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

Publication . Portela, Maria Conceição A. Silva; Thanassoulis, Emmanuel

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.

2014Journal article

Open access

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

Publication . Thanassoulis, Emmanuel; Portela, Maria C.A. Silva; Graveney, Mike

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).

2012Journal article

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Benchmarking clinical practice in surgery: looking beyond traditional mortality rates

Publication . Castro, Ricardo A. S.; Oliveira, Pedro N.; Portela, Maria; Camanho, Ana S.; Queiroz e Melo, João

This paper proposes two new measures to assess performance of surgical practice based on observed mortality: reliability, measured as the area under the ROC curve and a living score, the sum of individual risk among surviving patients, divided by the total number of patients. A Monte Carlo simulation of surgeons' practice was used for conceptual validation and an analysis of a real-world hospital department was used for managerial validation. We modelled surgical practice as a bivariate distribution function of risk and final state. We sampled 250 distributions, varying the maximum risk each surgeon faced, the distribution of risk among dead patients, the mortality rate and the number of surgeries performed yearly. We applied the measures developed to a Portuguese cardiothoracic department. We found that the joint use of the reliability and living score measures overcomes the limitations of risk adjustedmortality rates, as it enables a different valuation of deaths, according to their risk levels. Reliability favours surgeons with casualties, predominantly, in high values of risk and penalizes surgeons with deaths in relatively low levels of risk. The living score is positively influenced by the maximum risk for which a surgeon yields surviving patients. These measures enable a deeper understanding of surgical practice and, as risk adjusted mortality rates, they rely only on mortality and risk scores data. The case study revealed that the performance of the department analysed could be improved with enhanced policies of risk management, involving the assignment of surgeries based on surgeon's reliability and living score.

2015Journal article

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Value and quantity data in economic and technical efficiency measurement

Publication . Portela, Maria Conceição A. Silva

This paper calls attention to the implications of using value data in efficiency measurement through Data Envelopment Analysis (DEA). The main contributions are twofold: (i) it provides a reconciliation of the previous literature on analysing issues of quantity and value data in efficiency measurement, (ii) it provides some guidelines on what to do, when these issues arise in a data set.

2014Journal article

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Benchmarking Hospitals through a web based platform

Publication . Portela, Maria; Camanho, A. S.; Almeida, Diogo Queiroz; Nogueira, Luís; Silva, Sofia Nogueira da; Castro, Ricardo A. S.

Purpose – In a context of international economic crisis the improvement in the efficiency and productivity of public services is seen as a way to maintain high-quality levels at lower costs. Increased productivity can be promoted through benchmarking exercises, where key performance indicators (KPIs), individually or aggregated, are used to compare health units. The purpose of this paper is to describe a benchmarking platform, called Hospital Benchmarking (HOBE), where hospital’s services are used as the unit of analysis. Design/methodology/approach – HOBE platform includes a set of managerial indicators through which hospital services’ are compared. The platform also benchmarks services through aggregate service indicators, and provides an aggregate measure of hospital’s performance based on a composite indicator of the service’s performances. These aggregate indicators were obtained through data envelopment analysis (DEA). Findings – Some results are presented for Portuguese hospitals for the trial years of 2008 and 2009, for which data is publicly available. Details for the service-level analysis are provided for a sample hospital, as well as details on the aggregate performance resulting from services performances. Practical implications – HOBE’s features and outcomes show that the platform can be used to guide management actions and to support the design of health policies by administrative authorities, provided that good quality and timely data are available, and that hospitals are involved in the design of the KPIs. Originality/value – The platform is innovative in the sense that it bases its analysis on hospital’s services, which are in general more comparable among hospitals than indicators of hospital overall performance. In addition, it makes use of DEA to aggregate performance indicators, allowing for user choice in the inputs and outputs to be aggregated, and it proposes a novel model to aggregate service’s efficiencies into a single measure of hospital performance.

2016Journal article

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