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. 2018 Sep 6;13(9):e0203017.
doi: 10.1371/journal.pone.0203017. eCollection 2018.

Quality and resource efficiency in hospital service provision: A geoadditive stochastic frontier analysis of stroke quality of care in Germany

Christoph Pross  1 , Christoph Strumann  2 , Alexander Geissler  1 , Helmut Herwartz  3 , Nadja Klein  4
Affiliations

Quality and resource efficiency in hospital service provision: A geoadditive stochastic frontier analysis of stroke quality of care in Germany

Christoph Pross et al. PLoS One. .

Abstract

We specify a Bayesian, geoadditive Stochastic Frontier Analysis (SFA) model to assess hospital performance along the dimensions of resources and quality of stroke care in German hospitals. With 1,100 annual observations and data from 2006 to 2013 and risk-adjusted patient volume as output, we introduce a production function that captures quality, resource inputs, hospital inefficiency determinants and spatial patterns of inefficiencies. With high relevance for hospital management and health system regulators, we identify performance improvement mechanisms by considering marginal effects for the average hospital. Specialization and certification can substantially reduce mortality. Regional and hospital-level concentration can improve quality and resource efficiency. Finally, our results demonstrate a trade-off between quality improvement and resource reduction and substantial regional variation in efficiency.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Centered estimated regional random effects of Model 2: Quality & resources.
Fig 2
Fig 2. Centered estimated regional random effects of Model 8: Quality only.
Fig 3
Fig 3. Centered estimated regional random effects of Model 9: Resources only.
Fig 4
Fig 4. Posterior distribution of slack resources.
See this image and copyright information in PMC

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