Technical efficiency:efficiency, change, technical progress and productivity growth in the national health systems of continental African countries

In May 2006, the Ministers of Health of all the countries on the African continent, at a special session of the African Union, undertook to institutionalise efficiency monitoring within their respective national health information management systems. The specific objectives of this study were: (i) to assess the technical efficiency of National Health Systems (NHSs) of African countries for measuring male and female life expectancies, and (ii) to assess changes in health productivity over time with a view to analysing changes in efficiency and changes in technology. The analysis was based on a five-year panel data (1999-2003) from all the 53 countries of continental Africa. Data Envelopment Analysis (DEA) - a non-parametric linear programming approach - was employed to assess the technical efficiency. Malmquist Total Factor Productivity (MTFP) was used to analyse efficiency and productivity change over time among the 53 countries' national health systems. The data consisted of two outputs (male and female life expectancies) and two inputs (per capital total health expenditure and adult literacy). The DEA revealed that 49 (92.5%) countries' NHSs were run inefficiently in 1999 and 2000; 50 (94.3%), 48 (90.6%) and 47 (88.7%) operated inefficiently in 2001, 2002, and 2003 respectively. All the 53 countries' national health systems registered improvements in total factor productivity attributable mainly to technical progress. Fifty-two countries did not experience any change in scale efficiency, while thirty (56.6%) countries' national health systems had a Pure Efficiency Change (PEFFCH) index of less than one, signifying that those countries' NHSs pure efficiency contributed negatively to productivity change. All the 53 countries' national health systems registered improvements in total factor productivity, attributable mainly to technical progress. Over half of the countries' national health systems had a pure efficiency index of less than one, signifying that those countries' NHSs pure efficiency contributed negatively to productivity change. African countries may need to critically evaluate the utility of institutionalising Malmquist TFP type of analyses to monitor changes in health systems economic efficiency and productivity over time. African national health systems, per capita total health expenditure, technical efficiency, scale efficiency, Malmquist indices of productivity change, DEA

Determining the contribution of technical change, efficiency change and scale change to productivity growth in the privatized English and Welsh water and sewerage industry:1985-2000

The water and sewerage industry of England and Wales was privatized in 1989 and subjected to a new regime of environmental, water quality and RPI+K price cap regulation. This paper estimates a quality-adjusted input distance function, with stochastic frontier techniques in order to estimate productivity growth rates for the period 1985-2000. Productivity is decomposed so as to account for the impact of technical change, efficiency change, and scale change. Compared with earlier studies by Saal and Parker [(2000) Managerial Decision Econ 21(6):253-268, (2001) J Regul Econ 20(1): 61-90], these estimates allow a more careful consideration of how and whether privatization and the new regulatory regime affected productivity growth in the industry. Strikingly, they suggest that while technical change improved after privatization, productivity growth did not improve, and this was attributable to efficiency losses as firms appear to have struggled to keep up with technical advances after privatization. Moreover, the results also suggest that the excessive scale of the WaSCs contributed negatively to productivity growth. © 2007 Springer Science+Business Media, LLC.

Profit sharing, technical efficiency change and finance constraints

This paper analyses the mechanisms through which profit-sharing schemes may induce debt constrained firms to improve technical efficiency over time to guarantee positive profits. This hypothesis is first formalised in a partial equilibrium framework and then is tested on a sample of Italian traditional and cooperative firms. Technical efficiency change indexes are computed by DEA. These are regressed on a measure of finance constraints to analyse their impact on firms’ efficiency growth. The results support the hypothesis that a restriction in the availability of financial resources can affect positively the growth in efficiency in firms with profit-sharing schemes.

Measurement efficiency and productivity in SAS/OR

This paper explores the use of the optimisation procedures in SAS/OR software with application to the measurement of efficiency and productivity of decision-making units (DMUs) using data envelopment analysis (DEA) techniques. DEA was originally introduced by Charnes et al. [J. Oper. Res. 2 (1978) 429] is a linear programming method for assessing the efficiency and productivity of DMUs. Over the last two decades, DEA has gained considerable attention as a managerial tool for measuring performance of organisations and it has widely been used for assessing the efficiency of public and private sectors such as banks, airlines, hospitals, universities and manufactures. As a result, new applications with more variables and more complicated models are being introduced. Further to successive development of DEA a non-parametric productivity measure, Malmquist index, has been introduced by Fare et al. [J. Prod. Anal. 3 (1992) 85]. Employing Malmquist index, productivity growth can be decomposed into technical change and efficiency change. On the other hand, the SAS is a powerful software and it is capable of running various optimisation problems such as linear programming with all types of constraints. To facilitate the use of DEA and Malmquist index by SAS users, a SAS/MALM code was implemented in the SAS programming language. The SAS macro developed in this paper selects the chosen variables from a SAS data file and constructs sets of linear-programming models based on the selected DEA. An example is given to illustrate how one could use the code to measure the efficiency and productivity of organisations.

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.

Efficiency analysis of Islamic banks:a case of Gulf Cooperation Council (GCC)

Although considerable effort has been invested in the measurement of banking efficiency using Data Envelopment Analysis, hardly any empirical research has focused on comparison of banks in Gulf States Countries This paper employs data on Gulf States banking sector for the period 2000-2002 to develop efficiency scores and rankings for both Islamic and conventional banks. We then investigate the productivity change using Malmquist Index and decompose the productivity into technical change and efficiency change. Further, hypothesis testing and statistical precision in the context of nonparametric efficiency and productivity measurement have been used. Specially, cross-country analysis of efficiency and comparisons of efficiencies between Islamic banks and conventional banks have been investigated using Mann-Whitney test.

Três ensaios sobre o gasto local no Brasil: descentralização, eficiência e voto

Partindo de uma avaliação sobre o contexto mundial de descentralização fiscal e de democratização em que o Brasil se encontrava no final do século XX, essa tese apresenta na primeira parte uma análise empírica para países em desenvolvimento evidenciando o condicionamento do tipo de regime de governo na relação entre descentralização fiscal e tamanho de governo. Estimações por system-GMM para países em desenvolvimento mostram que existe um nível de descentralização fiscal, entre 20% e 30%, que uma vez superado, resulta em democracias com tamanhos de governos menores do que as ditaduras. Esses resultado, que chama a atenção tanto para os governos locais, como para a influência da democracia no gasto público, estimulou a continuação da pesquisa na avaliação da eficiência dos gastos municipais no Brasil e sua relação com o voto. Assim, no segundo ensaio, são calculados indicadores de evolução da eficiência e da produtividade do gasto municipal (fatores de Malmquist) entre 2004 e 2008, para as áreas da saúde e educação. Os resultados da análise por fronteira estocástica mostram que tanto na educação, como na saúde, houve avanços na fronteira de produção (TFPC, em média, de 18.7%, na educação e de 14.2% na saúde) por avanços de mudança técnica (Technical Change - TC), ao invés de elevação da eficiência (Technical Efficiency Change – TEC). No último ensaio, os indicadores de eficiência e de produtividade são usados para testar a hipótese de que o eleitor municipal premia com o voto os prefeitos que melhoraram a eficiência do gasto da educação e/ou saúde em sua gestão. Os resultados não rejeitam a hipótese para a educação, mas rejeitam para a saúde. A fim de tratar prováveis erros de medida das variáveis de produtividade, as estimações são instrumentalizadas em regressões por dois estágios.

The impact of Medicare, Medicaid and Schip Extension Act of 2007 (MMSEA) on the long term acute care hospitals

The Long Term Acute Care Hospitals (LTACH), which serve medically complex patients, have grown tremendously in recent years, by expanding the number of Medicare patient admissions and thus increasing Medicare expenditures (Stark 2004). In an attempt to mitigate the rapid growth of the LTACHs and reduce related Medicare expenditures, Congress enacted Section 114 of P.L. 110-173 (§114) of the Medicare, Medicaid and SCHIP Extension Act (MMSEA) in December 29, 2007 to regulate the LTCAHs industry. MMSEA increased the medical necessity reviews for Medicare admissions, imposed a moratorium on new LTCAHs, and allowed the Centers for Medicare and Medicaid Services (CMS) to recoup Medicare overpayments for unnecessary admissions. ^ This study examines whether MMSEA impacted LTACH admissions, operating margins and efficiency. These objectives were analyzed by comparing LTACH data for 2008 (post MMSEA) and data for 2006-2007 (pre-MMSEA). Secondary data were utilized from the American Hospital Association (AHA) database and the American Hospital Directory (AHD).^ This is a longitudinal retrospective study with a total sample of 55 LTACHs, selected from 396 LTACHs facilities that were fully operational during the study period of 2006-2008. The results of the research found no statistically significant change in total Medicare admissions; instead there was a small but not statistically significant reduction of 5% in Medicare admissions for 2008 in comparison to those for 2006. A statistically significant decrease in mean operating margins was confirmed between the years 2006 and 2008. The LTACHs' Technical Efficiency (TE), as computed by Data Envelopment Analysis (DEA), showed significant decrease in efficiency over the same period. Thirteen of the 55 LTACHs in the sample (24%) in 2006 were calculated as “efficient” utilizing the DEA analysis. This dropped to 13% (7/55) in 2008. Longitudinally, the decrease in efficiency using the DEA extension technique (Malmquist Index or MI) indicated a deterioration of 10% in efficiency over the same period. Interestingly, however, when the sample was stratified into high efficient versus low efficient subgroups (approximately 25% in each group), a comparison of the MIs suggested a significant improvement in Efficiency Change (EC) for the least efficient (MI 0.92022) and reduction in efficiency for the most efficient LTACHs (MI = 1.38761) over same period. While a reduction in efficiency for the most efficient is unexpected, it is not particularly surprising, since efficiency measure can vary over time. An improvement in efficiency, however, for the least efficient should be expected as those LTACHs begin to manage expenses (and controllable resources) more carefully to offset the payment/reimbursement pressures on their margins from MMSEA.^

Economics of Wheat in Egypt

Este estudio pretende estimar la eficiencia y la productividad de las principales provincias de la producción de trigo en Egipto. Los datos utilizados en este estudio son datos de panel a nivel de provincias del período 1990-2012, obtenidos del Ministerio de Agricultura y Recuperación Tierras, y de la Agencia Central de Movilización Pública y Estadística, Egipto. Se aplica el enfoque de fronteras estocásticas para medir la eficiencia (función de producción de Cobb-Douglas) y se emplean las especificaciones de Battese y Coelli (1992) y (1995). También se utiliza el índice de Malmquist como una aproximación no paramétrica (Análisis de Envolvente de Datos) para descomponer la productividad total de los factores de las principales provincias productoras de trigo en Egipto en cambio técnico y cambio de eficiencia. El coeficiente de tierra es positivo y significativo en los dos especificaciones Battese y Coelli (1992) y (1995), lo que implica que aumentar la tierra para este cultivo aumentaría significativamente la producción de trigo. El coeficiente de trabajo es positivo y significativo en la especificación de Battese y Coelli (1992), mientras que es positivo y no significativo en la especificación de Battese y Coelli (1995). El coeficiente de la maquinaria es negativo y no significativo en las dos especificaciones de Battese y Coelli (1992) y (1995). El coeficiente de cambio técnico es positivo y no significativo en la especificación de Battese y Coelli (1992), mientras que es positiva y significativo en la especificación de Battese y Coelli (1995). Las variables de efectos del modelo de ineficiencia Battese y Coelli (1995) indican que no existe impacto de las diferentes provincias en la producción de trigo en Egipto; la ineficiencia técnica de la producción de trigo tendió a disminuir durante el período de estudio; y no hay ningún impacto de género en la producción de trigo en Egipto. Los niveles de eficiencia técnica varían entre las diferentes provincias para las especificaciones de Battese y Coelli (1992) y (1995); el nivel mínimo medio de eficiencia técnica es 91.61% en la provincia de Fayoum, mientras que el nivel máximo medio de la eficiencia técnica es 98.69% en la provincia de Dakahlia. La eficiencia técnica toma un valor medio de 95.37%, lo que implica poco potencial para mejorar la eficiencia de uso de recursos en la producción de trigo. La TFPCH de la producción de trigo en Egipto durante el período 1990-2012 tiene un valor menor que uno y muestra un declive. Esta disminución es debida más al componente de cambio técnico que al componente de cambio de eficiencia. La disminución de TFPCH mejora con el tiempo. La provincia de Menoufia tiene la menor disminución en TFPCH, 6.5%, mientras que dos provincias, Sharkia y Dakahlia, son las que más disminuyen en TFPCH, 13.1%, en cada uno de ellas. Menos disminución en TFPCH ocurre en el período 2009-2010, 0.3%, mientras que más disminución se produce en TFPCH en el período 1990-1991, 38.9%. La disminución de la PTF de la producción de trigo en Egipto se atribuye principalmente a la mala aplicación de la tecnología. ABSTRACT The objectives of this study are to estimate the efficiency and productivity of the main governorates of wheat production in Egypt. The data used in this study is a panel data at the governorates level, it represents the time period 1990-2012 and taken from the Ministry of Agriculture and Land Reclamation, and the Central Agency for Public Mobilization and Statistics, Egypt. We apply the stochastic frontier approach for efficiency measurement (Cobb-Douglas production function) and the specifications of Battese and Coelli (1992) and (1995) are employed. Also we use Malmquist TFP index as a non-parametric approach (DEA) to decompose total factor productivity of the main governorates of wheat production in Egypt into technical change and efficiency change. The coefficient of land is positive and significant at Battese and Coelli (1992) and (1995) specifications, implying that increasing the wheat area could significantly enhance the production of wheat. The coefficient of labor is positive and significant at Battese and Coelli (1992) specification, while it is positive and insignificant at Battese and Coelli (1995) specification. The coefficient of machinery is negative and insignificant at the specifications of Battese and Coelli (1992) and (1995). The technical change coefficient is positive and insignificant at Battese and Coelli (1992) specification, while it is positive and significant at Battese and Coelli (1995) specification. The variables of the inefficiency effect model indicate that there is no impact from the location of the different governorates on wheat production in Egypt, the technical inefficiency of wheat production tended to decrease through the period of study, and there is no impact from the gender on wheat production in Egypt. The levels of technical efficiency vary among the different governorates for the specifications of Battese and Coelli (1992) and (1995); the minimum mean level of technical efficiency is 91.61% at Fayoum governorate, while the maximum mean level of technical efficiency is 98.69% at Dakahlia governorate. The technical efficiency takes an average value of 95.37%, this implying that little potential exists to improve resource use efficiency in wheat production. The TFPCH of wheat production in Egypt during the time period 1990-2012 has a value less than one and shows a decline; this decline is due mainly to the technical change component than the efficiency change component. The decline in TFPCH is generally improves over time. Menoufia governorate has the least declining in TFPCH by 6.5%, while two governorates, Sharkia and Dakahlia have the most declining in TFPCH by 13.1% for each of them. The least declining in TFPCH occurred at the period 2009- 2010 by 0.3%, while the most declining in TFPCH occurred at the period 1990-1991 by 38.9%. The declining in TFP of wheat production in Egypt is attributed mainly to poor application of technology.

A Construction Management Framework for Mass Customisation in Traditional Construction

A Mass Customisation model is discussed as a competitive positioning strategy in the marketplace adding value to the customer’s end-use. It includes the user as part of the construction process responding to the customer’s demands and wishes. To the present day, almost all proposals for Mass Customisation have been focused on the design phase and single family houses. The reality is that the processes carried out in the work execution are so inefficient that the costs of the Mass Customisation models are assumed by the customer and they do not offer solutions that support the change management. Furthermore, this inefficiency often makes Mass Customisation unfeasible in terms of deadlines and site management. Therefore, the present proposal focuses on achieving the paradigm of Mass Customisation in the traditional residential construction complementary to the existing proposals in the design phase. All this through the proposal of a framework for the integral management in the work execution, which will address change management introduced by the users offering an efficient and productive model that reduces costs in the process. This model will focus on the synergy between different strategies, techniques and technologies currently used in the construction management (such as Lean Construction or Six Sigma), together with, other strategies and technologies that have proven to be valid solutions in other fields (such as Business Process Management, Service Oriented Architecture, etc.).

Total factor productivity and the spillover hypothesis: some new evidence

In this paper I test the spillover hypothesis of the endogenous growth literature on a sample of manufacturing firms in Italy, 1989–1994, using a new approach based on the Malmquist index. First, I measure the productivity growth registered by the high- and non-high-tech firms computing the Malmquist index with DEA. I decompose it into technical change and technical efficiency change. Then I test whether the technical change registered by high-tech firms affects productivity growth of non-high-tech firms, after controlling for factors which can potentially affect productivity growth.

Malmquist indexes using a geometric distance function (GDF)

Traditional approaches to calculate total factor productivity change through Malmquist indexes rely on distance functions. In this paper we show that the use of distance functions as a means to calculate total factor productivity change may introduce some bias in the analysis, and therefore we propose a procedure that calculates total factor productivity change through observed values only. Our total factor productivity change is then decomposed into efficiency change, technological change, and a residual effect. This decomposition makes use of a non-oriented measure in order to avoid problems associated with the traditional use of radial oriented measures, especially when variable returns to scale technologies are to be compared.

Malmquist indexes using a geometric distance function (GDF):application to a sample of Portuguese bank branches

Traditional approaches to calculate total factor productivity (TFP) change through Malmquist indexes rely on distance functions. In this paper we show that the use of distance functions as a means to calculate TFP change may introduce some bias in the analysis, and therefore we propose a procedure that calculates TFP change through observed values only. Our total TFP change is then decomposed into efficiency change, technological change, and a residual effect. This decomposition makes use of a non-oriented measure in order to avoid problems associated with the traditional use of radial oriented measures, especially when variable returns to scale technologies are to be compared. The proposed approach is applied in this paper to a sample of Portuguese bank branches.

A cost Malmquist productivity index

This paper develops a productivity index applicable when producers are cost minimisers and input prices are known. The index is inspired by the Malmquist index as extended to productivity measurement. The index developed here is defined in terms of input cost rather than input quantity distance functions. Hence, productivity change is decomposed into overall efficiency and cost technical change. Furthermore, overall efficiency change is decomposed into technical and allocative efficiency change and cost technical change into a part capturing shifts of input quantities and shifts of relative input prices. These decompositions provide a clearer picture of the root sources of productivity change. They are illustrated here in a sample of hospitals; results are computed using non-parametric mathematical programming. © 2003 Elsevier B.V. All rights reserved.

Comparison of contaminant removal effectiveness and air change efficiency as indicator of air diffusion quality.

The ventilation efficiency concept is an attempt to quantify a parameter that can easily distinguish the different options for air diffusion in the building spaces. Thirteen strategies of air diffusion were measured in a test chamber through the application of the tracer gas method, with the objective to validate the calculation by Computational fluid dynamics (CFD). Were compared the Air Change Efficiency (ACE) and the Contaminant Removal Effectiveness (CRE), the two indicators most internationally accepted. The main results from this work shows that the values of the numerical simulations are in good agreement with experimental measurements and also, that the solutions to be adopted for maximizing the ventilation efficiency should be the schemes that operate with low speeds of supply air and small differences between supply air temperature and the room temperature.