Economias de escala em centros hospitalares

RESUMO - Perante o actual contexto de contenção de gastos no sector da saúde e consequente preocupação com a eficiência do sistema, tem‐se assistido a mudanças várias no modelo de gestão e organizacional do sistema de saúde. Destaca‐se a alteração da estrutura hospitalar, com vista à racionalização dos seus recursos internos, onde as fusões hospitalares têm assumido um papel determinante. Em Portugal, nos últimos 10 anos, assistiu‐se a uma significativa redução do número de hospitais (de sensivelmente 90 para 50 unidades), exclusivamente através das fusões e sem quaisquer alterações no número de estruturas físicas existentes. Não obstante os argumentos justificativos desta reforma, a avaliação dos objectivos implícitos é insuficiente. Neste âmbito, pretendeu‐se com este estudo contribuir para a análise do impacte da criação de centros hospitalares na redução de gastos, isto é, verificar se a consolidação e consequente reengenharia dos processos produtivos teve consequencias ao nível da obtenção de economias de escala. Para esta análise usou‐se uma base de dados em painel, onde se consideraram 75 hospitais durante 7 anos (2003‐2009), número que foi reduzindo ao longo do período em análise devido às inúmeras fusões já referidas. Para avaliar os ganhos relativos às fusões hospitalares, ao nível da eficiência técnica e das economias de escala, recorreu‐se à fronteira estocástica especificada função custo translog. Estimada a fronteira, foi possível analisar três centros hospitalares específicos, onde se comparou o período pré‐fusão (2005‐2006) com o período após a fusão (2008‐2009). Como variáveis explicativas, relativas à produção hospitalar, considerou‐se o número de casos tratados e os dias de internamento (Vita, 1990; Schuffham et al., 1996), o número de consultas e o número de urgências, sendo estas variáveis as mais comuns na literatura (Vita, 1990; Fournier e Mitchell, 1992; Carreira, 1999). Quanto à variável dependente usou‐se o custo variável total, que compreende o total de custos anuais dos hospitais excepto de imobilizado. Como principais conclusões da investigação, em consequência da criação dos centros hospitalares, são de referir os ganhos de escala na fusão de hospitais de reduzida dimensão e com mais serviços complementares. --------ABSTRACT - Driven by the current pressure on resources induced by budgetary cuts, the Portuguese Ministry of Health is imposing changes in the management model and organization of NHS hospitals. The most recent change is based on the creation of Hospital Centres that are a result of administrative mergers of existing hospitals. In less than 10 years the number of hospitals passed from around 90 to around 50, only due to the mergers and without any change in the existing number of physical institutions. According to the political discourse, one of the main goals expected from this measure is the creation of synergies and more efficiency in the use of available resources. However, the merger of the hospitals has been a political decision without support or evaluation of the first experiments. The aim of this study is to measure the results of this policy by looking at economies of scale namely through reductions in the expenditures, as expected and sought by the MoH. Data used covers 7 years (2003‐2009) and 75 hospitals, number that has been reduced my the enoumerous mergers during the last decade. This work uses a stochastic frontier analysis through the translog cost function to examine the gains from mergers, which were decomposed into technical efficiency and economies of scale. It was analised these effects by the creation of three specific hospital centers, using a longitudinal approach to compare the period pre‐merger (2003‐2006) with the post‐merger period (2007‐09). To measure changes in inpatient hospital production volume and length of stay are going to be considered as done by Vita (1990) and Schuffham et al. (1996). For outpatient services the number of consultations and emergencies are going to be considered (Vita, 1990; Fournier e Mitchell, 1992; Carreira, 1999). Total variable cost is considered as the dependent variable explained the aforementioned ones. After a review of the literature results expected point to benefits from the mergers, namely a reduction in total expenditures and in the number of duplicated services. Results extracted from our data point in the same direction, and thus for the existence of some economies of scale only for small hospitals.

Cost efficiency in the Portuguese water sector: The case of multimunicipal systems operating at the bulk level

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and Economics

Economies of scale and scope in the provision of diagnostic techniques and therapeutic services in Portuguese hospitals

This paper analyses the provision of auxiliary clinical services that are typically carried out within the hospital. We estimate a exible cost function for the three most important (cost- wise) diagnostic techniques and therapeutic services in Portuguese hospitals: Clinical Pathology, Medical Imaging and Physical Medicine and Rehabilitation. Our objective in carrying out this estimation is the evaluation of economies of scale and scope in the provision of these services. For all services, we nd evidence of ray economies of scale and some evidence of economies of scope. These results have important policy implications and can be related to the ongoing discussion of where and how should hospitals provide these services.

Benchmarking in primary health care: An application of the stochasticd frontier analysis and the grades of membership approach to Portuguese family health units

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and Economics

Hospital costs and random demand

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and Economics

Comments on ‘‘Modeling fractional stochastic systems as non-random fractional dynamics driven Brownian motions

Applied Mathematical Modelling, Vol.33

On international cost-sharing of pharmaceutical R&D

Ramsey pricing has been proposed in the pharmaceutical industry as a principle to price discriminate among markets while allowing to recover the (fixed) R&D cost. However, such analyses neglect the presence of insurance or the fund raising costs for most of drug reimbursement. By incorporating these new elements, we aim at providing some building blocks towards an economic theory incorporating Ramsey pricing and insurance coverage. We show how coinsurance affects the optimal prices to pay for the R&D investment. We also show that under certain conditions, there is no strategic incentive by governments to set coinsurance rates in order to shift the financial burden of R&D. This will have important implications to the application of Ramsey pricing principles to pharmaceutical products across countries.

Applications of Fourier methods to the analysis of some stochastic processes

Dissertação de Doutoramento em Matemática: Processos Estocásticos

Low cost inertial-based localization system for a service robot

Dissertation presented at Faculty of Sciences and Technology of the New University of Lisbon to attain the Master degree in Electrical and Computer Science Engineering

Extremum estimators and stochastic optimization methods

Submitted in partial fulfillment for the Requirements for the Degree of PhD in Mathematics, in the Speciality of Statistics in the Faculdade de Ciências e Tecnologia

Stochastic model of transcription initiation of closely spaced promoters in escherichia coli

Dissertação para obtenção do Grau de Mestre em Engenharia Biomédica

Stochastic modelling of the reservoir lithological and petrophysical attributes. A case study of the Middle East carbonate reservoir

Dissertação para obtenção do Grau de Mestre em Engenharia Geológica (Georrecursos)

Stochastic simulation of the morphology of fluvial sand channels reservoirs

Dissertação para obtenção do Grau de Mestre em Engenharia Geológica (Georrecursos)

Stochastic modeling of the thermal and catalytic degradation of polyethylene using simultaneous DSC/TG analysis

Dissertação para obtenção do Grau de Mestre em Engenharia Química e Bioquímica

Aircraft Engines Maintenance Costs and Reliability: An Appraisal of the Decision Process to Remove an Engine for a Shop Visit Aiming at Minimum Maintenance Unit Cost

Dissertação apresentada como requisito parcial para obtenção do grau de Mestre em Estatística e Gestão de Informação.