Ekonomická výkonnost nemocnic v ČR

Abstract

The main objective of the master’s thesis is to analyze and compare the economic performance of selected hospitals in the Czech Republic over the period 2018–2024 by estimating efficiency, taking into account their size, specific composition of human resources, and the volume of their main output, and subsequently to describe differences in their efficiency. The analyzed sample consists of 14 hospitals from the reference network of hospitals in the Czech Republic, specifically from the category of university hospitals and large regional hospitals. The thesis is focused on the general question of what economic performance is and how it can be evaluated in practice. The main objective is further elaborated through two partial objectives. The first partial objective is to assess efficiency in relation to the provided healthcare services using non-financial data (technical efficiency), while the second partial objective is to evaluate efficiency by incorporating financial data, i.e., to assess allocative (price) efficiency using an economic model. The Data Envelopment Analysis (DEA) method was employed in combination with window analysis. Two DEA models (M1 and M2) were constructed, with different orientations, each in CCR and BCC variants. To achieve the first partial objective, an output-oriented model M1 was developed, including four input variables (number of acute care beds, number of physicians, number of nurses and midwives, number of other staff) and two output variables (number of hospitalized patients and number of outpatient treatments). The results of the window analysis indicated that the observed hospitals should, on average, increase their outputs by approximately 17.32%. It was also concluded that the hospitals exhibit scale inefficiency. The most significant negative impact on efficiency was identified as the increase in the parameter “number of other staff” (administrative and manual workers). To achieve the second partial objective, model M2 with an input orientation was applied, incorporating financial variables recalculated per bed. There were two input variables (personnel costs and operating costs) and two output variables (revenues from services and other revenues). The window analysis showed that hospitals should be able to reduce their costs per bed by an average of 4.69%. This implies that individual hospitals operated with a high degree of allocative efficiency. Correlation coefficients were calculated, revealing weak relationships between the observed variables and the achieved level of efficiency in model M2, suggesting that efficiency is influenced by a combination of multiple additional factors. For both models M1 and M2, a final ranking of hospitals according to their efficiency scores was established, and the required parameter adjustments were calculated. By synthesizing the results of models M1 and M2, the main objective was achieved, whereby hospitals that reached an optimal level of both technical and allocative efficiency are considered economically efficient. However, it should be noted that efficiency evaluation using DEA has its limitations and represents an estimate of relative (not absolute) efficiency. The calculations were performed using the MS Excel add-in DEA-Solver.