术效率的下降对TFP的增长造成了不利影响，而规模效应和混合效应影响较弱。文章还指出中国农业的育种能力和生物技术的发展是农业技术进步的决定力量。