Journal of Korean Academy of Nursing (대한간호학회지)

Korean Society of Nursing Science (한국간호과학회)
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Association between Efficiency and Quality of Health Care in South Korea Long-term Care Hospitals: Using the Data Envelopment Analysis and Matrix Analysis

요양병원의 효율성과 의료서비스 질의 관련성: 자료포락분석과 매트릭스 분석

  • Sohn, Minsung (Department of Public Health Science, Graduate School.BK21Plus Program in Public Health Science, Korea University) ;
  • Choi, Mankyu (School 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)
  • 손민성 (고려대학교 대학원 보건과학과.BK21PLUS 인간생명-상호작용 융합사업단) ;
  • 최만규 (고려대학교 보건과학대학 보건정책관리학부.대학원 보건과학과.BK21PLUS 인간생명-상호작용 융합사업단)
  • Received : 2014.04.21
  • Accepted : 2014.07.24
  • Published : 2014.08.29
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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

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 April 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 December. Report No.: Research Report 2010-11.
  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 Management Review. 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 Management Review. 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. International Journal of Nursing Studies. 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. Canadian Journal on 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. Journal of Housing for the 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. The Gerontologist. 2004;44(1):24-38. https://doi.org/10.1093/geront/44.1.24
  13. Blank JL, Eggink E. A quality-adjusted cost function in a regulated industry: The case of Dutch nursing homes. Health Care Management Science. 2001;4(3):201-211. https://doi.org/10.1023/A:1011496832304
  14. Anderson RI, Hobbs BK, Weeks HS, Webb JR. Quality of care and nursing home cost-efficiency research. Journal of Real Estate Literature. 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 Nursing Research. 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 Management Science. 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 Services Research. 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 "bestperforming" services: An application of DEA to long-term care. Benchmarking: An International Journal. 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. Journal of Korean Academy of Nursing. 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. 164. 2nd ed. New York, NY: Springer; 2011. p. 1-39.
  21. Nayar P, Ozcan YA. Data envelopment analysis comparison of hospital efficiency and quality. Journal of Medical Systems. 2008;32(3):193-199. https://doi.org/10.1007/s10916-007-9122-8
  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. European Journal of Operational Research. 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. Socio- Economic Planning Sciences. 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. European Journal of Operational Research. 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. Journal of Marketing. 1977;41(1):77-79. https://doi.org/10.2307/1250495
  27. Zhang NJ, Unruh L, Wan TT. Has the medicare prospective payment system led to increased nursing home efficiency? Health Services Research. 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. Journal of the American Medical Directors Association. 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. Medical Care. 2005;43(6):616-626. https://doi.org/10.1097/01.mlr.0000163661.67170.b9
  30. Newhouse JP. Toward a theory of nonprofit institutions: An economic model of a hospital. The American Economic Review. 1970;60(1):64-74.

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