Alan M. Leiken

Evaluating managerial efficiency of Veterans Administration medical centers using Data Envelopment Analysis.

This study applied the methodology of Data Envelopment Analysis (DEA) to the set of VA medical centers to evaluate their relative managerial efficiencies. Each VAMC was viewed as a producer of multiple outputs and a consumer of multiple inputs. DEA uses linear programming to identify resources that were underutilized and services that were inefficiently produced. Managerial strategies based on the dual variables were constructed to indicate the manner in which inefficient VAMCs may be made efficient. The analysis showed that relative inefficiency existed in about one third of the VAMCs nationwide. Elimination of this inefficiency would save the VA over

The impact of prospective reimbursement on nursing home efficiency.

300 million annually on personnel, equipment, drugs, and supplies, without reducing the level of services provided. A subsequent analysis of co-variance revealed that VAMCs affiliated with a university were generally less efficient than those without such an affiliation. A similar finding was obtained for larger VAMCs relative to smaller medical centers. In neither case, however, should these results be construed to imply that VAMCs should terminate their university affiliations or that VAMCs should be made smaller since factors other than relative efficiency are clearly as or more important in such decisions.

On increasing the supply of nurses: An interstate analysis

Data Envelopment Analysis (DEA) was used to estimate the relative efficiencies of nursing homes in Maine for 2 years before the introduction of a prospective payment system and for 2 years afterward. A multiple regression was performed in which the DEA-estimated efficiency was the dependent variable and a number of facility characteristics and study year were the independent variables. Study findings indicate that nursing home efficiency scores fell after the introduction of prospective reimbursement; that is, generally speaking, more inputs were being used per unit of output in the period after the introduction of prospective reimbursement than in the period preceding it. This may be the result of poor management, degraded quality of inputs, improved quality of outputs, or some other unobserved trend during this same period. The study also concludes that higher occupancy rates are associated with lower efficiencies and that patients in restraints produce severe negative effects on efficiency. In addition, it appears that a sudden increase in administrative hours in the final study year played a role in that years lower average efficiency scores, but also that all input levels generally rose while output levels remained virtually constant.

Government subsidy of critical-need occupations: the case of nurses.

During a period in which the health care system is undergoing a great deal of change and is subject to shifts in policy, it is necessary to understand the workings of each of its markets. In this paper the nursing market is analyzed. Among the studies in the literature on this subject is that of Benham [1971], whose work has been extended in this research. Benham used state-aggregated data for 1950 and 1960 to estimate a three equation model of supply and demand for registered nurses (RNs). Equations for RN wage, RN stock, and RN labor force participation rate were estimated. The model presented here is extended to include licensed practical nurses (LPNs) who are an important substitute for registered nurses in most practice environments. In addition, the participation rate equations, which have 0-1 range dependent variables, are estimated using the logit transformation. Because the duties, as opposed to training, of the two groups of nurses overlap greatly, simultaneous treatment of the two markets is important. The reaction of each in response to policy changes will determine outcomes. In regulation of the nursing market, especially as it relates to concerns about ameliorating nurse shortages, there are three policy alternatives generally given consideration. The first is to provide nursing educational subsidies that will increase the output of new nurses. The expectation is that nurse stocks will rise and, for a given participation rate, nurse labor supply will increase.

Modelling the effects of price competition on the utilization of health manpower

This paper undertakes an econometric evaluation of governmental policies aimed at increasing the labor force supply of nurses and at effecting greater hospital substitution among auxilliary health personnel, in times of nurse shortage. The methodology is to employ a simultaneous equation, multi-nurse econometric model which is estimated by a three-stage least-squares procedure incorporating use of logit transformation to deal with limited dependent variables and use of weighted least squares to deal with heteroskedasticity.

Ketorolac vs meperidine for the management of pain in the emergency department.

The introduction of diagnosis related groups (DRGs) and resource utilization groups (RUGs) for implementing prospective reimbursement is virtually certain to increase the cost-consciousness of hospital and nursing home administrators. One potential area for cost reduction is in nurse staffing. In this paper, we describe a model which identifies minimum cost nurse staffing patterns subject to constraints on patient needs, mandated staffing requirements, and labor availability, and which is also sensitive to quality considerations. We use the model to predict shifts in nursing patterns at an upstate New York nursing home. To the degree to which this model and this nursing home are typical, we foresee general reductions in the numbers of RNs and LPNs, compensated for by an increase in the number of Aides, and cost savings in the 5-10% range. We also demonstrate that the magnitudes of these changes will depend on the tradeoff between quality and cost considerations, and will certainly vary across facilities.