RESUMO
This study employs Data Envelopment Analysis (DEA) to determine technical efficiency using skilled nursing facilities in the United States, using a 10% national sample of 324 skilled nursing facilities stratified by ownership and size cluster groupings. Results show that nonprofit and for-profit firms operate using significantly different modes of production, thus allowing the best of the for-profits to achieve a level of technical efficiency .86 times higher than the most efficient nonprofit homes. The best larger nursing homes are .89 times more efficient than the best smaller facilities, also indicating a difference in production goals and technologies. A rationale for these differences is sought through an analysis of DEA generated slacks and a logistic regression. Controlling for size and ownership in the DEA, a higher percentage of Medicare patients leads to lower efficiency, while higher occupancy and greater percentage of Medicaid patients lead to greater efficiency. Regional characteristics do not impact efficiency. It is concluded that reimbursement policies should account for differences in organizational goals created by size and ownership differentials. The great variations in efficiency demonstrate tremendous potential for cost-savings through imitation of efficient firms.
Assuntos
Eficiência Organizacional/estatística & dados numéricos , Auditoria Administrativa/métodos , Instituições de Cuidados Especializados de Enfermagem/organização & administração , Interpretação Estatística de Dados , Instituições Privadas de Saúde , Tamanho das Instituições de Saúde , Reembolso de Seguro de Saúde , Modelos Logísticos , Medicare , Organizações sem Fins Lucrativos , Propriedade , Estados UnidosRESUMO
The purpose of the study was to assess whether Community Mental Health Centers (CMHC) operate at different levels of technical efficiency in the production of case management services. A nonparametric technique, Data Envelopement Analysis (DEA), was used to compare 39 CMHC case management programs. The CMHCs, located in Virginia, were compared on the basis of actual performance as reported in annual statistical reports. Efficient utilization of resources in the delivery of case management services was present in only six (15%) of the CMHCs. As a group, CMHCs with local inpatient services have lower technical efficiency than CMHCs without local inpatient services. The provision of local inpatient care is costly; thereby, giving CMHCs without such services a competitive edge on average technical efficiency. This suggests that the decision to provide local hospital care might be a philosophical one, rather than one that is financially driven.
