Evaluating the effect of organizationand context on technical efficiency:a second-stage DEA analysis of Italianhospitals

Filippa Bono, Francesco Vitale, Rosa Giaimo, Francesca Sapienza, Alessandra Casuccio, Alberto Firenze, Domenica Matranga, Laura Marsala, Alessandra Casuccio, Francesco Vitale, Domenica Matranga, Alberto Firenze, Maria Grazia Laura Marsala

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13 Citazioni (Scopus)


Objective: the purpose of this study was to compare the technical efficiency of Italian hospitals ata regional level and to examine if differences could be explained by organisational and contextualfactors. Technical efficiency was defined as the ability of the operating units evaluated to use optimalresource levels for their level of output.Methods: the effect of external factors was explored through a second stage Data EnvelopmentAnalysis (DEA). Efficiency scores were calculated for each hospital using the DEA method (Stage I).Through Tobit regression analysis, the estimated efficiency scores were regressed against a set oforganisational and contextual characteristics beyond managerial control, which reflected differencesin the population demographics and regional health expenditure (Stage II). Stage I and Stage IIefficiency scores were compared in order to indirectly assess managerial contribution in relation tohospital efficiency.Results: the highest efficiency (M±SD) was observed in hospitals in the North-West (75.7±15.1),followed by those in the North-East (75.5±15.1), Central Italy (73.9±16.4) and then Southern Italy(70.6±17.9). Hospital Trusts (HTs) were shown to be more technically efficient than Local PublicHospitals (LPHs). Organisational and contextual indicators were statistically significantly different atTobit regression analysis for HTs and LPHs. Emilia Romagna and Lombardia were the regions whosemanagement contributed to increased efficiency.ConclusionS: in our study, the distribution of regions according to technical efficiency only partlyreflected the North-South gradient shown by other studies regarding the gap of expenditure. Theimportant role of organisation and environment in establishing efficiency differences among hospitalswas demonstrated.
Lingua originaleEnglish
pagine (da-a)87851-878511
Numero di pagine11
RivistaEpidemiology Biostatistics and Public Health
Stato di pubblicazionePublished - 2014

All Science Journal Classification (ASJC) codes

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  • ???subjectarea.asjc.2700.2719???
  • ???subjectarea.asjc.2900.2905???
  • ???subjectarea.asjc.2700.2739???


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