Efficiency and Productivity Change of Public Hospitals in Panama: Do Management Schemes Matter?
Abstract
:1. Introduction
2. Literature Review
3. Materials and Methods
3.1. Context of the Study and Sample Design
3.2. Data and Variables
3.3. Methodology
4. Results
5. Discussion
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Hospital | Network | Province | District | Level of complexity | Area of Influence |
---|---|---|---|---|---|
Hospital Santo Tomas | MoH | Panamá | Panamá | III | Regional |
Hospital Del Niño | MoH | Panamá | Panamá | III | Urban |
Hospital de Especialidades Pediátricas Omar Torrijos Herrera | SSF | Panamá | Panamá | III | Rural |
Complejo Hospitalario Dr. Arnulfo Arias Madrid | SSF | Panamá | Panamá | III | Urban |
Hospital Dra. Susana Jones Cano | SSF | Panamá | San Miguelito | II | Urban |
Hospital San Miguel Arcangel | MoH | Panamá | San Miguelito | II | Urban |
Hospital de Changuinola | SSF | Bocas del Toro | Changuinola | II | Rural |
Hospital de Almirante | SSF | Bocas del Toro | Changuinola | I-II | Rural |
Hospital de Chiriquí Grande | SSF | Bocas del Toro | Chiriquí Grande | I-II | Rural |
Hospital Regional Dr. Rafael Hernandez | SSF | Chiriquí | David | II | Regional |
Hospital Dr. Cecilio A. Castillero | MoH | Herrera | Chitre | II | Urban |
Hospital Ezequiel Abadia | SSF | Veraguas | Sona | I-II | Urban |
Policlinica Especializada Dr. Horacio Diaz Gomez | SSF | Veraguas | Santiago | II | Urban |
Hospital Dr. Rafael Estevez | SSF | Coclé | Aguadulce | II | Urban |
Hospital Dr. Aquilino Tejeira | MoH | Coclé | Penonomé | II | Regional |
Hospital San José de la Palma | MoH | Darién | Chepigana | I-II | Urban |
Hospital Regional de Azuero Anita Moreno | MoH | Los Santos | La Villa de Los Santos | II | Regional |
Hospital Rafael H. Moreno | MoH | Los Santos | Macaracas | II | Rural |
Hospital Dr. Gustavo Nelson Collado | SSF | Herrera | Chitre | II | Regional |
Hospital Luis Chicho Fabrega | MoH | Veraguas | Santiago | II | Regional |
Hospital Materno Infantil Jose Domingo de Obaldia | MoH | Chiriquí | David | III | Regional |
Hospital Dr. Joaquin Pablo Franco Sayas | MoH | Los Santos | Las Tablas | II | Regional |
Malmquist | 2005–2006 | 2006–2007 | 2007–2008 | 2008–2009 | 2009–2010 | 2010–2011 | 2011–2012 | 2012–2013 | 2013–2014 | 2014–2015 |
Mean | 0.9784 | 0.9708 | 1.0552 | 1.0077 | 0.9419 | 1.0689 | 1.0525 | 1.0151 | 1.1593 | 1.1396 |
SD | 0.0865 | 0.1196 | 0.1000 | 0.0975 | 0.1175 | 0.1517 | 0.1287 | 0.1288 | 0.6770 | 0.3216 |
Min | 0.8506 | 0.6483 | 0.8891 | 0.8661 | 0.6286 | 0.8409 | 0.6621 | 0.7634 | 0.8750 | 0.8842 |
Max | 1.2196 | 1.2841 | 1.2466 | 1.3412 | 1.1487 | 1.5448 | 1.3335 | 1.4485 | 1.5645 | 1.3565 |
Efficiency | 2005–2006 | 2006–2007 | 2007–2008 | 2008–2009 | 2009–2010 | 2010–2011 | 2011–2012 | 2012–2013 | 2013–2014 | 2014–2015 |
Mean | 1.0640 | 0.9844 | 0.9956 | 1.0117 | 0.9849 | 0.8969 | 1.0125 | 0.9968 | 1.0372 | 1.1280 |
SD | 0.0932 | 0.1022 | 0.1074 | 0.0795 | 0.1119 | 0.1469 | 0.1181 | 0.0689 | 0.1555 | 0.2192 |
Min | 0.9471 | 0.6646 | 0.6940 | 0.8315 | 0.6351 | 0.6472 | 0.8352 | 0.8092 | 0.9169 | 0.8888 |
Max | 1.2927 | 1.1408 | 1.2491 | 1.1659 | 1.1710 | 1.0971 | 1.3662 | 1.1124 | 1.3598 | 1.2809 |
Pure Efficiency | 2005–2006 | 2006–2007 | 2007–2008 | 2008–2009 | 2009–2010 | 2010–2011 | 2011–2012 | 2012–2013 | 2013–2014 | 2014–2015 |
Mean | 1.0230 | 0.9866 | 1.0181 | 0.9804 | 0.9863 | 1.0279 | 1.0056 | 0.9995 | 1.0326 | 1.0842 |
SD | 0.0666 | 0.0714 | 0.1048 | 0.0768 | 0.0764 | 0.1808 | 0.1094 | 0.0791 | 0.1475 | 0.1912 |
Min | 0.9193 | 0.8026 | 0.8864 | 0.7358 | 0.7747 | 0.7454 | 0.6993 | 0.8053 | 0.8823 | 0.8747 |
Max | 1.2434 | 1.1384 | 1.3590 | 1.1467 | 1.1138 | 1.7628 | 1.2668 | 1.2331 | 1.4173 | 1.4419 |
Technological Change | 2005–2006 | 2006–2007 | 2007–2008 | 2008–2009 | 2009–2010 | 2010–2011 | 2011–2012 | 2012–2013 | 2013–2014 | 2014–2015 |
Mean | 0.9208 | 0.9852 | 1.0672 | 0.9988 | 0.9579 | 1.2137 | 1.0452 | 1.0189 | 1.0771 | 1.0068 |
SD | 0.0493 | 0.0420 | 0.1204 | 0.0950 | 0.0683 | 0.2001 | 0.1214 | 0.1145 | 0.3261 | 0.1647 |
Min | 0.7878 | 0.9348 | 0.8891 | 0.9112 | 0.8028 | 0.8409 | 0.6621 | 0.8758 | 0.9183 | 0.8814 |
Max | 0.9994 | 1.1514 | 1.4928 | 1.3412 | 1.0576 | 1.5554 | 1.2249 | 1.4485 | 1.5091 | 1.5310 |
Pure Technological Change | 2005–2006 | 2006–2007 | 2007–2008 | 2008–2009 | 2009–2010 | 2010–2011 | 2011–2012 | 2012–2013 | 2013–2014 | 2014–2015 |
Mean | 0.9211 | 0.9912 | 1.0477 | 1.0417 | 0.9514 | 1.0633 | 0.9984 | 1.1123 | 1.0364 | 1.0275 |
SD | 0.3360 | 0.3230 | 0.3289 | 0.4092 | 0.3038 | 0.3489 | 0.3284 | 0.4973 | 0.4463 | 0.3405 |
Min | 0.7515 | 0.7000 | 0.8118 | 0.7431 | 0.7280 | 0.6344 | 0.4322 | 0.8849 | 0.6898 | 0.8837 |
Max | 1.0615 | 1.4376 | 1.2249 | 1.6317 | 1.2268 | 1.3814 | 1.2116 | 1.4148 | 1.4336 | 1.5828 |
Scale Efficiency | 2005–2006 | 2006–2007 | 2007–2008 | 2008–2009 | 2009–2010 | 2010–2011 | 2011–2012 | 2012–2013 | 2013–2014 | 2014–2015 |
Mean | 1.0431 | 0.9973 | 0.9852 | 1.0358 | 0.9968 | 0.8842 | 1.0090 | 1.0002 | 1.0044 | 1.0394 |
SD | 0.1070 | 0.0761 | 0.1253 | 0.0928 | 0.0656 | 0.1509 | 0.0716 | 0.0654 | 0.0339 | 0.0579 |
Min | 0.9609 | 0.7781 | 0.6588 | 0.8315 | 0.8198 | 0.5538 | 0.8697 | 0.7531 | 0.9643 | 0.9913 |
Max | 1.3722 | 1.1282 | 1.2257 | 1.3338 | 1.1230 | 1.0934 | 1.2056 | 1.1103 | 1.0999 | 1.2049 |
Scale Technological Change | 2005–2006 | 2006–2007 | 2007–2008 | 2008–2009 | 2009–2010 | 2010–2011 | 2011–2012 | 2012–2013 | 2013–2014 | 2014–2015 |
Mean | 1.0061 | 1.0090 | 1.0334 | 0.9847 | 1.0179 | 1.1465 | 1.0613 | 0.9461 | 1.0528 | 0.9820 |
SD | 0.3696 | 0.3196 | 0.3305 | 0.3617 | 0.3180 | 0.3875 | 0.3354 | 0.3465 | 0.3212 | 0.2944 |
Min | 0.7430 | 0.8010 | 0.9042 | 0.8058 | 0.7839 | 0.8903 | 0.9309 | 0.5998 | 0.9570 | 0.8661 |
Max | 1.2555 | 1.3861 | 1.5046 | 1.2963 | 1.2737 | 1.5714 | 1.5320 | 1.0850 | 1.3818 | 1.0816 |
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Province | Total | SSF | MoH |
---|---|---|---|
Bocas del Toro | 3 | 3 | 0 |
Chiriquí | 2 | 1 | 1 |
Coclé | 2 | 1 | 1 |
Darién | 1 | 0 | 1 |
Herrera | 2 | 1 | 1 |
Los Santos | 3 | 0 | 3 |
Panama | 6 | 3 | 3 |
Veraguas | 3 | 2 | 1 |
Total | 22 | 11 | 11 |
Variables | Mean | SD | Min | Max | |
---|---|---|---|---|---|
Outputs | Discharges | 8885 | 8598 | 407 | 32,009 |
Emergencies | 52,153 | 36,082 | 2717 | 171,744 | |
Inputs | Beds | 205 | 209 | 15 | 843 |
Medical staff | 111 | 173 | 5 | 1021 | |
Non-medical staff | 321 | 256 | 6 | 1049 |
Variables | SSF | MoH | |||
---|---|---|---|---|---|
Mean | SD | Mean | SD | ||
Outputs | Discharges | 6178 | 6183 | 11,593 | 11,464 |
Emergencies | 43,623 | 43,638 | 60,684 | 60,486 | |
Inputs | Beds | 175 | 176 | 234 | 230 |
Medical staff | 131 | 131 | 92 | 90 | |
Non-medical staff | 338 | 341 | 303 | 302 |
MPI | EC | PEC | SEC | TC | PTC | STC | |
---|---|---|---|---|---|---|---|
Mean | 1.0253 | 1.0054 | 1.0144 | 0.9993 | 1.0242 | 1.0111 | 1.0300 |
SD | 0.0400 | 0.0253 | 0.0339 | 0.0142 | 0.0220 | 0.0330 | 0.0407 |
Min | 0.9788 | 0.9718 | 0.9769 | 0.9648 | 0.9904 | 0.9634 | 0.9775 |
Max | 1.1341 | 1.0770 | 1.1259 | 1.0319 | 1.0924 | 1.0863 | 1.1527 |
MPI | EC | TC | |
---|---|---|---|
Mean | 1.0253 | 1.0054 | 1.0242 |
Lower bound | 0.9911 | 0.8223 | 0.8534 |
Upper bound | 1.0704 | 1.2133 | 1.2613 |
Management System | MPI | EC | PEC. | SEC | TC | PTC | STC | |
---|---|---|---|---|---|---|---|---|
SSF | Mean | 1.0365 | 1.0093 | 1.0175 | 0.9993 | 1.0365 | 1.0208 | 1.0348 |
SD | 0.0470 | 0.0208 | 0.0279 | 0.0081 | 0.0281 | 0.0348 | 0.0469 | |
Min | 0.9836 | 0.9732 | 0.9769 | 0.9858 | 0.9904 | 0.9767 | 0.9869 | |
Max | 1.0924 | 1.0489 | 1.0685 | 1.0154 | 1.0924 | 1.0863 | 1.1227 | |
MoH | Mean | 1.0141 | 1.0015 | 1.0028 | 0.9997 | 1.0185 | 1.0006 | 1.0248 |
SD | 0.0297 | 0.0296 | 0.0164 | 0.0192 | 0.0127 | 0.0291 | 0.0341 | |
Min | 0.9788 | 0.9718 | 0.9833 | 0.9648 | 0.9967 | 0.9634 | 0.9775 | |
Max | 1.0860 | 1.0770 | 1.0473 | 1.0319 | 1.0412 | 1.0451 | 1.0850 |
Management System | MPI | EC | TC | |
---|---|---|---|---|
SSF | Mean | 1.0365 | 1.0093 | 1.0298 |
Lower bound | 1.0008 | 0.8262 | 0.8473 | |
Upper bound | 1.0919 | 1.2359 | 1.2749 | |
MoH | Mean | 1.0141 | 1.0015 | 1.0185 |
Lower bound | 0.9827 | 0.8185 | 0.8595 | |
Upper bound | 1.0489 | 1.1908 | 1.2477 |
System | Hospital | MPI | Lower Bound | Upper Bound | EC | Lower Bound | Upper Bound | TC | Lower Bound | Upper Bound |
---|---|---|---|---|---|---|---|---|---|---|
SSF | Hospital de Especialidades Pediatrica Omar Torrijos Herrera | 1.1341 | 1.0525 | 1.3378 | 1.0489 | 0.7875 | 1.4774 | 1.0590 | 0.8193 | 1.3920 |
SSF | Hospital de Almirante | 1.0924 | 1.0721 | 1.1133 | 1.0000 | 0.7813 | 1.2900 | 1.0924 | 0.8575 | 1.4002 |
MoH | Hospital Regional de Azuero Anita Moreno | 1.0860 | 1.0309 | 1.1332 | 1.0770 | 0.8754 | 1.2558 | 1.0070 | 0.8695 | 1.2469 |
SSF | Hospital de Changuinola | 10807 | 1.0387 | 1.1427 | 1.0375 | 0.9942 | 1.0731 | 1.0151 | 0.8822 | 1.2209 |
MoH | Hospital San Miguel Arcangel | 1.0426 | 1.0243 | 1.0601 | 1.0319 | 0.8656 | 1.1891 | 1.0148 | 0.8790 | 1.2051 |
SSF | Policlinica Especializada Dr. Horacio Diaz Gomez | 1.0326 | 0.9966 | 1.0830 | 1.0000 | 0.7859 | 1.3207 | 1.0326 | 0.7965 | 1.3253 |
SSF | Hospital Dr. Gustavo Nelson Collado (Chitre) | 1.0290 | 1.0073 | 1.0717 | 1.0343 | 0.8331 | 1.2311 | 1.0177 | 0.8558 | 1.2616 |
SSF | Hospital Regional Dr. Rafael Hernandez | 1.0265 | 1.0067 | 1.0651 | 1.0161 | 0.8535 | 1.2019 | 1.0210 | 0.8669 | 1.2161 |
SSF | Complejo Hospitalario Metropolitano Arnulfo A. Madrid | 1.0227 | 1.0094 | 1.0399 | 0.9946 | 0.7997 | 1.2162 | 1.0331 | 0.8463 | 1.2863 |
MoH | Hospital Materno Infantil Jose Domingo de Obaldia | 1.0217 | 0.9740 | 1.0566 | 0.9862 | 0.8196 | 1.1538 | 1.0412 | 0.8823 | 1.2672 |
MoH | Hospital San José de La Palma | 1.0185 | 0.9798 | 1.0487 | 1.0020 | 0.8368 | 1.1556 | 1.0190 | 0.8798 | 1.2218 |
MoH | Hospital Luis Chicho Fabrega | 1.0135 | 0.9887 | 1.0386 | 1.0000 | 0.7893 | 1.2282 | 1.0135 | 0.8351 | 1.2831 |
SSF | Hospital Dr. Rafael Estevez | 1.0134 | 0.9580 | 1.0657 | 1.0117 | 0.8614 | 1.1533 | 1.0188 | 0.8850 | 1.1833 |
MoH | Hospital Rafael H. Moreno | 1.0116 | 0.9946 | 1.0389 | 1.0000 | 0.7903 | 1.2250 | 1.0116 | 0.8320 | 1.2863 |
MoH | Hospital Santo Tomas | 1.0026 | 1.0001 | 1.0284 | 0.9912 | 0.8148 | 1.1789 | 1.0282 | 0.8607 | 1.2569 |
MoH | Hospital Del Niño | 1.0016 | 0.9896 | 1.0330 | 0.9755 | 0.8283 | 1.1551 | 1.0353 | 0.8758 | 1.2312 |
SSF | Hospital Dra. Susana Jones Cano | 0.9959 | 0.9717 | 1.0182 | 1.0000 | 0.7776 | 1.2198 | 0.9959 | 0.8245 | 1.2908 |
SSF | Hospital de Chiriqui Grande | 0.9904 | 0.9582 | 1.0350 | 1.0000 | 0.8031 | 1.2496 | 0.9904 | 0.8130 | 1.2341 |
MoH | Hospital Dr. Aquilino Tejeira | 0.9895 | 0.9617 | 1.0232 | 0.9933 | 0.7743 | 1.2082 | 0.9967 | 0.8260 | 1.2928 |
MoH | Hospital Dr. Joaquin Pablo Franco | 0.9893 | 0.9308 | 1.0350 | 0.9876 | 0.8026 | 1.1788 | 1.0148 | 0.8569 | 1.2199 |
SSF | Hospital Ezequiel Abadia | 0.9836 | 0.9247 | 1.0390 | 0.9732 | 0.8108 | 1.1618 | 1.0368 | 0.8733 | 1.2133 |
MoH | Hospital Dr. Cecilio A. Castillero | 0.9788 | 0.9351 | 1.0418 | 0.9718 | 0.8062 | 1.1703 | 1.0219 | 0.8571 | 1.2131 |
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Cordero, J.M.; García-García, A.; Lau-Cortés, E.; Polo, C. Efficiency and Productivity Change of Public Hospitals in Panama: Do Management Schemes Matter? Int. J. Environ. Res. Public Health 2021, 18, 8630. https://doi.org/10.3390/ijerph18168630
Cordero JM, García-García A, Lau-Cortés E, Polo C. Efficiency and Productivity Change of Public Hospitals in Panama: Do Management Schemes Matter? International Journal of Environmental Research and Public Health. 2021; 18(16):8630. https://doi.org/10.3390/ijerph18168630
Chicago/Turabian StyleCordero, José M., Agustín García-García, Enrique Lau-Cortés, and Cristina Polo. 2021. "Efficiency and Productivity Change of Public Hospitals in Panama: Do Management Schemes Matter?" International Journal of Environmental Research and Public Health 18, no. 16: 8630. https://doi.org/10.3390/ijerph18168630