Productivity analysis of regional-level hospital care in the Czech republic and Slovak Republic

Abstract

Background: Providing hospital care is an essential objective of national health policies. The countries that share common history, when they emerged from the same health system and similar conditions in the early 1990s, after the division of Czechoslovakia, became the objects of evaluation of the development of technical efciency of hospital care. The subsequent development of their health care system also was very similar, but no longer entirely identi cal. The article aims to identify the trends and disparities in the productivity of the capacities of hospital care on the regional level (NUTS III.) in the Czech Republic and the Slovak Republic in 2009–2018 before the COVID-19 pandemic using the multi-criteria decision methods.

Methods: The window analysis as a dynamic DEA method based on moving averages and also the Malmquist Index, that allows the evaluation of changes in relative efciency and of changes in the production possibilities frontier have become the key methods for evaluating the over time efciency evolution. To model technical efciency, an output oriented method assuming constant returns to scale was chosen. Aggregated input and output parameters for each region were the object of study.

Results: The results showed that diferences in the efciency trends in terms of the examined parameters among the individual regions are slightly greater in the Czech Republic than in the Slovak Republic. The least efcient regions are those where capital cities are located. Furthermore, the analysis showed that in 2018 all of the Slovak Republic regions improved its productivity compared to 2009 and that technological conditions had a signifcant impact on this improvement. The results of the Czech Republic regions show productivity improvement in 57% of the regions that, on the contrary, was due to changes in technical efciency.

Conclusions: It should be recommended to the state- and regional-level governments to refrain from unilaterally preferring the orientation of public policies on the efciency of the provision of hospital care, and rather focus on increasing the quality and availability of hospital care, especially in smaller, rural, and border regions, in the interest of population safety during pandemics and other emergencies.