مقاله سال ۲۰۱۶

 مجله امگا – Omega

In this study, we analyze production performance of healthcare services in Ontario province (Canada) and its key drivers. In Ontario, the costs of all hospital services are covered under the Canada Health Act and are therefore fully funded by the provincial Ministry of Health and LongTerm Care (MOHLTC). Thus, irrespective of sizes, geographic location and teaching status, all hospitals operate under the same financing system and are indifferent to profit rather striving to maximize the quantity and quality of healthcare services as per service accountability agreement between hospitals and local health integrated network (LHIN). i Therefore, the main research focus of our study has been to analyze the determinants of efficiency of hospital services considering different geographic locations (i.e., rural vs. urban), size (i.e., small vs. large), teaching status and other key characteristics. The performance measurement across the different groups of hospitals is very important for understanding the utilization of scarce resources. It also provides important information for development of healthcare reforms to improve global funding system while simultaneously promoting quality and efficiency (Goldstein et al., 2002; Griffith et al., 2002; Mannion et al., 2005; Villard et al., 2005; Navarro-Espigares and Torres, 2011; Liu et al., 2012; Mauro et. al., 2013) as well as better accountability among healthcare providers.

For our analysis, we followed the existing classifications of rural vs. urban, small vs. large, and teaching vs. non-teaching hospitals used by the MOHLTC, the public funder of all hospital services. The concept of a rural hospital, however, is generally defined by several components,including, but not limited to, population size and density, geographic and professional isolation and lifestyle factors. Small hospitals are normally located in rural areas, and rural hospitals tend to be smaller than urban hospitals. A small hospital in Ontario is defined by multiple criteria, including hospital activity, expected stay index (ESI), referral population size and whether it acts as a single provincial community provider (see JPPC, 1997). Teaching hospitals provide both acute and complex patient care and are affiliated with a medical or health sciences school, involved in significant research activity and provide training for interns and residents. ii

The performance analysis in this study is based on production theory in economics, where one can determine the extent of resource utilization by estimating the production frontier and considering hospital services provision as a production process where inputs (e.g., nurses’ hours, staffed beds, etc.) are transformed into different outputs (e.g., inpatient and outpatient volume). For empirical estimation, we used the data envelopment analysis (DEA) estimator along with both the non-parametric kernel-based density estimation method and truncated regression with doublebootstrap.