Has DRG payment influenced the technical efficiency and productivity of diagnostic technologies in Portuguese public hospitals? An empirical analysis using parametric and non‐parametric methods

The use of Diagnosis Related Groups (DRG) as a mechanism for hospital financing is a currently debated topic in Portugal. The DRG system was scheduled to be initiated by the Health Ministry of Portugal on January 1, 1990 as an instrument for the allocation of public hospital budgets funded by the National Health Service (NHS), and as a method of payment for other third party payers (e.g., Public Employees (ADSE), private insurers, etc.). Based on experience from other countries such as the United States, it was expected that implementation of this system would result in more efficient hospital resource utilisation and a more equitable distribution of hospital budgets. However, in order to minimise the potentially adverse financial impact on hospitals, the Portuguese Health Ministry decided to gradually phase in the use of the DRG system for budget allocation by using blended hospitalspecific and national DRG casemix rates. Since implementation in 1990, the percentage of each hospitals budget based on hospital specific costs was to decrease, while the percentage based on DRG casemix was to increase. This was scheduled to continue until 1995 when the plan called for allocating yearly budgets on a 50% national and 50% hospitalspecific cost basis. While all other nonNHS third party payers are currently paying based on DRGs, the adoption of DRG casemix as a National Health Service budget setting tool has been slower than anticipated. There is now some argument in both the political and academic communities as to the appropriateness of DRGs as a budget setting criterion as well as to their impact on hospital efficiency in Portugal. This paper uses a twostage procedure to assess the impact of actual DRG payment on the productivity (through its components, i.e., technological change and technical efficiency change) of diagnostic technology in Portuguese hospitals during the years 1992–1994, using both parametric and nonparametric frontier models. We find evidence that the DRG payment system does appear to have had a positive impact on productivity and technical efficiency of some commonly employed diagnostic technologies in Portugal during this time span.

An investigation into the nature and consequences of teachers' implicit philosophies of science

The aims of this study were to investigate the beliefs concerning the philosophy of science held by practising science teachers and to relate those beliefs to their pupils' understanding of the philosophy of science. Three philosophies of science, differing in the way they relate experimental work to other parts of the scientific enterprise, are described. By the use of questionnaire techniques, teachers of four extreme types were identified. These are: the H type or hypothetico-deductivist teacher, who sees experiments as potential falsifiers of hypotheses or of logical deductions from them; the I type or inductivist teacher, who regards experiments mainly as a way of increasing the range of observations available for recording before patterns are noted and inductive generalisation is carried out; the V type or verificationist teacher, who expects experiments to provide proof and to demonstrate the truth or accuracy of scientific statements; and the 0 type, who has no discernible philosophical beliefs about the nature of science or its methodology. Following interviews of selected teachers to check their responses to the questionnaire and to determine their normal teaching methods, an experiment was organised in which parallel groups were given H, I and V type teaching in the normal school situation during most of one academic year. Using pre-test and post-test scores on a specially developed test of pupil understanding of the philosophy of science, it was shown that pupils were positively affected by their teacher's implied philosophy of science. There was also some indication that V type teaching improved marks obtained in school science examinations, but appeared to discourage the more able from continuing the study of science. Effects were also noted on vocabulary used by pupils to describe scientists and their activities.