Journal List > J Korean Acad Nurs > v.44(4) > 1003005

TOOLS
Sohn and Choi: Association between Efficiency and Quality of Health Care in South Korea Long-term Care Hospitals: Using the Data Envelopment Analysis and Matrix Analysis
Original Article

Journal of Korean Academy of Nursing 2014; 44(4): 418-427.

Published online: 29 August 2014

DOI: https://doi.org/10.4040/jkan.2014.44.4.418

Association between Efficiency and Quality of Health Care in South Korea Long-term Care Hospitals: Using the Data Envelopment Analysis and Matrix Analysis

Minsung Sohn1, Mankyu Choi2

1Department of Public Health Science, Graduate School·BK21Plus Program in Public Health Science, Korea University, Seoul, Korea.

2School of Health Policy & Management, College of Public Health Science·Department of Public Health Science, Graduate School·BK21 Plus Program in Public Health Science, Korea University, Seoul, Korea.

Address reprint requests to: Choi, Mankyu. Justice hall 703, Department of Public Health Science, Graduate School, Korea University, San 1, Jeongneung 3-dong, Seongbuk-gu, Seoul 136-703, Korea. Tel: +82-2-940-2871, Fax: +82-2-940-2879, mkchoi@korea.ac.kr

Received 21 April 2014       Revised 17 May 2014       Accepted 24 July 2014

© 2014 Korean Society of Nursing Science

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0/) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

Objectives of this study were to investigate the association between efficiency and quality of health care in Long-term Care Hospitals (LTCH) and determine related factors that would enable achievement of both high efficiency and high quality at the same time.

Methods

Major data sources were the "2012 Korean Assessment of Propriety by Long-term Care Hospitals" obtained from the Health Insurance Review & Assessment Service. Cost variables were supplemented by a National Tax Service accounting document. First, data envelopment analysis was performed by generating efficiency scores for each LTCH. Second, matrix analysis was conducted to ascertain association between efficiency and quality. Lastly, kruskal-wallis and mann-whitney tests were conducted to identify related factors.

Results

First, efficiency and quality of care are not in a relationship of trade-offs; thus, LTCH can be confident that high efficiency-high quality can be achieved. Second, LTCH with a large number of beds, longer tenure of medical personnel, and adequate levels of investment were more likely to have improved quality as well as efficiency.

Conclusion

It is essential to enforce legal standards appropriate to the facilities, reduce turnover of nursing staff, and invest properly in human resources. These consequences will help LTCH to maintain the balance of high efficiency-high quality in the long-run.

Keywords: Long-term care hospitals, Efficiency, Quality of health care

Figures and Tables

Figure 1
The theoretical framework of this study.
jkan-44-418-g001
Figure 2
Association between efficiency (CCR and BCC) and quality of health care.
jkan-44-418-g002
Table 1
Characteristics of the Long-term Care Hospitals (N=72)
jkan-44-418-i001

LTCH=Long-term care hospitals.

Table 2
Characteristics of the Long-term Care Hospitals (N=72)
jkan-44-418-i002

big=beyond the possible efficiency score from the super-efficiency model; DMU=Decision making unit; CCR=Charnes, cooper, & rhodes model; BCC=Banker, charnes, & cooper model.

Table 3
Characteristics of the Long-term Care Hospitals (N=72)
jkan-44-418-i003

A=high efficiency-high quality; B=low efficiency-high quality; C=high efficiency-low quality; D=low efficiency-low quality; CCR = Charnes, Cooper, & Rhodes model; BCC = Banker, Charnes, & Cooper model.

Notes

This manuscript is based on a part of the first author's master's thesis from Korea University.

References

1. Statistics Korea. Population projections for Korea: 2010-2060. Daejeon: Author;2011.
2. Health Insurance Review & Assessment Service. 2011 national health insurance statistical yearbook. Seoul: Health Insurance Review & Assessment Service, National Health Insurance Service;2012.
3. National Health Insurance Service. 2013 evaluation results of longterm care facility. Press Release. 2014. 04. 28.
4. The Organisation for Economic Co-operation and Development. OECD health policies and data 2010 [Internet]. Paris, FR: Author;2010. cited 2014 January 20. Available from: http://www.oecd.org/els/health-systems/.
5. Health Insurance Review & Assessment Service. Effective management of long-term care hospital. Seoul: Author;2010. 12. Report No.: HETA2000-0139-2824.
6. Shimshak DG, Lenard ML, Klimberg RK. Incorporating quality into data envelopment analysis of nursing home performance: A case study. Omega. 2009; 37(3):672–685. http://dx.doi.org/10.1016/j.omega.2008.05.004.
7. DeLellis NO, Ozcan YA. Quality outcomes among efficient and inefficient nursing homes: A national study. Health Care Manage Rev. 2013; 38(2):156–165. http://dx.doi.org/10.1097/HMR.0b013e31824bec38.
8. Nayar P, Ozcan YA, Yu F, Nguyen AT. Benchmarking urban acute care hospitals: Efficiency and quality perspectives. Health Care Manage Rev. 2013; 38(2):137–145. http://dx.doi.org/10.1097/HMR.0b013e3182527a4c.
9. Lee HY, Blegen MA, Harrington C. The effects of RN staffing hours on nursing home quality: A two-stage model. Int J Nurs Stud. 2014; 51(3):409–417. http://dx.doi.org/10.1016/j.ijnurstu.2013.10.007.
10. Berta W, Laporte A, Kachan N. Unpacking the relationship between operational efficiency and quality of care in Ontario long-term care homes. Can J Aging. 2010; 29(4):543–556. http://dx.doi.org/10.1017/s0714980810000553.
11. Keaysa S, Wistera AV, Gutmana GM. Administrators and quality of care in long-term care facilities. J Hous Elderly. 2009; 23(3):243–260. http://dx.doi.org/10.1080/02763890903035621.
12. Rantz MJ, Hicks L, Grando V, Petroski GF, Madsen RW, Mehr DR, et al. Nursing home quality, cost, staffing, and staff mix. Gerontologist. 2004; 44(1):24–38.
13. Blank JL, Eggink E. A quality-adjusted cost function in a regulated industry: The case of Dutch nursing homes. Health Care Manag Sci. 2001; 4(3):201–211.
14. Anderson RI, Hobbs BK, Weeks HS, Webb JR. Quality of care and nursing home cost-efficiency research. J Real Estate Lit. 2005; 13(3):323–336.
15. Lee I, Wang HH. Preliminary development of humanistic care indicators for residents in nursing homes: A delphi technique. Asian Nurs Res. 2014; 8(1):75–81. http://dx.doi.org/10.1016/j.anr.2014.03.001.
16. Garavaglia G, Lettieri E, Agasisti T, Lopez S. Efficiency and quality of care in nursing homes: An Italian case study. Health Care Manag Sci. 2011; 14(1):22–35. http://dx.doi.org/10.1007/s10729-010-9139-2.
17. Lee RH, Bott MJ, Gajewski B, Taunton RL. Modeling efficiency at the process level: An examination of the care planning process in nursing homes. Health Serv Res. 2009; 44(1):15–32. http://dx.doi.org/10.1111/j.1475-6773.2008.00895.x.
18. Duffy JAM, Fitzsimmons JA, Jain N. Identifying and studying "best-performing" services: An application of DEA to long-term care. Benchmarking. 2006; 13(3):232–251. http://dx.doi.org/10.1108/14635770610668767.
19. Lee SH. Multi-level analysis of factors related to quality of service in long-term care hospitals. J Korean Acad Nurs. 2009; 39(3):409–421. http://dx.doi.org/10.4040/jkan.2009.39.3.409.
20. Cooper WW, Seiford LM, Zhu J. Data envelopment analysis: History, models and interpretations. In : Cooper WW, Seiford LM, Zhu J, editors. Handbook on data envelopment analysis. 2nd ed. New York, NY: Springer;2011. p. 1–39.
21. Nayar P, Ozcan YA. Data envelopment analysis comparison of hospital efficiency and quality. J Med Syst. 2008; 32(3):193–199.
22. Donabedian A. Quality assessment and assurance: Unity of purpose, diversity of means. Inquiry. 1988; 25(1):173–192.
23. Charnes A, Cooper WW, Rhodes E. Measuring the efficiency of decision making units. Eur J Oper Res. 1978; 2(6):429–444. http://dx.doi.org/10.1016/0377-2217(78)90138-8.
24. O'Neill L, Rauner M, Heidenberger K, Kraus M. A cross-national comparison and taxonomy of DEA-based hospital efficiency studies. Socioecon Plann Sci. 2008; 42(3):158–189. http://dx.doi.org/10.1016/j.seps.2007.03.001.
25. Zhu J. Super-efficiency and DEA sensitivity analysis. Eur J Oper Res. 2001; 129(2):443–455. http://dx.doi.org/10.1016/S0377-2217(99)00433-6.
26. Martilla JA, James JC. Importance-performance analysis: An easily-applied technique for measuring attribute importance and performance can further the development of effective marketing programs. J Mark. 1977; 41(1):77–79.
27. Zhang NJ, Unruh L, Wan TT. Has the medicare prospective payment system led to increased nursing home efficiency? Health Serv Res. 2008; 43(3):1043–1061. http://dx.doi.org/10.1111/j.1475-6773.2007.00798.x.
28. Bostick JE, Rantz MJ, Flesner MK, Riggs CJ. Systematic review of studies of staffing and quality in nursing homes. J Am Med Dir Assoc. 2006; 7(6):366–376. http://dx.doi.org/10.1016/j.jamda.2006.01.024.
29. Castle NG, Engberg J. Staff turnover and quality of care in nursing homes. Med Care. 2005; 43(6):616–626.
30. Newhouse JP. Toward a theory of nonprofit institutions: An economic model of a hospital. Am Econ Rev. 1970; 60(1):64–74.
TOOLS
Similar articles