Possibilities and factors of measuring and evaluating the efficiency and effectiveness of hospital health care in Germany

Abstract

Subject and objective: The objectives of national and regional health policy are to provide a high-quality health care system and in particular efficient hospital care. However, also due to the responsibility of the respective federal state for hospital care, its respective structure in the 16 federal states in Germany varies considerably from region to region. Therefore, the aim of this dissertation is, at the macro-level, to evaluate the technical efficiency and effectiveness of all 1,534 general hospitals in the 16 federal states for the period 2016–2021, to find out the relationship between the exogenous factors and the efficiency value as well as the influence of the ownership of general hospitals on the technical efficiency. In addition, the aim of this dissertation is to evaluate the technical efficiency and effectiveness at the micro-level of 141 selected individual general hospitals from 2018–2021 and in context of hospital quality, to find out the relationship between patient satisfaction and technical efficiency results. Methods: A multi-stage approach was used. For the first partial aim, three input-oriented Data Envelopment Analysis models (DEA) with constant returns to scale and variable returns to scale were applied for the 6-year period from 2016–2021. The calculations of technical efficiency contain the three components total technical efficiency (TTE), pure technical efficiency (PTE) and scale efficiency (SE). In the second stage, the influence of exogenous variables on the determined technical efficiency was evaluated by applying Tobit regression analysis. For the second partial aim, two input-oriented DEA models with constant and variable returns to scale were applied for the 4-year period from 2018–2021 with the components TTE, PTE and SE. In the second step, the results of the two DEA models were applied to the patient satisfaction scores using the Kendall Tau correlation coefficient to find out a possible correlation. Results: For partial aim one, although the level of average technical efficiency of about 90 % is high, total technical efficiency has deteriorated steadily from 2016–2021. This is notably influenced by the lower results in 2020 and 2021. A Tobit regression analysis showed that only 9.61 % of the change in efficiency values can be explained by the influence of exogenous factors for total technical, 10.83 % for pure technical and 2.43 % for scale efficiency. Only a small negative influence of a non-profit ownership structure on hospital efficiency was confirmed in the analysis of ownership structures. For partial aim two, it was found that the average efficiency scores of small hospitals were in a poor range of 62 %, reaching a low of 51 % in 2020. Large hospitals were in the good range with an average technical efficiency of 86 % and even improved slightly to 88 % in the pandemic year 2020. Using the correlation analysis, it was found that a slight negative correlation can be derived between technical efficiency and patient satisfaction at large hospitals. Conclusions: The results of the analysis of the overall technical efficiency reveal that the aggregated data of all general hospitals of all 16 federal states show a steadily worsening since 2016. For inefficient units and the relevant policy authorities in the hospital sector, it can be recommended in the main result that capital and labor input factors as the number of beds and the number of non-physician and non-nursing staff should be reduced, in order to achieve an improvement of the technical efficiency values on the one hand and not to worsen hospital quality on the other.