ABSTRACT
Investment in sanitation and drinking water infrastructure is essential for universal access to these services in developing countries. Universal coverage of water and sanitation services (WSS) can prevent the dissemination of waterborne diseases and mitigate their adverse effects. These diseases are responsible for many deaths worldwide, especially among the disadvantaged population and children. A causal effect can be established between WSS investment and hospital admissions due to waterborne diseases. Therefore, we considered an innovative network-DEA approach that models the link between serially connected subsystems (upstream investment and downstream hospitalizations). This approach allowed us: to measure the efficiency of both subsystems; estimate the amount of (efficient) investment necessary to universalize the access to proper WSS infrastructure; and mitigate hospital admissions due to waterborne diseases. We used the Brazil case study to test our model. On average, Brazilian states could increase the number of people not requiring hospitalizations due to waterborne diseases by 157 thousand per R$100 million invested in sanitation and 26 thousand per R$100 million invested in drinking water. Our results suggest that relatively small (efficient) investment in those two infrastructure types has a massive impact on hospitalizations. This impact would be more significant than the investment in WSS coverage. Therefore, if safely managed, WSS would cover all citizens, and Brazil would come closer to developed countries.
Subject(s)
Drinking Water , Waterborne Diseases , Brazil , Child , Humans , Sanitation , Water Supply , Waterborne Diseases/epidemiologyABSTRACT
Objetivo: Os hospitais públicos em Portugal melhoraram desde 2002 seus resultados em termos de eficiência, porém, nem sempre na mesma proporção nas diferentes regiões do país. O presente estudo tem como objetivo analisar os escores de eficiência em unidades hospitalares nas cinco regiões administrativas portuguesas. Métodos: A técnica da Análise Envoltória de Dados para quantificar e comparar a eficiência na atenção hospitalar em 27 unidades hospitalares das cinco regiões. Na aplicação dos modelos usaram-se quatro tipos de variáveis: insumos (custos totais), serviços prestados medidos pelo número de doentes atendidos ajustados por case-mix, qualidade do serviço prestado e acesso ao mesmo, bem como o ambiente externo (demografia e epidemiologia) usado para homogeneizar as condições em que os hospitais operam. Resultados: O nível de ineficiência médio, apenas para hospitais ineficientes, é aproximadamente 6%, um valor próximo do encontrado na literatura. Este valor corresponde a cerca de 370 milhões de Euros desperdiçados. Conclusões: Os hospitais públicos portugueses exibem um desempenho médio considerável. No entanto, existem regiões com pontuações maiores que a média nacional e outras com resultados mais pobres. A diversidade encontrada aponta para disparidades que merecem atenção especial de formuladores de políticas e gestores.
Objective: This study analysis the efficiency levels of public hospitals in Portugal. The paper explains the health care decentralization process in Portugal (started 1993) and the reforms of corporatization and merging. These ones intended to optimize costs with health care, improving efficiency, and augmenting the access and quality to the health services. Methods: Data Envelopment Analysis was used to estimate and compare the efficiency of 27 hospital units distributed across five administrative regions. In the application of the models four types of variables were used: inputs (total costs), services provided measured by the number of patients attended by case-mix, quality of service provided and access to it, as well as the external environment (demography and epidemiolog) used to homogenize the conditions in which the hospitals operate. Results: The average level of inefficiency, only for inefficient hospitals, is approximately 6%, a value close to that found in the literature. This amount corresponds to about 370 million Euros wasted. Conclusions: Portuguese public hospitals exhibit a considerable average performance. Nevertheless, there are regions with scores larger than the national average and others with poorer outcomes. The diversity found points towards disparities deserving special attention from policy makers and managers.
Subject(s)
Humans , Efficiency , Hospital Care , Health PolicyABSTRACT
Objetivo: Os hospitais públicos em Portugal apresentaram nos últimos anos uma melhoria dos seus resultados em termos de assistência. Porém, poucas têm sido as avaliações realizadas no âmbito do seu desempenho. Este estudo procura determinar a eficiência dos hospitais públicos em Portugal. Métodos: Este estudo considerou duas alternativas de modelos não paramétricos bidireccionais, baseados em Análise Envoltória de Dados e em Ordem-a. A utilização de ambos os modelos visa a validação da robustez dos resultados. Usaram-se quatro tipos de variáveis: custos totais, número de doentes atendidos ajustados ao risco, qualidade do serviço prestado, e o ambiente externo (demografia e epidemiologia). Com referência ao ano 2016, consideraram-se 27 hospitais e centros hospitalares públicos portugueses. Resultados: O nível de ineficiência médio, apenas para hospitais ineficientes, é aproximadamente 10%, correspondendo a cerca de 617 milhões desperdiçados. Conclusões: Os níveis de ineficiência variam conforme os modelos apresentados. A avaliação do desempenho deve considerar fatores como a presença de outliers, o número de variáveis, as condições externas desfavoráveis, bem como as características das fronteiras de eficiência. Um aspeto importante corresponde à convexidade da fronteira. Conclui-se que a melhor solução para avaliar o desempenho hospitalar é a abordagem por Ordem-a.
Objective: Portuguese public hospitals have exhibited an improvement of resources management in the past few years. However, only few analyses over their performance have been done. This study aims at find technical efficiency levels of Portuguese public hospitals using robust methods. Methods: This study has considered two different nonparametric alternatives for efficiency assessment. These methods are based on the Data Envelopment Analysis and on the Order-a frameworks. Four main variable categories were used: total expenses, risk-adjusted treated patients, delivered healthcare services' quality, and the epidemiologic and demographic conditions in which hospitals operate. A sample of 27 Portuguese public hospitals and hospital centres was used. Data regards the year of 2016. Results: Inefficient hospitals exhibit average technical inefficiency levels of about 10%, which corresponds to the waste of nearly 617 million. Conclusions: Inefficiency levels have a strong dependence on model features. Hence, performance evaluation should account for the existence of potential outliers, the number of variables, the existence of external factor affecting the hospitals' production process, as well as the characteristics of the achieved frontiers. An important aspect is the assumption of convexity of the frontier. A better solution for hospital performance assessment is, then, the Order-a method.