Yasar A. Ozcan

Ownership and organizational performance. A comparison of technical efficiency across hospital types.

Using a national data base of urban hospitals, the effect of ownership (government, nonprofit, and for-profit) on the technical efficiency of hospitals was examined. Efficiency scores were computed using a method called data envelopment analysis. Controlling for environmental and hospital characteristics, for-profit hospitals were found somewhat less frequently and government hospitals consistently more frequently in the efficient category. When examining highly inefficient hospitals as a percentage of those receiving inefficient scores, for-profit hospitals appeared to be highly inefficient relative to the other ownership forms. Government and nonprofit hospitals were somewhat indistinguishable from one another regarding their percentages of highly inefficient scores. For-profit hospitals also tended to use supply and capital asset (hospital size) inputs less efficiently, and service and labor inputs more efficiently than hospitals in the other ownership categories.

Organizational and Environmental Determinants of Hospital EMR Adoption: A National Study

The recent focus on health care quality improvement and cost containment has led some policymakers and practitioners to advocate the adoption of health information technology. One such technology is the Electronic Medical Record (EMR), which is predicted to change and improve health care in the USA. Little is known about factors that influence hospital adoption of this relatively new technology. The purpose of this paper is to determine the national prevalence of EMR adoption in acute care hospitals while examining the organizational and environmental correlates using a Resource Dependence Theoretical Perspective. Significant predictors of hospital EMR use may indicate barriers to use for some hospitals and can be used to guide policy. This study uses a non-experimental cross sectional design to examine hospital EMR use in 2004. A logistic regression approach is used to determine the correlations between hospital EMR use and organizational and environmental characteristics. Hospital EMR use was identified using the HIMSS Analytics data. Organizational and environmental variables were measured using data from the AHA, CMS (financial and case mix) and ARF. Hospital EMR adoption is significantly associated with environmental uncertainty, type of system affiliation, size, and urban-ness. The effects of competition, munificence, ownership, teaching status, public payer mix, and operating margin were not statistically significant. Significant predictors of hospital EMR adoption represent barriers that may prevent certain hospitals from obtaining and using EMRs. These hospitals include those that are smaller, more rural, non-system affiliated, and in areas of low environmental uncertainty. Since EMR adoption may be an organizational survival strategy for hospitals to improve quality and efficiency, hospitals that are at risk of missing the wave of implementation should be offered services and incentives to enable them to implement and maintain EMR systems.

Data Envelopment Analysis Comparison of Hospital Efficiency and Quality

Using a sample of Virginia hospitals, performance measures of quality were examined as they related to technical efficiency. Efficiency scores for the study hospitals were computed using Data Envelopment Analysis (DEA). The study found that the technically efficient hospitals were performing well as far as quality measures were concerned. Some of the technically inefficient hospitals were also performing well with respect to quality. DEA can be used to benchmark both dimensions of hospital performance: technical efficiency and quality. The results have policy implications in view of growing concern that hospitals may be improving their efficiency at the expense of quality.

Do mergers enhance the performance of hospital efficiency

Due to the wave of mergers that have taken place in the USA, the early 1990s could be labelled as a restructuring era for health care systems. The question of whether mergers have an impact on organizational performance is still an area of interest for health services researchers. In this study, we examined the impacts of horizontal mergers of US hospitals technical efficiency before and after merger using longitudinal Data Envelopment Analysis (DEA). The findings of our study illustrate that mergers do increase a hospitals level of efficiency. Constant returns-to-scale model indicated an overall reduction in input utilisation after merger, compared to variable returns-to-scale model. This indicates the role of scale efficiency as a dominant source of improvement in inefficiency of hospitals involved in horizontal mergers, but not for technical efficiency. Suggestions for future study are provided.

Do Hospitals With Electronic Medical Records (EMRs) Provide Higher Quality Care? An Examination of Three Clinical Conditions

This study investigates how hospital electronic medical record (EMR) use influences quality performance. Data include nonfederal acute care hospitals in the United States. Sources of the data include the American Hospital Association, Hospital Quality Alliance, the Healthcare Information and Management Systems Society, and the Centers for Medicare and Medicaid Services case-mix index sets. The authors use a retrospective cross-sectional format with linear regression to assess the relationship between hospital EMR use and quality performance. Quality performance is measured using 10 process indicators related to 3 clinical conditions: acute myocardial infarction, congestive heart failure, and pneumonia. The authors also use a propensity score adjustment to control for possible selection bias. After this adjustment, the authors identify a positive significant relationship between EMR use and 4 of the 10 quality indicators. They conclude that there is limited evidence of the relationship between hospital EMR use and quality.

Technical Efficiencies of Turkish Hospitals: DEA Approach

This study uses Data Envelopment Analysis to examine the technical efficiencies of 573 Turkish acute general hospitals. Inputs of number of beds, number of primary care physicians, and number of specialists, and how they are used to produce outputs of inpatient discharges, outpatient visits, and surgical operations, are examined. Results illustrate that less than ten percent of Turkish acute general hospitals operate efficiently compared to their counterparts. Inefficient, compared to efficient hospitals, on average utilize 32% more specialists, 47% more primary care physicians, and have 119% more staffed bed capacity. They also produce on average less output. Particularly, 13% less outpatient visits, 16% inpatient hospitalization, and 57% less surgical procedures. Additionally, the validity of DEA is illustrated by comparing it to the ratio analysis method; no discernible differences in the results are found.

Public Sector Hospital Efficiency for Provincial Markets in Turkey

This study uses Data Envelopment Analysis to examine public sector hospital efficiency in 80 provincial markets in Turkey. Outputs of the study includes mortality rate as quality measure as well as inpatient discharges and outpatient visits. Patient beds, four levels of health labor, and expenditures are used to capture capital, labor and material resources as inputs. Results show that 55% of the public hospitals in served markets are operated inefficiently. Analysis of inefficient provinces suggests that in those 44 inefficient provinces are collectively overbedded, employ excessive number of specialists and other health labor. They spent approximately

Physician benchmarking: measuring variation in practice behavior in treatment of otitis media

70,000,000 from their revolving funds in excess compared to efficient provinces.

Efficiency of hospital service production in local markets: The balance sheet of U.S. medical armament

The study uses Data Envelopment Analysis (DEA) to analyze physician practice behavior and develops measures of physician practice efficiency as a basis for improving productivity and reducing costs in otitis media treatment. Other objectives include determining geographic variations in practice patterns for otitis media, and the impact of inefficient practice patterns on the cost of treatment of otitis media. Only 46 (28.8%) of the 160 physicians were classified as efficient. Average total cost of an episode by efficient providers was

Efficiency Evaluation of Skilled Nursing Facilities

357.03 and