Efficiency in chronic illness care coordination: public-private collaboration models vs. traditional management.

BACKGROUND: The aim of this paper is to analyze the differences in the coordination of chronic illness care between the different public hospital management models coexisting in the Spanish region of Madrid (25 hospitals) during the period 2013-2017. METHODS: The performance of hospitals might be affected by the characteristics of the population they serve and, therefore, this information should be taken into account when estimating efficiency measures. For this purpose, we apply the nonparametric Data Envelopment Analysis (DEA) conditioned to some contextual variables and adapted to a dynamic framework, so that we can assess hospitals during a five-year period. The outputs considered are preventable hospitalizations, readmissions for heart failure and readmissions for chronic obstructive pulmonary disease, whereas the inputs considered are the number of beds, personnel (physicians and other healthcare professionals) and total expenditure on goods and services. RESULTS: The results suggest that the level of efficiency demonstrated by the public-private collaboration models of hospital management is higher than traditionally managed hospitals throughout the analyzed period. Nevertheless, we notice that efficiency differences among hospitals are significantly reduced when contextual factors were taken into account. CONCLUSIONS: Hospitals managed under public-private collaboration models are more efficient than those under traditional management in terms of chronic illness care coordination, being this difference attributable to more agile and flexible management under the collaborative models.

Analysis of the technical efficiency of the forms of hospital management based on public-private collaboration of the Madrid Health Service, as compared with traditional management.

FUNDAMENTALS: The study aims to carry out a comparative analysis of the technical efficiency of hospital management based on public-private collaboration, as compared with traditional management. Specifically, we compare traditionally managed public hospitals, public hospitals managed by a private finance initiative (PFI), public hospitals managed through a public-private partnership (PPP), and hospitals managed through other forms of management, during the period 2009 to 2014, in the hospitals dependent on the Madrid Health Service (SERMAS). METHODS: The study covers all publicly owned general hospitals under SERMAS, consisting of seven PFI hospitals, three PPP hospitals, 11 traditionally managed public hospitals (with the category of general hospital), and four hospitals managed through other forms of hospital management. The technical efficiency indices of the hospitals were calculated using the data envelopment analysis technique. Subsequently, a sensitivity analysis was performed by bootstrapping and variation of model variables to verify their impact on efficiency. Finally, an analysis of the evolution of efficiency in the analyzed period was carried out using the Malmquist Index. RESULTS: In all the analysis models carried out in the analyzed period, the hospitals managed based on public-private collaboration were more efficient than the hospitals under traditional management. CONCLUSIONS: The greater efficiency of hospitals managed based on public-private collaboration, as compared with traditional management, could be attributed to greater organizational and management flexibility.

Estimación del aprovechamiento máximo sostenible y distribución diamétrica estable de masas irregulares de pinus nigra mediante modelos matriciales / Estimation of the maximum sustainable yield and stable diametric distribution of irregular masses of pinus nigra through matrix models / Estimação do aproveitamento máximo sustentável e distribuição diamétrica estável de massas irregulares de pinus nigra mediante modelos matriciais

Se presenta un modelo matricial de proyección para cuantificar las tasas máximas de aprovechamiento que aseguren la sostenibilidad y la estabilidad de las distribuciones diamétricas de tres calidades de Pinus nigra. Considerando períodos de proyección de 10 años, los pies han sido agrupados en cinco clases diamétricas: 0-10, 10-20, 20-30, 30-40 y >40cm. Las probabilidades de transición se calcularon ajustando una aproximación por esplines cúbicos a las curvas de crecimiento diamétrico y asumiendo distribuciones uniformes para los diámetros dentro de cada clase. Se plantea una condición para la gestión sostenible de la masa, que además permite alcanzar y mantener en el tiempo una distribución diamétrica estable. Los resultados obtenidos indican que, para asegurar la sostenibilidad/estabilidad de la población, y para cada intervalo de proyección, las tasas máximas de extracción deberían estar entre el 17,21 y 40,09%, dependiendo del nivel de calidad, para reclutamientos comprendidos entre 200 y 840 pies/ha y áreas basimétricas comprendidas entre 20 y 30m²·ha-1. Finalmente, se obtienen para cada nivel de calidad las distribuciones diamétricas estables en relación al reclutamiento para áreas basimétricas de 20, 25 y 30m²·ha-1.

A matrix model is presented for the projection in time and maximal profiting that ensures sustainability and stability of diameter distributions of three qualities of Pinus nigra. Considering projection periods of 10 years, trunks were grouped in five diameter classes: 0-10, 10-20, 20-30, 30-40 and >40cm. Transition probabilities were calculated adjusting diameter growth curves by cubic approximations and assuming uniform diameter distributions within each class. A condition is proposed for the sustainable management of the tree mass that permits to reach and maintain in time a stable diameter distribution. The results indicate that, in order to ensure population sustainability/stability, for each projection time interval the maximal extraction rate should be between 17.21 and 40.09%, depending on quality level, for recruitments between 200 and 840 trunks/ha and total sectional areas of 20 to 30m²·ha-1. Finally, for each quality level the stable diameter distributions in relation to recruitment for total sectional areas of 20, 25 and 30m²·ha-1 were obtained.

Apresenta-se um modelo matricial de projeção para quantificar as taxas máximas de aproveitamento que assegurem a sustentabilidade e a estabilidade das distribuições diamétricas de três qualidades de Pinus nigra. Considerando períodos de projeção de 10 anos, os pés foram agrupados em cinco classes diamétricas: 0-10, 10-20, 20-30, 30-40 e >40cm. As probabilidades de transição se calcularam ajustando uma aproximação por splines cúbicos às curvas de crescimento diamétrico e assumindo distribuições uniformes para os diâmetros dentro de cada classe. Sugere-se uma condição para a gestão sustentável da massa, que, além disso, permite alcançar e manter no tempo uma distribuição diamétrica estável. Os resultados obtidos indicam que, para assegurar a sustentabilidade/estabilidade da população, e para cada intervalo de projeção, as taxas máximas de extração deveriam estar entre 17,21% e 40,09%, dependendo do nível de qualidade, para recrutamentos compreendidos entre 200 e 840 pés/ha e áreas basimétricas compreendidas entre 20 e 30m²·ha-1. Finalmente, se obtêm para cada nível de qualidade as distribuições diamétricas estáveis em relação ao recrutamento para áreas basimétricas de 20, 25 e 30m²·ha-1.