Comparing Hospital Efficiency: An Illustrative Study of Knee and Hip Replacement Surgeries in Spain

Sophie Gorgemans (), Micaela Comendeiro-Maaløe, Manuel Ridao-López and Enrique Bernal-Delgado
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Sophie Gorgemans: Department of Business Management and Organization, School of Engineering and Architecture, University of Zaragoza, 50009 Zaragoza, Spain
Micaela Comendeiro-Maaløe: Institute for Health Sciences in Aragon (IACS), 50009 Zaragoza, Spain
Manuel Ridao-López: Institute for Health Sciences in Aragon (IACS), 50009 Zaragoza, Spain
Enrique Bernal-Delgado: Institute for Health Sciences in Aragon (IACS), 50009 Zaragoza, Spain

IJERPH, 2023, vol. 20, issue 4, 1-12

Abstract: WHO’s Health Systems Performance Assessment framework suggests monitoring a set of dimensions. This study aims to jointly assess productivity and quality using a treatment-based approach, specifically analyzing knee and hip replacement, two prevalent surgical procedures performed with consolidated technology and run in most acute-care hospitals. Focusing on the analysis of these procedures sets out a novel approach providing clues for hospital management improvements, covering an existing gap in the literature. The Malmquist index under the metafrontier context was used to estimate the productivity in both procedures and its decomposition in terms of efficiency, technical and quality change. A multilevel logistic regression was specified to obtain the in-hospital mortality as a quality factor. All Spanish public acute-care hospitals were classified according to their average severity attended, dividing them into three groups. Our study revealed a decrease in productivity mainly due to a decrease in the technological change. Quality change remained constant during the period with highest variations observed between one period to the next according to the hospital classification. The improvement in the technological gap between different levels was due to an improvement in quality. These results provide new insights of operational efficiency after incorporating the quality dimension, specifically highlighting a decreasing operational performance, confirming that the technological heterogeneity is a critical question when measuring hospital performance.

Keywords: Malmquist index; data envelopment analysis; knee replacement; hip replacement; in-hospital mortality ratio; public hospitals (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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