This article applies the technique known as Data Envelopment Analysis (DEA) to assess differences in performance efficiency among two branches of the federal hospital system, The Department of Defense (DoD) and The Department of Veterans' Affairs (VA). The analysis is based on two measures of performance output (inpatient days and outpatient visit, and six measures of resource input (capital investment in operational beds, service mix intensity, and supplies and three components of labor— providers, nurses and support). This study finds that based on these input and output measures, DoD hospitals are, on average, significantly more efficient than their VA counterparts. Within DoD, however, there are no significant differences in efficiency among the service components (US Air Force, Army or Navy), although Army hospitals appear more efficient in using service mix and provider labor.
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References
1.
Air Force Magazine: 1991 USAF Almanac (1991). Arlington, VA: The Air Force Association.
2.
Blue Ribbon Panel (1985). Secretary of Defense Blue Ribbon Panel Report. The Blue Ribbon Pale on Sizing Department of Defense Medical Treatment Facilities., Washington, DC.
3.
BurkeM. (1991) ‘Bill on resource sharing among DVA and federal agencies debated’. AHA News, Nov 4,1991, p 6.
4.
CharnesA.CooperW.W.RhodesE. (1981). ‘Evaluating program and managerial efficiency: An application of data envelopment analysis to program follow through’. Management Science, 27(6), 668–97.
5.
GoldsmithJ. (1990). ‘Death of a paradigm: The challenge of competition’. Health Affairs, 3(3), 5–19.
6.
GrosskopfS.ValdmanisV. (1987). ‘Measuring hospital performance: A non parametric approach’. Journal of Health Economics, 6, 89–107.
7.
GunbyP. (1991). ‘Another war. and more lessons for medicine to ponder in aftermath’. The Journal of the American Medical Association, 266(5), August 7, 619–620.
8.
HCFR: Health Care Financing Review. (1990). Table 19. 12(2), p 29.
9.
HoganA. J.WroblewskiR.‘Aggregation Bias in Data Envelopment Analysis: A Self-Related vs Average Cost Efficiency,’ Working paper, College of Human Medicine, Michigan State University.
10.
HuangY-G. L. (1990). ‘An application of data envelopment analysis: Measuring the relative performance of Florida general hospitals’. Journal of Medical Systems, 14(4), 191–196.
11.
MoreyR. C.FineD. J.LoreeS. W.1990. ‘Comparing the allocative efficiencies of hospitals’. OMEGA International Journal of Management Science, 18(1): 71–83.
12.
NunamakerT. (1983). ‘Measuring routine nursing service efficiency: A comparison of cost per patient day and data envelopment analysis models’. Health Services Research, 18, No 2, Part 1:183–205.
13.
OzcanY. A.LukeR. D. (forthcoming). ‘A national study of the efficiency of hospitals in urban markets’. Health Services Research, 27(6), 1993.
14.
OzcanY. A.LukeR. D.HakseverC.‘Ownership and organizational performance: A comparison of technical efficiency across hospital types’. Medical Care, 30(9), 1992.
15.
OzcanY. A.MarkhamC. (1991). ‘Sensitivity of hospital efficiencies under various output/input variables and peer groupings: A review’. Invited paper, ORSA/TIMS Joint National Meeting, Anaheim, CA, 1991.
16.
RoskoM. D. (1990). ‘Measuring technical efficiency in health care organizations’. Journal of Medical Systems, 14(5), 307–322.
17.
RuchlinH. S. (1990). ‘Problems in measuring institutional productivity’. Topics in Health Care Financing: Improving Productivity (CH 2), 13–27.
18.
SextonT. R., (1986). ‘The methodology of Data Envelopment Analysis’. In Measuring Efficiency: An Analysis of Data Envelopment Analysis, (SilkmanR. H., ed) San Francisco: Jossey-Bass Inc., Publishers, 1986.
19.
SextonT. R.LeikenA. M.NolanA. H.LissS.HoganA.SilkmanR.H. (1989). ‘Evaluating Managerial Efficiency of Veterans Administration Medical Centers Using Data Envelopment Analysis’. Medical Care, 27:12, 1175–1188.
20.
ShermanD. H. (1984). ‘Hospital efficiency measurement and evaluation—empirical test of a new technique’. Medical Care,(22), 10:922–939.
21.
ShermanD. H. (1986). ‘Managing productivity of health care organizations’. Measuring Efficiency: An Assessment of Data Envelopment Analysis (R.H. Silkman, ed), in the series New Directions for Program Evaluation (32), Winter. San Francisco: Jossey-Bass, 31–46.
22.
SiefordL. M. (1990). A Bibliography of Data Envelopment Analysis (1978–1990)., The University of Massachusetts, Amherst, MA.
23.
StarrP. (1981). ‘The coming of the corporation’ (Ch 5). The Social Transformation of American Medicine—Book Two., Basic Books, Harper Collins Publishers.
24.
SternL. (1991). ‘Militant medicine—the Defense Department has health care costs in its bombsights. There may be strategic lessons here for employers’. Business & Health, October, 70–80.
25.
ValdmanisV.G. (1990). ‘Ownership and technical efficiency of hospitals’. Medical Care, 28(6), June: 552–559.
