Efficiency and Total Factor Productivity of Public Hospitals in Haryana (India): A Data Envelopment Analysis
Abstract
The present study endeavors to analyze the efficiency and total factor productivity of public hospitals in the state of Haryana, one of the leading states of India, using Data Envelopment Analysis. The input variables identified for the study are doctors and support staff (including nurses, lab technicians and pharmacists) for measuring efficiency and total factor productivity. Similarly, inpatients and outpatients have been taken as outputs. Twenty hospitals have been chosen for the study. The study is based on primary and secondary data collected from officials and record maintained by public hospitals. Data Envelopment Analysis (DEA) is used to evaluate efficiency, allocative efficiency and total factor productivity (TFP) change making use of DEAP software. 90% hospitals have been observed to be technically inefficient having a mean TE score of 32%. Overall average TE score is 0.39 which implies that the public hospitals in Haryana may reduce the consumption of inputs by 61% without reducing the outputs. 90% hospitals have been observed to be scale inefficient having a mean SE score of 39%. Overall average scale efficiency has been observed 0.44. 60% hospitals make efficient use of input related to doctors whereas 35% hospitals have been efficient in using support staff efficiently. 60% hospitals were found working efficiently regarding inpatients. 85% hospitals were found working efficiently regarding outpatients. 15% hospitals were found to be allocatively efficient. The score of TFPCH (1.094) indicates that out of 9.4% growth, 5.9% is by TECHCH (1.059) and 3.3% by EFFCH (1.033). It is suggested by the study that on an average, scale inefficiency has been due to the increasing returns to scale. The estimate of total elasticity also suggests the operation of increasing returns to scale in public hospitals of Haryana State.
Â
Keywords: Public Hospitals, DEA, Efficiency, TFP, Haryana, India.
References
Department of Economic and Statistical Analysis. (2015) Economic survey of Haryana, Department of Economic and Statistical Analysis Haryana, 1094. http://web1.hry.nic.in/budget/Esurvey.pdf, Accessed 10 October, 2015.
Dash U, Vaishnavi S D, Muraleedharan V R and Acharya D (2007) Benchmarking the performance of public hospitals in Tamil Nadu: An Application of Data Envelopment Analysis, Journal of Health Management, 9 (1): 59-74.
Friesner D, Neufelder D, Raisor J and Khayum M (2005) Benchmarking patient improvement in physical therapy with data envelopment analysis, International Journal of Health Care Quality Assurance, 18(6): 441-457.
Hollingsworth B (2003) Non-parametric and parametric applications measuring efficiency in health care, Health Care Management Science, 6: 203-218.
Mancebon, M, Jand Mar-Molinero C (2000) Performance in primary schools, Journal of the Operational Research Society, 51: 843-854.
Ohlan R (2013) Efficiency and total factor productivity growth in Indian dairy sector, Quarterly Journal of International Agriculture, 52 (1): 51-77. http://ageconsearch.umn.edu/bitstream/155486/2/3_Ohlan.pdf, Accessed 22 June, 2015.
Ray S C (1997) Regional variation in productivity growth in Indian manufacturing: A non-parametric analysis, Journal of Quantitative Economics, 13: 73-94.
Sehgal S and Sharma S (2011) Total factor productivity of manufacturing sector in India: A Regional Analysis for the State of Haryana, Economic Journal of Development issues, vol. 13 & 14 No. 1-2: 97-118. www.nepjol.info/index.php/EJDI/article/download/7213/5841, Accessed 22 June, 2015.
Farrell M J (1957) The measurement of productive efficiency, Journal of Royal Statistical Society, series A 120: 253-290.
Charnes A, Cooper W W, Rhodes E (1978) Measuring the efficiency of decision making units, European Journal of Operational Research, 2: 429-444. http://www.utdallas.edu/~ryoung/phdseminar/CCR1978.pdf, Accessed 22 June, 2015.
Banker R D, Charnes A and Cooper WW (1984) Some models for estimating technical and scale inefficiencies in data envelopment analysis, Management Science, 30: 1078-1092. http://down.cenet.org.cn/upfile/181/200681741326146.pdf, Accessed 22 June, 2015.
Pascoe S, Kirrely J E and Greboval D F (2003) Measuring and assessing capacity in Fisheries, Issues and Methods, FAO Rome. ftp://ftp.fao.org/docrep/fao/006/Y5027E/Y5027E00.pdf, Accessed 22 June, 2015.
Singh S P (2004) Post WTO era: impact on export prospects of livestock products, Occasional Paper 32. Department of Economic Analysis and Research, National Bank for Agriculture and Rural Development, Mumbai.
Coelli T J (1996) A Guide to DEAP Version 2.1: A Data Envelopment Analysis (Computer) Program, CEPA Working Paper 96/08, Department of Econometrics, University of New England, Australia. http://www.owlnet.rice.edu/~econ380/DEAP.PDF, Accessed 22 June, 2015.
Cooper W W, L M Seiford and K. Tone (2007) Data envelopment analysis, a comprehensive text with models, applications, references and DEA-solver software. 2nd edition. Springer, Norwell, USA.
Coelli T, Rao D S P, O’Donnell C J and Battese G E (2005) An introduction to efficiency and productivity analysis. 2nd edition. Springer. http://facweb.knowlton.ohiostate.edu/pviton/courses/crp394/coelli_Intro_effic.pdf, Accessed 22 June, 2015.
Laha A and Kuri P K (2011) Measurement of allocative efficiency in agriculture and determinants: Evidence from Rural West Bengal, India, International Journal of Agricultural Research, 6 (5): 377-388. http://scialert.net/abstract/?doi=ijar.2011.377.388, doi: 10.3923/ijar.2011.377.388, Accessed 25 July, 2015.
Joshi R N and Singh S P (2010) Estimation of total factor productivity in the Indian garment industry, Journal of Fashion Marketing and Management, 14(1): 145-160.
Grosskopf S (1986) The role of the reference technology in measuring productive efficiency, The Economic Journal, 96: 499-513.
Caves D W, Christensen L R and Diewert W E (1982) The economic theory of index numbers and the measurement of input, output and productivity. Econometrica, 50: 1393-1414.http://www.aae.wisc.edu/aae741/Ref/Caves%20Econometrica%201982.pdf, Accessed 22 June, 2015.
Fare, R. and Grosskopf, S. (1992), Malmquist indexes and Fisher ideal indexes, The Economic Journal, 102 (410): 158-160.
Fare R, Grosskopf S, Norris M and Zhang Z (1994) Productivity growth, technical progress and efficiency changes in industrialized countries, American Economic review, 84: 66-83. www.aae.wisc.edu/aae741/Ref/Fare%20AER%201994.pdf, Accessed 30 June, 2015.
Osei D, George M D, Almeida S, Kirigia J M, Mensah A O, Kainyu L H (2005) Technical efficiency of public district hospitals and health centres in Ghana: a pilot study, Cost Effectiveness and Resource Allocation, 3-9. http://www.resource-allocation.com/content/3/1/9, Accessed 30 October, 2015.
Jat T R and Sebastian M S (2013) Technical efficiency of public district hospitals in Madhya Pradesh, India: a data envelopment analysis, Glob Health Action, 6: 21742. http://dx.doi.org/10.3402/gha.v6i0.21742, Accessed 30 July, 2015.
Mogha S K., Yadav S P and Singh S P (2014) Technical efficiency and productivity growth in public sector hospitals of Uttarakhand (India), International Journal of System Assurance Engineering and Management, ISSN 0975-6809.http://dx. doi 10.1007/s13198-014-0270-1, Accessed 20 October, 2015.
Tlotlego N, Nonvignon J, Sambo L G, Asbu E Z, Kirigia J M (2010) Assessment of productivity of hospitals in Botswana: A DEA application, International Archives of Medicine, 3-27. http://dx. doi: 10.1186/1755-7682-3-27, Accessed 30 October, 2015.
Kirigia J M and Asbu E Z (2013) Technical and scale efficiency of public community hospitals in Eritrea: an exploratory study, Health Economics Review, 3-6.http://www.healtheconomicsreview.com/content/3/1/6, Accessed 25 August, 2015.
Ouellete P, Vierstraete V (2004) Technological change and efficiency in the presence of quasi-fixed inputs: a DEA application to the hospital sector, European Journal of Operational Research, 154:755-763.
Gannon B (2008) Total factor productivity growth of hospitals in Ireland: a nonparametric approach, Applied Economics Letters, 15(2):131-135.
Dash U (2009) Evaluating the comparative performance of District Head Quarters Hospitals, 2002-07: a non-parametric Malmquist approach. Mumbai, India: Indra Gandhi Institute of Development Research (IGIDR).
Kirigia J M, Emrouznejad A, Cassoma B, Asbu E Z, Barry S (2008) A performance assessment method for hospitals: the case of Municipal Hospitals in Angola, Journal of Medical Systems, 32(6): 509-519. http://dx.doi.org/10.1007/s10916-008-9157-5, Accessed 25 August, 2015.
