The Impact of the Prospective Payment System on the Technical Efficiency of Hospitals
Journal of Medical Systems
Public Sector Hospital Efficiency for Provincial Markets in Turkey
Journal of Medical Systems
Measurement of Technical Efficiency of Public Hospitals in Kenya: Using Data Envelopment Analysis
Journal of Medical Systems
Data Envelopment Analysis: Theory, Methodology and Application
Data Envelopment Analysis: Theory, Methodology and Application
Integration Mechanisms and Hospital Efficiency in Integrated Health Care Delivery Systems
Journal of Medical Systems
Efficiency of Federal Hospitals in the United States
Journal of Medical Systems
Data Envelopment Analysis: A Comprehensive Text with Models, Applications, References and DEA-Solver Software
Efficiency Measurement for Hospitals Owned by the Iranian Social Security Organisation
Journal of Medical Systems
Data Envelopment Analysis Comparison of Hospital Efficiency and Quality
Journal of Medical Systems
A Performance Assessment Method for Hospitals: The Case of Municipal Hospitals in Angola
Journal of Medical Systems
The Association between Hospital Ownership and Technical Efficiency in a Managed Care Environment
Journal of Medical Systems
A Novel Approach for Evaluating the Risk of Health Care Failure Modes
Journal of Medical Systems
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There is a conflict between Data Envelopment Analysis (DEA) theory's requirement that inputs (outputs) be substitutable, and the ubiquitous use of nonsubstitutable inputs and outputs in DEA applications to hospitals. This paper develops efficiency indicators valid for nonsubstitutable variables. Then, using a sample of 87 community hospitals, it compares the new measures' efficiency estimates with those of conventional DEA measures. DEA substantially overestimated the hospitals' efficiency on the average, and reported many inefficient hospitals to be efficient. Further, it greatly overestimated the efficiency of some hospitals but only slightly overestimated the efficiency of others, thus making any comparisons among hospitals questionable. These results suggest that conventional DEA models should not be used to estimate the efficiency of hospitals unless there is empirical evidence that the inputs (outputs) are substitutable. If inputs (outputs) are not substitutes, efficiency indicators valid for nonsubstitutability should be employed, or, before applying DEA, the nonsubstitutable variables should be combined using an appropriate weighting scheme or statistical methodology.