RT info:eu-repo/semantics/doctoralThesis
T1 Eficiencia de los hospitales públicos del Sistema de Salud de Castilla y León
A1 Cabezas Pascual, Carlos Fernando
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Hospitales - Administración
K1 Hospital Efficiency
K1 Eficiencia Hospital
K1 32 Ciencias Médicas
AB Healthcare spending is, after pensions, the second most important item in the public budget (15.28% in 2020) and hospitals and specialized services represent more than 60% out of the total consolidated public healthcare spending. These figures make hospitals efficiency studies especially relevant, making them dependent mainly on the use that the institution makes of its resources and their costs. The objective of this thesis has been focused on the analysis of the degree of efficiency the fourteen public hospitals of the Castilla y León Health System have been managed over the five-year period 2014-2018 using the non-parametric technique of Data Envelopment Analysis ( DEA), leading that way to the determination the relative efficiency levels (technical, pure and scale) and the productive change, and thus allowing the identification of inefficiencies, which, logically, should be translated into opportunities for improvement.Our study covers an important gap through carrying out an efficiency study of the hospitals of the Castilian and Leonese Community once the healthcare powers were transferred in 2002 and after going over the financial crisis of 2008-2014, and where, given the complexity of the hospitals activity, that is characterized by a multiplicity of objectives with a plurality of both resources and products, we have applied factor analysis techniques to reduce the dimensionality of the variables of our study into three specific aspects as follows: on the inputs side (resources) the physical and technological resources used and, on outputs side (products) , the ambulatory assistance activity as well as the rest of the healthcare activity, in such a way that starting from a first selection of 12 input variables (6 linked to physical and technological, 3 linked to human resources and another 3 linked to economic resources) and 13 output variables (all of them linked to various sorts of healthcare activity: hospital check-ins, surgical interventions, births, external patient consultations, emergencies, day-hospital treatments, diagnostic tests, etc.), we have finally taken on  board 5 variables (3 inputs and 2 outputs .To guarantee the soundness of the results, we have used three models depending on the inputs (DEA-1, DEA-2 and DEA-3) and, at the same time, each of them with six variants depending on the outputs (variant 1,...,variant 6), counting on, this way, with 18 variations.The analysis carried out has allowed us to obtain results of the following tenor:1) a complete descriptive study both on the population with an individual health card by health complex or hospital and on the different input and output variables that has been taken into consideration in the study.2) the static technical efficiency in each of the six variants of the DEA-1, DEA-2 and DEA-3 models, establishing the global, pure and scale technical efficiency in each variant, as well as the longitudinal efficiency by years and by hospital groups.3) the efficiency values are related to certain characteristics (16 specifically) of the hospital centers4) it is also determined the temporal evolution of the average efficiency of the DEA-1, DEA-2 and DEA-3 models, working only with constant scale returns (DEA-CCR model) and, in terms of dynamic efficiency (Malmquist Index), as an example, it is only determined the evolution of the productivity of the DEA-3 model, exclusively for the variants 1, 2 and 3.5) it is run a unique analysis of one of the evaluated units, the Hospital Clínico Universitario de Valladolid, based on the efficiency data and others, also calculated by the application used in our study, such as the clearances (slacks), the reference units (references) and objective values (targets), thus obtaining action plans to improve their efficiency.
YR 2022
FD 2022
LK https://uvadoc.uva.es/handle/10324/59722
UL https://uvadoc.uva.es/handle/10324/59722
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 06-jun-2024