Quality and technical efficiency do not evolve hand in hand in Spanish hospitals: Observational study with...

Area of Science:

• Health Services Research
• Healthcare Management
• Public Health Policy

Background:

• Spanish National Health System (SNHS) hospitals show potential for efficiency and quality enhancement.
• Previous studies have analyzed hospital efficiency and quality separately, not jointly.
• This research addresses the gap by evaluating both dimensions concurrently.

Purpose of the Study:

• To jointly assess technical efficiency (TE) and quality in Spanish public hospitals.
• To classify hospitals based on their combined performance in efficiency and quality.
• To identify optimal performing hospitals within the SNHS.

Main Methods:

• Stochastic frontier analysis (SFA) for TE estimation.
• Multilevel logistic regressions to construct a low-quality (LQ) composite measure, including mortality and safety events.
• Analysis of hospitalizations from 2003 and 2013 across 179 acute-care general hospitals in Spain.

Main Results:

• Median TE improved from 0.89 in 2003 to 0.93 in 2013; LQ decreased from 42.6 to 27.7 per 1,000 patients.
• Technical progress was observed over the study period.
• No significant correlation was found between TE and LQ rates, but complex hospitals showed better joint performance.

Conclusions:

• Both hospital efficiency and quality have improved within the Spanish public healthcare system.
• Improvements in efficiency did not consistently translate to equal improvements in quality across all hospitals.
• Joint analysis effectively identified hospitals excelling in both technical efficiency and quality.