Browsing by Author "Dreyer, Kathryn Ann"

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    The evaluation of case-mix adjusted efficiency scores the case of the South African private hospital industry
    (2013) Dreyer, Kathryn Ann; Ramjee, Shivani
    There is little existing South African literature relating to hospital efficiency that allows for differences in case mix across hospitals. One of the primary motivations for this dissertation is to help fill this gap in the literature by examining the impact that adjusting for differences in case mix has on efficiency scores. Data Envelopment Analysis (DEA) is chosen as the efficiency measurement method because of its exibility and ease of handling multiple inputs and outputs. A number of DEA models are applied to a sample of South African private hospitals for the years 2008 to 2011 inclusive. Three different case-mix adjustment techniques are investigated and their ability to capture differences in case mix is assessed. The three techniques investigated are: a case-mix adjustment factor (constructed using Diagnosis-Related Groups (DRGs)) to adjust outputs; including the case-mix adjustment factor as an additional output; and disaggregating hospital admissions into broad categories which are used as outputs. A comparison of the unadjusted model with the case-mix adjusted model reveals that omitting the adjustment can have a considerable impact on efficiency scores. Whilst little difference is noted in average efficiency scores for the group of hospitals, 90% for the unadjusted model and 92% for the adjusted model in 2011, there are substantial differences between the adjusted and unadjusted efficiency scores of individual hospitals. On comparison of the three different techniques investigated, it is evident that if there is sufficient data to construct a case-mix adjustment factor, case-mix adjusted admissions should be used, rather than using the factor as an additional output variable. In the case where insufficient data is available, disaggregating admissions does capture some of the differences in case mix but a substantial amount of power is lost as a result of increasing the number of output variables.
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    Using DEA to profile in-hospital surgeon services: A South African funder perspective
    (2014) Abraham, Matan; Ramjee, Shivani; Dreyer, Kathryn Ann
    The comparative assessment of physician performance, also known as ‘physician profiling’ is frequently used by healthcare funders. It aims to identify and improve the resource efficiency and quality of physician care. South African private healthcare funders use a wide range of profiling techniques; however, currently the use of frontier analysis is absent. This study explores the use of the non - parametric frontier analysis technique called Data Envelopment Analysis (DEA) for the profiling of physicians in South Africa. This is investigated by following a DEA profiling approach to evaluate the performance of 403 general/ paediatric surgeons in providing in - hospital services in 2012. A 7 - input 1 - output VRS DEA model is used to determine the efficiency of the surgeons. The profiling results are then analysed to determine their usefulness. It results reveal that 58 surgeons are efficient, representing only 14.4% of surgeons profiled. Therefore, the DEA approach reveals a large potential for efficiency improvements. The average efficiency score of inefficient surgeons is found to be 0.68. This means that, on average, inefficient surgeons have to decrease resource utilisation by 32% to achieve efficiency. The DEA approach is also found to be proficient at identifying the physicians presenting the most severe levels of inefficiency. 37 surgeons are found to be significantly inefficient. The approach also allows for the identification of peers against which inefficient surgeons are able to directly compare their practices. These results are determined to be of significant potential use to South African private healthcare funders. It is, however, noted that the analysis and results obtained was solely of a statistical nature. Closer consideration of the clinical appropriateness of the results is essential. In any case, this study concludes that a DEA profiling approach can be considered a useful technique in the comparison of physician performance in South Africa.