Efficiency analysis of emergency departments in metropolitan areas

The demand in the healthcare industry is increasing exponentially due to aging population of the world and this is leading to a rapid increase in the cost of healthcare. The emergency departments of the hospitals are the frontline of health care systems and play an additional critical role in providing an efficient and high-quality response for patients. The overcrowding at the emergency departments due to growing demand results in a situation where the demand for ED services exceeds the ability to provide care in a reasonable amount of time. This has led countries to reconsider their health policies in a way to increase their efficiency in their healthcare systems in general and in emergency departments, in particular. As in many countries, there has been a steady and significant increase in the number of patients that seek health services at the emergency departments of state hospitals of Turkey, due to the significant structural reforms in health services since 2003. While meeting this increasing demand, it is ever more important to provide these critical health services efficiently. Therefore, the efficiency of the emergency departments of seven general hospitals run by Istanbul's Beyoglu State Hospitals Association have been analyzed using categorical Data Envelopment Analysis (DEA) models. The analysis of DEA results is supported by a set of statistical methods to make it easier for the hospital administrators to interpret the analysis and draw conclusions. The analysis shows that less-equipped EDs are supported by better equipped, larger EDs, resulting in a hub-and-spoke type of structure among the EDs where “satellite” EDs serve an important referral function and thus evaluating their efficiency without taking the interoperability among these units into account would not be an accurate assessment of their performance.     

Efficiency evaluation of Chinese regional industrial systems using a dynamic two-stage DEA approach

Industrial air pollution control recently becomes a major policy issue in China. Performnce evaluation can examine policy effectiveness and provide decesion support for industrial development. A regional industrial system in China contains production and abatement stages. Within this structure, the capacity of industrial waste gas treatment can be treated as a carry-over variable. More precisely, it is a desirable output of the abatement stage in the previous period but an input to the abatement stage in the current period. Using this framework, this study establishes a dynamic two-stage data envelopment analysis model to explore the efficiencies of regional industrial systems in China. This model provides measures of the overall, period, stage, and period stage efficiencies. Based on empirical data from 2007 to 2015, it is concluded that (1) the carry-over variable capacity of industrial waste gas treatment has significant influences on the operational efficiency scores of regional industrial systems, especially in the abatement stage; (2) there exist distinct geographic characteristics of inefficiencies in the regional industrial systems; (3) the average period efficiency of the abatement stage was lower than that of the production stage during China's 11th Five-Year Plan period (2006–2010); however, the reverse happens during the 12th Five-Year Plan period (2011–2015); and 4) industrial structure and economic development level are the key influencing factors of regional industrial efficiencies. This study entails important implications for policy makers in terms of industrial waste gas treatment and revelant contextual factors.     

Financial liberalization and banking efficiency: evidence from Turkey

This paper examines the banking efficiency in a pre- and post-liberalization environment by drawing on the Turkish experience by using DEA. The paper also investigates the scale effect on efficiency. Our findings suggest that liberalization programs were followed by an observable decline in efficiency. Another finding of the study is that the Turkish banking system had a serious scale problem during the study period. The second part of our analysis relied on econometric methods and found that one major reason for such system-wide efficiency decline has been the growing macroeconomic instability of the Turkish economy in general and financial sector in particular.

Efficiency aggregation with enhanced Russell measures in data envelopment analysis

In aggregation for data envelopment analysis (DEA), a jointly determined aggregate measure of output and input efficiency is desired that is consistent with the individual decision making unit measures. An impasse has been reached in the current state of the literature, however, where only separate measures of input and output efficiency have resulted from attempts to aggregate technical efficiency with the radial measure models commonly employed in DEA. The latter measures are “incomplete” in that they omit the non-zero input and output slacks, and thus fail to account for all inefficiencies that the model can identify. The Russell measure eliminates the latter deficiency but is difficult to solve in standard formulations. A new approach has become available, however, which utilizes a ratio measure in place of the standard formulations. Referred to as an enhanced Russell graph measure (ERM), the resulting model is in the form of a fractional program. Hence, it can be transformed into an ordinary linear programming structure that can generate an optimal solution for the corresponding ERM model. As shown in this paper, an aggregate ERM can then be formed with all the properties considered to be desirable in an aggregate measure—including jointly determined input and output efficiency measures that represent separate estimates of input and output efficiency. Much of this paper is concerned with technical efficiency in both individual and system-wide efficiency measures. Weighting systems are introduced that extend to efficiency-based measures of cost, revenue, and profit, as well as derivatives such as rates of return over cost. The penultimate section shows how the solution to one model also generates optimal solutions to models with other objectives that include rates of return over cost and total profit. This is accomplished in the form of efficiency-adjusted versions of these commonly used measures of performance.     

基于DEA的区域高等院校协作效率评价

本文应用DEA方法从定量的角度研究通过区域内和区域之间的合作带来的益处。通过构建评价高等院校协作效率的DEA模型,对某地14所院校的区域内和区域间的高等院校协作效率进行评价。计算结果表明,通过区域内合作,每一个区域内都有部分院校的效率有较大的提高,最高的超过30％。     

Measuring efficiency in Australian Schools: A preliminary analysis

In this paper, we apply a public sector Data Envelopment Analysis model to estimate the efficiency of Australian primary and secondary schools. Standard microeconomic production theory showing the transformation of inputs into outputs is extended to allow nondiscretionary environmental variables characteristic of educational production. Failure to properly control for the socioeconomic environment leads to inappropriate comparisons and biased efficiency estimates. We employ a conditional estimator that does not allow a school with a better environment to serve as a benchmark for a school with a worse environment. The results suggest that Australian schools are moderately inefficient and that efficiency increases for the quintile of schools with the most favorable environment. Further, efficiency gains are realized with increasing enrollment.     

Measuring efficiency in education: The influence of imprecision and variability in data on DEA estimates

Many studies devoted to efficiency performance evaluation in the education sector are based on measures of central tendency at school level as, for example, the average values of students belonging to the same school. Although this is a common and accepted way of summarizing data from the original observations (students), it is not less true that this approach neglects the existing dispersion of data, which may become a serious problem if variability across schools is high. Additionally, imprecision may arise when experts on each evaluated subject select the battery of questions, with different levels of difficulty, which will be the base for the final questionnaires completed by students. This paper uses data from US students and schools participating in PISA (Programme for International Student Assessment) 2015 to illustrate that schools' efficiency measures based on aggregate data and imprecision may reflect an inaccurate picture of their performance if they are compared to measures estimated accounting for broader information provided by all students of the same school. In order to operationalize our approach, we resort to Fuzzy Data Envelopment Analysis. This methodology allows us to deal with the notion of fuzziness in some variables such as the socio-economic status of students or test scores. Our results indicate that the estimated measures of performance obtained with the fuzzy DEA approach are highly correlated with those calculated with traditional DEA models. However, we find some relevant divergences in the identification of efficient units when we account for data dispersion and vagueness.     

Efficiency in fundraising and distributions to cause-related social profit enterprises

Managerial efficiency is as important in social profit enterprises (SPEs) as it is for more traditional financial-profit organizations. In this regard, both donors and SPE executives use efficiency information in making decisions. Here, we suggest a linked, two-stage Data Envelopment Analysis (DEA) methodology for assessing efficiency in both charitable fundraising and cause delivery, while empirically investigating results for international aid organizations. The model allows efficiency assessment for both the fundraising and utilization of generated funds when directed for cause-related purposes. This, in particular, allows for measurement of the organization’s managerial efficiency relative to both multiple phased goals and peer organizations. Additionally, the approach provides benchmarks for identifying sources of improved performance in fundraising and program/cause service delivery. It can also project the results of changes in inputs on the amount of resources available for the charitable organization’s cause.The proposed model(s) allow the examiner to assess performance while, at the same time, identifying those instances wherein the simple ratio measures commonly used in non-profit assessment are (1) deficient, and/or (2) misleading because of the use of ‘incorrect’ variables, or the ‘hiding’ of inefficiency if/when tax form categories are filed by an SPE. Importantly, the suggested two-stage DEA methodology can be useful for any organization with multiple-linked goals.     

Efficiency analysis of social protection expenditure in the Italian Regions

The attention and demand for greater social protection is increasing among the populations of all European countries. It is difficult to identify which of the structures and infrastructures, sectors and regional budgets are inefficient and/or negligent in respect of providing more social protection. In the political sphere the problem is examined from a qualitative point of view, because it is essential to have a valid decisional support system that provides useful information for structural and economic intervention programs devised to improve social protection. Regional spending on social protection is a fundamental component of individual well-being. This work is precisely aimed at assessing individual well-being in terms of technical expenses efficiency in the Italian Regions. Stochastic frontier analysis and a nonparametric deterministic model structure are the tools used to investigate the social protection determinants in the paper.     

Using DEA to improve the management of congestion in Chinese industries (1981–1997)

Congestion is said to be present when increases in inputs result in output reductions. An “iron rice bowl” policy instituted in China shortly after the revolution led by Mao Tze Tung resulted in congestion that ultimately led to bankruptcy in the textile industry, and near bankruptcy in other industries. A major policy shift away from the “iron rice bowl policy” in 1990 led to massive layoffs and increasing social tensions. Were these massive layoffs necessary? Extensions of data envelopment analysis models effected in the present paper identified inefficiencies in the management of congestion. Using textiles and automobiles for illustration, it is shown how elimination of such managerial inefficiencies could have led to output augmentation without reducing employment. Thus, even in the presence of congestion, it proved to be possible to identify additional (managerial) inefficiencies that provided opportunities for improvement. In the heavily congested textile industry, these output augmentations could have been accompanied by reductions in the amounts of capital used (as an added bonus). In any case, we show how to identify and evaluate new types of efficiency—viz., the efficiency with which needed (or desired) inefficiencies are managed.     

Economic development and growth in Colombia: An empirical analysis with super-efficiency DEA and panel data models

In this paper, we analyse economic development and growth through traditional measures (gross domestic product and human development index) and Data Envelopment Analysis (DEA) in Colombian departments over the period 1993–2007. We use a DEA model to measure and rank economic development and growth from different approaches such as poverty, equality and security. The results show considerable variation in efficiency scores across departments. A second-stage panel data analysis with fixed effects reveals that higher levels of economic activity, quality life, employment and security are associated with a higher efficiency score based on the standards of living, poverty, equality and security. All findings of this analysis should demonstrate that economic development and growth could be achieved most effectively through a decrease in poverty, an increase in equality, a reduction in violence, and improved security. This indicates the need to generate effective policies that guarantee the achievement of these elements in the interest of all members of society.     

Evaluation of public HEI on teaching,research, and knowledge dissemination by Data Envelopment Analysis

Governmental policies, such as educational ones, require money from taxes to implement them. Therefore, a government must spend its resources in such a way to maximise the benefits. However, to evaluate the Public Higher Education Institutions (P–HEI) is a very complex task since many factors that can be assessed are involved. In this study, we focus on the performance of P–HEI in three activities: teaching, research, and knowledge dissemination. To accomplish this end, we develop a Data Envelopment Analysis Model to evaluate the efficiency of each activity, separately. Using an official database called ExECUM, we compute the efficiency of 40 Mexican P–HEI from year 2008–2016. The funds allocated for the government are an input in our study.According to our results, most P-HEIs are efficient in only one activity, while few are efficient in two activities. Only one P–HEI reached efficiency of 100% in the three models. On the other hand, 37.5% of the P–HEI do not reach 100% efficiency in any model. Our study provides the set of references for each P–HEI and the increments/decrements in the inputs and outputs to increase its efficiency.     

Efficiency vectors, efficiency and performance measures: new methods for ranking efficient organizational units

We present and discuss measures for analyzing productivity in deterministic frontier models. A new efficiency measure is introduced allowing for discrimination among efficient organizational units. In addition, a new performance measure for analyzing productivity of organizational units is presented. This measure fulfills various properties of efficiency measures but relaxes the indicator property. Both new approaches are based on the development of efficiency vectors which is a new vector measure for measuring efficiency. The vector components are efficiency measures related to subsets of a production possibility set. The new approaches are applied in the context of data envelopment analysis.

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.     

Testing Independence in Models of Productive Efficiency

Bootstrap methods for inference in nonparametric models of productive efficiency can be simplified, reducing computational burden, when the independence condition implicitly assumed in Simar and Wilson (1998) holds. This paper surveys nonparametric tests of independence that might be useful in this context.     

Slack-adjusted efficiency measures and ranking of efficient units

In non-parametric methods many units are calculated as efficient. The article suggests a method for ranking efficient units, not by their efficiency, but by importance as benchmarks for the inefficient units, in contrast to earlier suggestions in the literature which rank units high if they are specialized. However, the total potentials for improvement frequently remain unrevealed by calculating radial efficiency measures of the Farrell type only. The article therefore first develops efficiency measures that explicitly extend the radial measures to include slacks. The new measures are applied to a typical multidimensional small-sample data set for Norwegian employment offices.     

Causes of inefficiency in Japanese railways: Application of DEA for managers and policymakers

Although railway services have been suffering financially due to modal shifts and aging populations, they have been, and will continue to be, an essential component of nations' basic social infrastructures. Since railway firms generate positive externalities, and are required to operate in pre-determined licensed areas, governmental intervention/support may, in some cases, be justified. Indeed, many types of subsidies are created and offered for railway operations in Japan; while some are meant to cover large investments, others are used as compensation for regional disparities. However, thus far, no attempt has been made to analyze the reasons for the underperformance of Japanese railway services. In other words, it is unclear whether this underperformance can be attributed to exogenous and uncontrollable causes, or endogenous phenomena and, hence, capable of being handled by managers. The optimal degree of intervention is thus not sufficiently known. In the current paper, we propose a method based on data envelopment analysis (DEA) to analyze the causes of inefficiency in Japanese railway operations, and, further, to calculate optimal subsidy levels. The latter are designed to compensate for railways' lack of complete discretion in changing location of their operations and/or increasing/decreasing these operations since they are a regulated service. Our proposed method was applied to 53 Japanese railway operators. In so doing, we identified several key characteristics related to their inefficiencies, and developed optimal subsidies designed to improve performance.     

A new method for measuring congestion in data envelopment analysis

In data envelopment analysis (DEA), there are two principal methods for identifying and measuring congestion: Those of Färe et al. [Färe R, Grosskopf S. When can slacks be used to identify congestion. An answer to W. W. Cooper, L. Seiford, J. Zhu. Socio-Economic Planning Sciences 2001;35:1–10] and Cooper et al. [Cooper WW, Deng H, Huang ZM, Li SX. A one-model approach to congestion in data envelopment analysis. Socio-Economic Planning Sciences 2002;36:231–8]. In the present paper, we focus on the latter work in proposing a new method that requires considerably less computation. Then, by proving a selected theorem, we show that our proposed methodology is indeed equivalent to that of Cooper et al.     

Efficiency and Global Scale Characteristics on the “No Free Lunch” Assumption Only

In a production technology, the type of returns to scale (RTS) associated with an efficient decision making unit (DMU) is indicative of the direction of marginal rescaling that the DMU should undertake in order to improve its productivity. In this paper a concept of global returns to scale (GRS) is developed as an indicator of the direction in which the most productive scale size (MPSS) of an efficient DMU is achieved. The GRS classes are useful in assisting strategic decisions like those involving mergers of units or splitting into smaller firms. The two characterisations, RTS and GRS, are the same in a convex technology but generally different in a non-convex one. It is shown that, in a non-convex technology, the well-known method of testing RTS proposed by Färe et al. is in fact testing for GRS and not RTS. Further, while there are three types of RTS: constant, decreasing and increasing (CRS, DRS and IRS, respectively), the classification according to GRS includes the fourth type of sub-constant GRS, which describes a DMU able to achieve its MPSS by both reducing and increasing the scale of operations. The notion of GRS is applicable to a wide range of technologies, including the free disposal hull (FDH) and all polyhedral technologies used in data envelopment analysis (DEA).     

Mix Efficiency in a Multi-species Fishery

A feature of fisheries that distinguishes them from most other industries is the level of control imposed on the production process. Previous studies have identified inefficiency in fisheries that is directly related to the management restrictions. The development of Slack-based measure (SBM) models allows the effects of management distortions to be further investigated through consideration of input and output mix efficiency. In this paper, the mix efficiency of a fleet operating in a multispecies fishery is examined. The results indicate that inefficiencies exist in the mix of inputs, which have developed as a consequence of the management restrictions imposed.