Hospital efficiency: How to spend less maintaining quality? [Comunicazione breve]

Background The recent global economic crisis has negatively affected the availability of budget for health care systems and is pushing governments worldwide to obtain a more explicit and urgent rationing of resources. The purpose of this study is to provide, through Data Envelopment Analysis (DEA), a methodological framework useful for investigating technical efficiency of hospital care.To validate such a methodological framework, in this study we compared 50 Italian public hospital trusts (AOs) to identify relative efficient. We also evaluated if, and how, efficiency is affected by various exogenous factors. Methods To model our efficiency analysis through DEA technique we used as input (number of beds per patient admitted, number of medical doctors per patient admitted and number of nurses per patient admitted) and output (30-day risk-adjusted mortality for acute myocardial infarction, 30-day risk-adjusted mortality for heart failure and 30-day risk-adjusted mortality for chronic obstructive pulmonary disease). Bootstrap method was employed as sensitivity analysis technique. Moreover we modeled the efficiency scores obtained against some variables potentially affecting the production process non controllable, at least in a short-term period, by the hospitals managers such as case-mix and entropy indexes,being in a specific area of the country, in a region with fiscal autonomy, with soft budget constraints and with a specific oldage dependency ratio, public and private expenditure on health as percentage of GDP. Results On average, Italian AOs had an efficiency score of 88% (SD 0.12). Eighteen out of 50 health facilities were 100% technically efficient, while the lowest efficiency score was 60%. Sensitivity analysis with bootstrap method showed these results to be robust. Tobit regression model identified a positive association between efficiency and being in the north of the country, in a region with fiscal autonomy, with a higher public and a lower private expenditure on health as percentage of GDP. Conclusions Data Envelopment Analysis may provide useful and especially objective information regarding the technical efficiency of hospital care. In order to obtain a more explicit and urgent rationing of resources, DEA is therefore a useful tool for supporting hospital management and policy makers decisions. Key messages Data Envelopment Analysis may provide useful information regarding the technical efficiency of hospital care. Hospital management and policy makers may take advantage of the objective results of DEA application.