Public and private hospital services reform:an investigation in Iranian hospitals

This research aimed to present a model of efficiency for selected public and private hospitals of East Azerbaijani province of Iran by making use of DEA approach in order to recognize and suggest the best practice standards. In other words, its aim was to suggest a suitable context to develop efficient hospital systems while maintaining the quality of care at minimum expenditures. It is recommended for inefficient hospitals to make use of the followings: transferring, selling, or renting idle/unused beds; transferring excess doctors and nurses to the efficient hospitals or other health centers; pensioning off, early retirement clinic officers, technicians/technologists, and other technical staff. The saving obtained from the above approaches could be used to improve remuneration for remaining staff and quality of health care services of hospitals, rural and urban health centers, support communities to start or sustain systematic risk and resource pooling and cost sharing mechanisms for protecting beneficiaries against unexpected health care costs, compensate the capital depreciation, increasing investments, and improve diseases prevention services and facilities in the provincial and national levels.

Estimating the scope for savings in referrals and drug prescription costs in the general Practice units of a UK primary care trust

This paper explores the potential for cost savings in the general Practice units of a Primary Care Trust (PCT) in the UK. We have used Data Envelopment Analysis (DEA) to identify benchmark Practices, which offer the lowest aggregate referral and drugs costs controlling for the number, age, gender, and deprivation level of the patients registered with each Practice. For the remaining, non-benchmark Practices, estimates of the potential for savings on referral and drug costs were obtained. Such savings could be delivered through a combination of the following actions: (i) reducing the levels of referrals and prescriptions without affecting their mix (£15.74 m savings were identified, representing 6.4% of total expenditure); (ii) switching between inpatient and outpatient referrals and/or drug treatment to exploit differences in their unit costs (£10.61 m savings were identified, representing 4.3% of total expenditure); (iii) seeking a different profile of referral and drug unit costs (£11.81 m savings were identified, representing 4.8% of total expenditure). © 2012 Elsevier B.V. All rights reserved.

The measurement and decomposition of economy-wide productivity growth:Assessing the accuracy and selecting between different approaches

Productivity at the macro level is a complex concept but also arguably the most appropriate measure of economic welfare. Currently, there is limited research available on the various approaches that can be used to measure it and especially on the relative accuracy of said approaches. This thesis has two main objectives: firstly, to detail some of the most common productivity measurement approaches and assess their accuracy under a number of conditions and secondly, to present an up-to-date application of productivity measurement and provide some guidance on selecting between sometimes conflicting productivity estimates. With regards to the first objective, the thesis provides a discussion on the issues specific to macro-level productivity measurement and on the strengths and weaknesses of the three main types of approaches available, namely index-number approaches (represented by Growth Accounting), non-parametric distance functions (DEA-based Malmquist indices) and parametric production functions (COLS- and SFA-based Malmquist indices). The accuracy of these approaches is assessed through simulation analysis, which provided some interesting findings. Probably the most important were that deterministic approaches are quite accurate even when the data is moderately noisy, that no approaches were accurate when noise was more extensive, that functional form misspecification has a severe negative effect in the accuracy of the parametric approaches and finally that increased volatility in inputs and prices from one period to the next adversely affects all approaches examined. The application was based on the EU KLEMS (2008) dataset and revealed that the different approaches do in fact result in different productivity change estimates, at least for some of the countries assessed. To assist researchers in selecting between conflicting estimates, a new, three step selection framework is proposed, based on findings of simulation analyses and established diagnostics/indicators. An application of this framework is also provided, based on the EU KLEMS dataset.

Estimating the efficiency of healthcare facilities providing HIV/AIDS treatment in Zambia:a data envelopment approach

Zambia and many other countries in Sub-Saharan Africa face a key challenge of sustaining high levels of coverage of AIDS treatment under prospects of dwindling global resources for HIV/AIDS treatment. Policy debate in HIV/AIDS is increasingly paying more focus to efficiency in the use of available resources. In this chapter, we apply Data Envelopment Analysis (DEA) to estimate short term technical efficiency of 34 HIV/AIDS treatment facilities in Zambia. The data consists of input variables such as human resources, medical equipment, building space, drugs, medical supplies, and other materials used in providing HIV/AIDS treatment. Two main outputs namely, numbers of ART-years (Anti-Retroviral Therapy-years) and pre-ART-years are included in the model. Results show the mean technical efficiency score to be 83%, with great variability in efficiency scores across the facilities. Scale inefficiency is also shown to be significant. About half of the facilities were on the efficiency frontier. We also construct bootstrap confidence intervals around the efficiency scores.

Performance measurement with fuzzy data envelopment analysis

The intensity of global competition and ever-increasing economic uncertainties has led organizations to search for more efficient and effective ways to manage their business operations. Data envelopment analysis (DEA) has been widely used as a conceptually simple yet powerful tool for evaluating organizational productivity and performance. Fuzzy DEA (FDEA) is a promising extension of the conventional DEA proposed for dealing with imprecise and ambiguous data in performance measurement problems. This book is the first volume in the literature to present the state-of-the-art developments and applications of FDEA. It is designed for students, educators, researchers, consultants and practicing managers in business, industry, and government with a basic understanding of the DEA and fuzzy logic concepts.

Advances in data envelopment analysis

Since its introduction in 1978, data envelopment analysis (DEA) has become one of the preeminent nonparametric methods for measuring efficiency and productivity of decision making units (DMUs). Charnes et al. (1978) provided the original DEA constant returns to scale (CRS) model, later extended to variable returns to scale (VRS) by Banker et al. (1984). These ‘standard’ models are known by the acronyms CCR and BCC, respectively, and are now employed routinely in areas that range from assessment of public sectors, such as hospitals and health care systems, schools, and universities, to private sectors, such as banks and financial institutions (Emrouznejad et al. 2008; Emrouznejad and De Witte 2010). The main objective of this volume is to publish original studies that are beyond the two standard CCR and BCC models with both theoretical and practical applications using advanced models in DEA.

Economic efficiency when prices are not fixed:disentangling quantity and price efficiency

This paper proposes an approach to compute cost efficiency in contexts where units can adjust input quantities and to some degree prices so that through their joint determination they can minimise the aggregate cost of the outputs they secure. The model developed is based on the data envelopment analysis (DEA) framework and can accommodate situations where the degree of influence over prices ranges from minimal to considerable. When units cannot influence prices at all the model proposed reduces to the standard cost efficiency DEA model for the case where prices are taken as exogenous. In addition to the cost efficiency model, we introduce an additive decomposition of potential cost savings into a quantity and a price component, based on Bennet indicators. © 2014 Elsevier Ltd.

Efficiency analysis of forestry journals:suggestions for improving journals' quality

In this paper we attempt to assess the impact of journals in the field of forestry, in terms of bibliometric data, by providing an evaluation of forestry journals based on data envelopment analysis (DEA). In addition, based on the results of the conducted analysis, we provide suggestions for improving the impact of the journals in terms of widely accepted measures of journal citation impact, such as the journal impact factor (IF) and the journal h-index. More specifically, by modifying certain inputs associated with the productivity of forestry journals, we have illustrated how this method could be utilized to raise their efficiency, which in terms of research impact can then be translated into an increase of their bibliometric indices, such as the h-index, IF or eigenfactor score. © 2013 Elsevier Ltd.

A modified semi-oriented radial measure for target setting with negative data

Over the last few years Data Envelopment Analysis (DEA) has been gaining increasing popularity as a tool for measuring efficiency and productivity of Decision Making Units (DMUs). Conventional DEA models assume non-negative inputs and outputs. However, in many real applications, some inputs and/or outputs can take negative values. Recently, Emrouznejad et al. [6] introduced a Semi-Oriented Radial Measure (SORM) for modelling DEA with negative data. This paper points out some issues in target setting with SORM models and introduces a modified SORM approach. An empirical study in bank sector demonstrates the applicability of the proposed model. © 2014 Elsevier Ltd. All rights reserved.

A bi-objective weighted model for improving the discrimination power in MCDEA

Lack of discrimination power and poor weight dispersion remain major issues in Data Envelopment Analysis (DEA). Since the initial multiple criteria DEA (MCDEA) model developed in the late 1990s, only goal programming approaches; that is, the GPDEA-CCR and GPDEA-BCC were introduced for solving the said problems in a multi-objective framework. We found GPDEA models to be invalid and demonstrate that our proposed bi-objective multiple criteria DEA (BiO-MCDEA) outperforms the GPDEA models in the aspects of discrimination power and weight dispersion, as well as requiring less computational codes. An application of energy dependency among 25 European Union member countries is further used to describe the efficacy of our approach. © 2013 Elsevier B.V. All rights reserved.

The state of the art in fuzzy data envelopment analysis

Data envelopment analysis (DEA) is a methodology for measuring the relative efficiencies of a set of decision making units (DMUs) that use multiple inputs to produce multiple outputs. Crisp input and output data are fundamentally indispensable in conventional DEA. However, the observed values of the input and output data in real-world problems are sometimes imprecise or vague. Many researchers have proposed various fuzzy methods for dealing with the imprecise and ambiguous data in DEA. This chapter provides a taxonomy and review of the fuzzy DEA (FDEA) methods. We present a classification scheme with six categories, namely, the tolerance approach, the α-level based approach, the fuzzy ranking approach, the possibility approach, the fuzzy arithmetic, and the fuzzy random/type-2 fuzzy set. We discuss each classification scheme and group the FDEA papers published in the literature over the past 30 years. © 2014 Springer-Verlag Berlin Heidelberg.

Productivity growth and efficiency measurements in fuzzy environments with an application to health care

Health care organizations must continuously improve their productivity to sustain long-term growth and profitability. Sustainable productivity performance is mostly assumed to be a natural outcome of successful health care management. Data envelopment analysis (DEA) is a popular mathematical programming method for comparing the inputs and outputs of a set of homogenous decision making units (DMUs) by evaluating their relative efficiency. The Malmquist productivity index (MPI) is widely used for productivity analysis by relying on constructing a best practice frontier and calculating the relative performance of a DMU for different time periods. The conventional DEA requires accurate and crisp data to calculate the MPI. However, the real-world data are often imprecise and vague. In this study, the authors propose a novel productivity measurement approach in fuzzy environments with MPI. An application of the proposed approach in health care is presented to demonstrate the simplicity and efficacy of the procedures and algorithms in a hospital efficiency study conducted for a State Office of Inspector General in the United States. © 2012, IGI Global.

Classifying flexible measures in data envelopment analysis:a slack-based measure

Data envelopment analysis (DEA) has gained a wide range of applications in measuring comparative efficiency of decision making units (DMUs) with multiple incommensurate inputs and outputs. The standard DEA method requires that the status of all input and output variables be known exactly. However, in many real applications, the status of some measures is not clearly known as inputs or outputs. These measures are referred to as flexible measures. This paper proposes a flexible slacks-based measure (FSBM) of efficiency in which each flexible measure can play input role for some DMUs and output role for others to maximize the relative efficiency of the DMU under evaluation. Further, we will show that when an operational unit is efficient in a specific flexible measure, this measure can play both input and output roles for this unit. In this case, the optimal input/output designation for flexible measure is one that optimizes the efficiency of the artificial average unit. An application in assessing UK higher education institutions used to show the applicability of the proposed approach. © 2013 Elsevier Ltd. All rights reserved.

A new slacks-based measure of Malmquist-Luenberger index in the presence of undesirable outputs

In the majority of production processes, noticeable amounts of bad byproducts or bad outputs are produced. The negative effects of the bad outputs on efficiency cannot be handled by the standard Malmquist index to measure productivity change over time. Toward this end, the Malmquist-Luenberger index (MLI) has been introduced, when undesirable outputs are present. In this paper, we introduce a Data Envelopment Analysis (DEA) model as well as an algorithm, which can successfully eliminate a common infeasibility problem encountered in MLI mixed period problems. This model incorporates the best endogenous direction amongst all other possible directions to increase desirable output and decrease the undesirable outputs at the same time. A simple example used to illustrate the new algorithm and a real application of steam power plants is used to show the applicability of the proposed model.

Evaluation efficiency of large-scale data set with negative data:an artificial neural network approach

Data envelopment analysis (DEA) is the most widely used methods for measuring the efficiency and productivity of decision-making units (DMUs). The need for huge computer resources in terms of memory and CPU time in DEA is inevitable for a large-scale data set, especially with negative measures. In recent years, wide ranges of studies have been conducted in the area of artificial neural network and DEA combined methods. In this study, a supervised feed-forward neural network is proposed to evaluate the efficiency and productivity of large-scale data sets with negative values in contrast to the corresponding DEA method. Results indicate that the proposed network has some computational advantages over the corresponding DEA models; therefore, it can be considered as a useful tool for measuring the efficiency of DMUs with (large-scale) negative data.