آیا تصویب فن آوری جدید باعث افزایش بهره وری تولیدی در بخش دولتی می شود؟سیستم بخشهای مراقبت ویژه

In the last decade, a significant amount of financial resources has been devoted by the Greek Government and the European Union to provide the intensive care units (ICU) of the Greek Public Health Care System with high-tech medical equipment in order to improve their productive efficiency. Using a unique data set, we employ the DEA bootstrap of Simar and Wilson (2007) approach to estimate the efficiency of each ICU and to explore the impact of these investments on their efficiency. Our results indicate that, although the technical efficiency is benefited from the embodiment of new medical technology, the scale efficiency remains unaffected. The role of the asymmetric information, of the ICUs' proximity to pools of knowledge and of the composition of the medical personnel, seems to be the crucial factors for the improvement of their productive efficiency.

Intensive care medicine focuses on the diagnosis and treatment of patients whose life is at a critical stage. Intensive care units (ICUs) were therefore organized with the assumption that critically ill patients require constant attention and often quick responsive action, both of which depend on high technology life support systems and skilled personnel. In order to achieve this, the best option was to keep all critically ill patients together in one ward, close to the most sophisticated equipment and the best qualified staff rather than disperse them in the various wards of the hospital. According to the Universal Medical Device Nomenclature System (UMDNS), the most frequently used equipment in an ICU are infusion pumps, physiologic monitoring systems, ventilators, pumps, eternal feeding, oximeters, pulse defibrillators, sphygmomanometers, electronic electrocardiographs and aspirators blood gas/pH analysers. In the last few years the care of critically ill patients in Greece and intensive care units in particular have become the focus of public health economics, which attribute a large proportion of the increase in health expenditure on their operation and maintenance (ECRI, 2000). As a consequence, the Greek Government exerts pressure on these units to increase their efficiency (Greek Ministry of Health, 2000). A thorough literature review concerning alternative approaches for ICU performance measurement is presented by Dey et al. (2006) and Dervaux et al. (2009). Over the last two decades an excessive demand for ICU services has become noticeable in the Greek Healthcare System, accompanied by public investment aiming to supply ICUs with modern medical equipment. Financial resources were drawn from the second and third European Union Support Frameworks. More specifically, in the context of measure 1.2. “Operational modernization of Hospitals”, of the third European Support Framework, efforts were made for the replacement and upgrading of medical equipment and especially upgrading with high-tech equipment for special health units, like the intensive care and increased care units (Greek Ministry of Health, 2000). The total funds spent under the abovementioned measure were 103.08 M Euros, from which 44.23 M Euros came from the European Social Fund, 25.95 M Euros from the European Regional Development Fund and 33.62 M Euros from the Greek National Resources, and more specifically from the Greek Government’s Public Investment Budget. One of the benefits that were expected from these investments was to reduce the excess demand for ICU services, through the improvement of the ICUs’ productive efficiency (Greek Ministry of Health, 2000). Researchers (Sissouras et al., 1994, Athanassopoulos et al., 1999 and Athanassopoulos and Gounaris, 2001) have argued that the cause of the demand–supply deficit should be explored in the direction of the spatial distribution of ICUs in Greece. More specifically, they argue that (i) the spatial distribution of ICUs does not correspond to the spatial distribution of the demand for ICU services (the abovementioned researchers claim that for consumers not residents of the large Greek cities (Athens, Thessaloniki and Patras), the opportunity cost which is associated to the consumer’s decision to “buy” medical care from a peripheral ICU exceeds the corresponding transportation cost) and (ii) that there exist significant differences in the marginal utilities that the consumers attain from the services of a centrally located ICU in comparison to an ICU that is located peripherally. However, the Greek Administration has explicitly adopted and carried out mainly through policy priorities and interventions, the productive efficiency approach, and a significant amount of financial resources has been allocated to the technological modernization of the ICU system. In light of the above, the main objective of the present paper is to determine the impact of new medical technology on the production efficiency of intensive care units (ICUs) in Greece, and as a consequence, on the reduction of the excess demand for the ICUs’ produced services. Furthermore, we investigate the ICUs’ spatial distribution, age, institutional and organizational (human capital, internal structure) characteristics that may be associated with inefficiency in the use of resources. In doing so, we are able to provide an efficiency ranking, as well as the set of determinants that affect both technical and scale efficiency of the ICU system in Greece, focusing on the role of medical technology. The above information may prove to be valuable for healthcare systems’ policy makers. The paper is organized as follows: In the second section, we present the basic methodological approach used in this study; that is bootstrapped data envelopment analysis (DEA). In the third section, we briefly present the data used as well as the survey procedure we have undertaken. Fourth section includes the estimation results, further empirical elaboration and the discussion of the study’s findings. Finally, the fifth section concludes the paper.

In the present paper, we examined the role of new technology equipment on the productive performance of Greek Intensive Care Units. In the Greek ICU system an excess demand has been observed persistently over the last two decades. Financial sources from public investments and from the second and third European Union Support Frameworks have been allocated to provide Greek ICUs with new technology medical equipment. One of the benefits expected from these investments was to minimize the deficit between demand and supply for ICU services. A cross section data set, for year 2004, has been used in order to estimate technical and scale efficiency for each Greek ICU, taking advantage of techniques which unbar non-parametric techniques from severe restrictions. Subsequently, maximum likelihood estimates that come from a bootstrapped truncated regression examine the influence of a set of environmental variables on the two distinct faces of the productive efficiency of Greek ICUs. New technology medical equipment has been found to affect positively the technical but not the scale efficiency of the Greek ICUs examined in the study. Thus, investing in new technology is not expected to serve, to the full extent, the excess demand for the Greek ICU services. Political factors related mostly with size choices of ICUs, prohibit from the optimizing ICUs’ productive performance. Consequently, new medical technology does not perform the maximum of its potential, with respect to the ICUs productive performance aspects that are exogenously determined. A distinction between technical and scale efficiency of ICUs, regarding the effect of the new technology adoption, raises the role of asymmetric information between local agents, that is ICUs’ everyday management, and central planning authorities, that is the National Ministry of Health. We have to note that this result should to be considered only in quantitative terms, since the effects of new technology equipment on the quality of the produced output are not examined. No significant effects of the investment in medical equipment have been identified on the ICUs’ scale efficiency, which is also a crucial parameter for the determination of their capacity utilization and thus the supply’s magnitude. In addition, we have to take into consideration that the ICUs’ scale efficiency is immediately related to their size and consequently to the total supply of intensive care health services. Finally, policy makers should place effort and resources on employing more nurses for the Greek ICUs, since nursing shortage reduces the marginal product of doctors. Investment in human capital, that is for example training the nurses already employed, is expected to improve the overall technical efficiency of the ICUs. Future research should focus on the qualitative effects of new technology medical equipment on the efficiency of ICUs, mainly through the redefinition of inputs and produced outputs of the ICU system