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 pupil and school performance by non-parametric and parametric techniques

Often observations are nested within other units. This is particularly the case in the educational sector where school performance in terms of value added is the result of school contribution as well as pupil academic ability and other features relating to the pupil. Traditionally, the literature uses parametric (i.e. it assumes a priori a particular function on the production process) Multi-Level Models to estimate the performance of nested entities. This paper discusses the use of the non-parametric (i.e. without a priori assumptions on the production process) Free Disposal Hull model as an alternative approach. While taking into account contextual characteristics as well as atypical observations, we show how to decompose non-parametrically the overall inefficiency of a pupil into a unit specific and a higher level (i.e. a school) component. By a sample of entry and exit attainments of 3017 girls in British ordinary single sex schools, we test the robustness of the non-parametric and parametric estimates. We find that the two methods agree in the relative measures of the scope for potential attainment improvement. Further, the two methods agree on the variation in pupil attainment and the proportion attributable to pupil and school level.

Statnote 15: the non-parametric correlation coefficients

If in a correlation test, one or both variables are small whole numbers, scores based on a limited scale, or percentages, a non-parametric correlation coefficient should be considered as an alternative to Pearson’s ‘r’. Kendall’s t and Spearman’s rs are similar tests but the former should be considered if the analysis is to be extended to include partial correlations. If the data contain many tied values, then gamma should be considered as a suitable test.

The effect of corruption on FDI:a parametric and non-parametric analysis

This paper analyses the effect of corruption on Multinational Enterprises' (MNEs) incentives to undertake FDI in a particular country. We contribute to the existing literature by modelling the relationship between corruption and FDI using both parametric and non-parametric methods. We report that the impact of corruption on FDI stock is different for the different quantiles of the FDI stock distribution. This is a characteristic that could not be captured in previous studies which used only parametric methods. After controlling for the location selection process of MNEs and other host country characteristics, the result from both parametric and non-parametric analyses offer some support for the ‘helping-hand’ role of corruption.

COOPER-framework:a unified process for non-parametric projects

Practitioners assess performance of entities in increasingly large and complicated datasets. If non-parametric models, such as Data Envelopment Analysis, were ever considered as simple push-button technologies, this is impossible when many variables are available or when data have to be compiled from several sources. This paper introduces by the 'COOPER-framework' a comprehensive model for carrying out non-parametric projects. The framework consists of six interrelated phases: Concepts and objectives, On structuring data, Operational models, Performance comparison model, Evaluation, and Result and deployment. Each of the phases describes some necessary steps a researcher should examine for a well defined and repeatable analysis. The COOPER-framework provides for the novice analyst guidance, structure and advice for a sound non-parametric analysis. The more experienced analyst benefits from a check list such that important issues are not forgotten. In addition, by the use of a standardized framework non-parametric assessments will be more reliable, more repeatable, more manageable, faster and less costly. © 2010 Elsevier B.V. All rights reserved.

General and multiplicative non-parametric corporate performance models with interval ratio data

The increasing intensity of global competition has led organizations to utilize various types of performance measurement tools for improving the quality of their products and services. Data envelopment analysis (DEA) is a methodology for evaluating and measuring the relative efficiencies of a set of decision making units (DMUs) that use multiple inputs to produce multiple outputs. All the data in the conventional DEA with input and/or output ratios assumes the form of crisp numbers. However, the observed values of data in real-world problems are sometimes expressed as interval ratios. In this paper, we propose two new models: general and multiplicative non-parametric ratio models for DEA problems with interval data. The contributions of this paper are fourfold: (1) we consider input and output data expressed as interval ratios in DEA; (2) we address the gap in DEA literature for problems not suitable or difficult to model with crisp values; (3) we propose two new DEA models for evaluating the relative efficiencies of DMUs with interval ratios, and (4) we present a case study involving 20 banks with three interval ratios to demonstrate the applicability and efficacy of the proposed models where the traditional indicators are mostly financial ratios. © 2011 Elsevier Inc.

A non-parametric data envelopment analysis approach for improving energy efficiency of grape production

Grape is one of the world's largest fruit crops with approximately 67.5 million tonnes produced each year and energy is an important element in modern grape productions as it heavily depends on fossil and other energy resources. Efficient use of these energies is a necessary step toward reducing environmental hazards, preventing destruction of natural resources and ensuring agricultural sustainability. Hence, identifying excessive use of energy as well as reducing energy resources is the main focus of this paper to optimize energy consumption in grape production.In this study we use a two-stage methodology to find the association of energy efficiency and performance explained by farmers' specific characteristics. In the first stage a non-parametric Data Envelopment Analysis is used to model efficiencies as an explicit function of human labor, machinery, chemicals, FYM (farmyard manure), diesel fuel, electricity and water for irrigation energies. In the second step, farm specific variables such as farmers' age, gender, level of education and agricultural experience are used in a Tobit regression framework to explain how these factors influence efficiency of grape farming.The result of the first stage shows substantial inefficiency between the grape producers in the studied area while the second stage shows that the main difference between efficient and inefficient farmers was in the use of chemicals, diesel fuel and water for irrigation. The use of chemicals such as insecticides, herbicides and fungicides were considerably less than inefficient ones. The results revealed that the more educated farmers are more energy efficient in comparison with their less educated counterparts. © 2013.

Non-Gaussian statistics of an optical soliton in the presence of amplified spontaneous emission

A study was performed on non-Gaussian statistics of an optical soliton in the presence of amplified spontaneous emission. An approach based on the Fokker-Planck equation was applied to study the optical soliton parameters in the presence of additive noise. The rigorous method not only allowed to reproduce and justify the classical Gordon-Haus formula but also led to new exact results.

Calculation of non-Gaussian statistics and bit error rate degradation due to pulse-to-pulse interaction

We develop a theoretical method to calculate jitter statistics of interacting solitons. Applying this approach, we have derived the non-Gaussian probability density function and calculated the bit-error rate as a function of noise level, initial separation and phase difference between solitons.

Clustering in non-parametric multivariate analyses.

Non-parametric multivariate analyses of complex ecological datasets are widely used. Following appropriate pre-treatment of the data inter-sample resemblances are calculated using appropriate measures. Ordination and clustering derived from these resemblances are used to visualise relationships among samples (or variables). Hierarchical agglomerative clustering with group-average (UPGMA) linkage is often the clustering method chosen. Using an example dataset of zooplankton densities from the Bristol Channel and Severn Estuary, UK, a range of existing and new clustering methods are applied and the results compared. Although the examples focus on analysis of samples, the methods may also be applied to species analysis. Dendrograms derived by hierarchical clustering are compared using cophenetic correlations, which are also used to determine optimum  in flexible beta clustering. A plot of cophenetic correlation against original dissimilarities reveals that a tree may be a poor representation of the full multivariate information. UNCTREE is an unconstrained binary divisive clustering algorithm in which values of the ANOSIM R statistic are used to determine (binary) splits in the data, to form a dendrogram. A form of flat clustering, k-R clustering, uses a combination of ANOSIM R and Similarity Profiles (SIMPROF) analyses to determine the optimum value of k, the number of groups into which samples should be clustered, and the sample membership of the groups. Robust outcomes from the application of such a range of differing techniques to the same resemblance matrix, as here, result in greater confidence in the validity of a clustering approach.

Clustering in non-parametric multivariate analyses.

Non-parametric multivariate analyses of complex ecological datasets are widely used. Following appropriate pre-treatment of the data inter-sample resemblances are calculated using appropriate measures. Ordination and clustering derived from these resemblances are used to visualise relationships among samples (or variables). Hierarchical agglomerative clustering with group-average (UPGMA) linkage is often the clustering method chosen. Using an example dataset of zooplankton densities from the Bristol Channel and Severn Estuary, UK, a range of existing and new clustering methods are applied and the results compared. Although the examples focus on analysis of samples, the methods may also be applied to species analysis. Dendrograms derived by hierarchical clustering are compared using cophenetic correlations, which are also used to determine optimum  in flexible beta clustering. A plot of cophenetic correlation against original dissimilarities reveals that a tree may be a poor representation of the full multivariate information. UNCTREE is an unconstrained binary divisive clustering algorithm in which values of the ANOSIM R statistic are used to determine (binary) splits in the data, to form a dendrogram. A form of flat clustering, k-R clustering, uses a combination of ANOSIM R and Similarity Profiles (SIMPROF) analyses to determine the optimum value of k, the number of groups into which samples should be clustered, and the sample membership of the groups. Robust outcomes from the application of such a range of differing techniques to the same resemblance matrix, as here, result in greater confidence in the validity of a clustering approach.

Life History, Diet, Abundance and Distribution, and Length-Frequencies of Selected Invertebrates in Florida Bay, Everglades National Park, Florida

This report presents information on the life history, diet, abundance and distribution, and length-frequency distributions of five invertebrates in Florida Bay, Everglades National Park. Collections were made with an otter trawl in basins on a bi-monthly basis. Non-parametric statistics were used to test spatial and temporal differences in the abundance of invertebrates when numbers were appropriate (i. e., $25). Invertebrate species are presented in four sections. The sections on Life History, and Diet were derived from the literature. The section on Abundance and Distribution consists of data from otter-trawl collections. In addition, comparisons with other studies are included here following our results. The section on Length-frequency Distributions consists of length measurements from all collections, except 1984-1985 when no measurements were taken. Length-frequency distributions were used, when possible, to estimate life stage captured, spawning times, recruitment into Florida Bay for those species which spawn outside the Bay, and growth. Additional material from the literature was added when appropriate. (PDF contains 39 pages)

Habilidades sociais, bem-estar psicológico e rendimento escolar

O propósito do presente estudo foi o de examinar o impacto da implementação de um programa de desenvolvimento de habilidades sociais no bem-estar psicológico (BEP) e no rendimento escolar numa amostra de estudantes adolescentes portugueses. Para aferir o BEP, foi utilizada a versão portuguesa de 30 itens para adolescentes das escalas de Ryff; o rendimento escolar foi aferido com recurso às avaliações finais de cada período letivo. O programa utilizado baseou-se no desenvolvimento das habilidades sociais de comunicação, assertividade e resolução de problemas, durante o ano letivo numa frequência semanal de 45 minutos nas aulas de Formação Cívica, em estudantes do 7º e 8º anos de escolaridade. Os dados longitudinais foram analisados através da estatística não paramétrica, recorrendo aos testes Wilcoxon-Mann-Whitney correlação de Spearman do programa SPSS®, versão 20.0. Os resultados mostram impacto do programa de desenvolvimento de habilidades sociais nas dimensões do BEP – autoaceitação, relações positivas com os outros, domínio do meio, crescimento pessoal, objetivos na vida e no BEP global em um ou mais momentos do pós teste. Os resultados demonstram igualmente correlações positivas entre as dimensões do BEP – autonomia, autoaceitação, domínio do meio, objetivos na vida e do BEP global e o rendimento escolar, em três ou mais momentos observados.

Infiltración grasa hepática difusa y su correlación con índice de masa corporal, triglicéridos y transaminasas

Introducción: la enfermedad hepática grasa no alcohólica (NAFLD) es una enfermedad muy frecuente y de curso insidioso. El diagnostico, seguimiento y tratamiento de esta condición permanecen aun sin consenso debido principalmente a la falta de conocimiento de su historia natural y la dificultad de un diagnostico preciso de forma no invasiva. Materiales y Métodos: estudio prospectivo, observacional de corte transversal y correlación usando un muestreo no aleatorio de los pacientes que asistieron al servicio de chequeo médico de la Fundación CardioInfantil – Instituto de Cardiología. Se evaluaron variables clínicas y para-clínicas como Índice de Masa Corporal, transaminasas, triglicéridos y apariencia ultrasonográfica del hígado. Se realizo análisis no paramétrico de varianza con la prueba de Kruskal-Wallis y análisis de correlación por medio del índice de correlación de Spearman. Resultados: se incluyeron 619 pacientes. Se encontró una variación estadísticamente significativa (p<0,001) entre todas las variables analizadas agrupadas de acuerdo a la apariencia ultrasonográfica del hígado. Finalmente, se encontraron coeficientes de correlación positivos y estadísticamente significativos (p<0,001) para las mismas variables. Discusión: la evaluación por ultrasonografía del hígado es una opción atractiva para el diagnostico y seguimiento de los pacientes con NAFLD debido a sus características no invasivas, bajo costo y amplia disponibilidad. Los resultados obtenidos sugieren que dada la variación de los parámetros clínicos de acuerdo con la apariencia hepática, esta herramienta puede ser útil tanto en fase de diagnostico como en fase de seguimiento para los pacientes de esta población. Los coeficientes de correlación sugieren que la posibilidad de predecir variables sanguíneas usando este método que debería estudiarse más a fondo. Conclusiones: en conjunto, los resultados de este estudio soportan la utilidad de la evaluación ultrasonográfica del hígado como herramienta de evaluación y posible seguimiento en pacientes con sospecha de NAFLD en esta población.