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.

Assessing the capability to acquire and absorb technology within the public sector in developing countries : the case of Kuwait

The aim of this research is to assess the acquisition and absorption technology capabilities of the public sector in developing countries, with specific focus on the State of Kuwait. The assessment process of these two capabilities was conducted using a model originally designed for the private sector. In addition, the research aims to propose a framework to enhance the technological capability of developing countries, as well as the performance of the public sector. To achieve these aims, an investigation of the technology process to three public ministries in Kuwait was conducted. The prime interest of this investigation was to evaluate the role of the transferred technology in enhancing the indigenous technological capability of the public sector. The research is based on a case study approach, comprising a main case study (Ministry of Electricity and Water) and three minor case studies. Based on the outcomes from an extensive literature review and the preliminary sectoral visits, the research question and four hypotheses were formulated. These hypotheses were then tested using interview-based survey and documentation. The findings of the research revealed the weakness of the acquisition and absorption technological capabilities of the public sector. Consequently, the public sector relies extensively on foreign contractors and expatriates to compensate for this weakness. Also, it was found that Kuwait Government has not taken the necessary measures to develop its technological capability. This research has proposed a framework which could lead, if properly managed, to the enhancement of indigenous capability. It has also proposed how to improve performance and productivity in the public sector. Finally, the findings suggest that the assessment model, with minor adjustment, is applicable to the public sector.