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- Assessing the efficiency of mother-to-child HIV prevention in low- and middle-income countries using data envelopment analysisPublication . Santos, Sérgio Pereira dos; Amado, Carla; Santos, MauroAIDS is one of the most significant health care problems worldwide. Due to the difficulty and costs involved in treating HIV, preventing infection is of paramount importance in controlling the AIDS epidemic. The main purpose of this paper is to explore the potential of using Data Envelopment Analysis (DEA) to establish international comparisons on the efficiency of implementation of HIV prevention programmes. To do this we use data from 52 low- and middle-income countries regarding the prevention of mother-to-child transmission of HIV. Our results indicate that there is a remarkable variation in the efficiency of prevention services across nations, suggesting that a better use of resources could lead to more and improved services, and ultimately, prevent the infection of thousands of children. These results also demonstrate the potential strategic role of DEA for the efficient and effective planning of scarce resources to fight the epidemic.
- Formative evaluation of electricity distribution utilities using data envelopment analysisPublication . Santos, Sérgio Pereira dos; Amado, Carla; Rosado, JoaquimThe use of Data Envelopment Analysis (DEA) in the electricity distribution sector has been prolific in the number of papers published in research journals. However, while numerous studies have been documented, they have mostly been summative. Their aim has been predominantly descriptive and classificatory. This paper argues that evaluations of a formative nature are more effective than summative studies in promoting a better understanding of the structures and processes of electricity distribution utilities and, consequently, are more appropriate to contribute to performance improvement. To illustrate the use of DEA for formative evaluation, and highlight some of the difficulties of using DEA in practice, this paper compares the cost-efficiency of the Portuguese electricity distribution companies from 2002 to 2006. A dynamic analysis using Malmquist Indices is also conducted in order to evaluate the changes in productivity over this period. Our analysis shows that the application of DEA for formative purposes meets some difficulties. In particular it shows that while the modelling of productivity/efficiency scores using DEA is relatively straightforward, it is comparatively more difficult to develop models that are economically valid and that produce results with face validity. On the basis of the insights derived from this analysis, the paper provides some recommendations regarding the successful application of DEA for performance improvement.
- Using data envelopment analysis for formative evaluation of radiotherapy services: an exploratory studyPublication . Santos, Sérgio Pereira dos; Amado, Carla; Tànfani, E.; Testi, A.Radiotherapy is an important element in cancer treatment, both for cure and for palliation. Whilst performance measurement and performance improvement are major concerns of most radiotherapy departments, measuring and managing the performance of these departments is particularly challenging. This article critically explores the use of Data Envelopment Analysis (DEA) for formative evaluation of radiotherapy services. Following a review of the literature, a conceptual framework for performance assessment of radiotherapy departments is developed and its use illustrated. Our empirical analysis uses mostly data from 2007 and compares the fairness of access to services, technical efficiency, and clinical effectiveness across the English strategic health authorities. The analysis shows that whilst the application of DEA in this context meets some difficulties, it also has great potential by providing valuable information to improve services, especially if used in a formative mode.
- Measuring active ageing: a Data Envelopment Analysis approachPublication . Amado, Carla; São José, José; Santos, Sérgio Pereira dosThe 'Active Ageing Index' was created with the purpose of helping policy makers implement and monitor active ageing policies both at European and national levels. However, this index has not fully achieved this purpose. In this article we propose a methodological approach based on Data Envelopment Analysis to enhance the measurement of active ageing in the European Union countries. We use a model with 22 indicators grouped into four domains. By introducing different types of virtual weight restrictions, we combine normative judgements with an optimisation procedure, showing each country in the best possible light. Furthermore, we undertake a sensitivity analysis regarding the effect of varying the limits of the relative contribution of each domain.The results show that the proposed approach has great potential in this context, allowing the comparison of countries and the identification of relevant targets and benchmarks, even when there is uncertainty regarding the relative importance of the indicators and domains considered. For most countries, the results are robust regarding different levels of flexibility for the relative contribution of each domain. We identify six countries that represent relevant benchmarks for the underperforming countries. The underperforming countries have some potential for improvement in terms of active ageing, whilst respecting their preferences and specificities for the processes that can be used to actively age. Based on a flexible evaluation of the countries, we contribute to develop a better tool to guide the European Union countries towards the formulation and monitoring of more effective policy measures to promote active ageing. (C) 2016 Elsevier B.V. All rights reserved.
- Integrating the data envelopment analysis and the balanced scorecard approaches for enhanced performance assessmentPublication . Amado, Carla; Santos, Sérgio Pereira dos; Marques, P.This article presents the development of a conceptual framework which aims to assess Decision Making Units (DMUs)from multiple perspectives. The proposed conceptual framework combines the Balanced Scorecard(BSC)method with the non-parametric technique known as Data Envelopment Analysis (DEA) by using various interconnected models which try to encapsulate four perspectives of performance (financial, customers, internal processes,learning and growth). The practical relevance of the conceptual model has been tested by using it to assess the performance of DMUs in a multinational company which operates in two business areas.Various models were developed with the collaboration of the directors of the company in order to conceive an appropriate and consensual framework, which may provide useful information for the company.The application of the conceptual framework provides structured information regarding the performance of each DMU(from multiple perspectives)and ways to improve it.By integrating the BSC and the DEA approaches this research helps to identify where there is room for improving organisational performance and points out opportunities for reciprocal learning between DMUs.In doing so,this article provides a set of recommendations relating to the successful application of DEA and its integration with the BSC,in order to promote a continuous learning process and to bring about improvements in performance.
- On the need for reform of the portuguese judicial system - does data envelopment analysis assessment support it?Publication . Santos, Sérgio Pereira dos; Amado, CarlaThe Portuguese judicial system has attracted considerable criticism in recent years and demands for reforms have gained prominence. By using the Data Envelopment Analysis technique and focusing on the performance of 223 Portuguese first instance courts during the period of 2007 to 2011, this research has found evidence that supports some of this criticism and justifies the calls for reforms, better performance and accountability of the judicial system. In particular, our results found a sector with considerable scope for improvement with less than 16 percent of the 223 courts analysed making an efficient use of their resources in each year and with only one third of the courts being considered efficient in at least one of the five years assessed. Whilst the results suggest that improvement can be achieved with better case management, scale factors also seem to play an important role in explaining inefficiency, with most of the inefficient courts being smaller than optimal and with smaller courts being, on average, less efficient than larger ones. The existence of a statistically significant relationship between courts’ efficiency and size was confirmed by the Mann-Whitney test. These results indicate considerable scope for improvement and that some of the planned reforms are timely and seem well targeted. However, the results also suggest that efficiency increases matching peers’ best practices are not enough to sustainably reduce the prevailing judicial backlog and length of court proceedings in a considerable number of courts. Major changes in the capacity and/or functioning of the Portuguese judicial system might also be required.
- Um estudo exploratório sobre o potencial do Data Envelopment Analysis para avaliar a equidade de acesso em cuidados de saúde primáriosPublication . Ribeiro, A. R. F.; Amado, Carla; Santos, Sérgio Pereira dosThis article focuses on the assessment of equity of access to primary health care in Portugal and has three specific objectives: (1) to present a conceptual model for performance evaluation in primary health care, (2) to evaluate the equity of access in a sample of Portuguese health centers groupings (ACES), (3) to analyze the relationship between the level of equity of access and other variables theoretically related to equity of access in primary care. We use the technique Data Envelopment Analysis to compare equity of access. The level of equity of access across the ACES compared varies between 56% and 100% with an average of 82%. Seven ACES (17% of the total) have a relative level of 100% of equity of access. These results suggest that the geographical distribution of human resources in the ACES compared could be improved in order to meet the satisfaction of the local health needs in each ACES. Based on correlation analysis, it was concluded that the relative level of equity of access is positively correlated with the rate of use of hospital emergency rooms, suggesting effects of transferring demand from health centers to hospitals.
- Exploring the potential of Data Envelopment Analysis for performance-related-pay in health care provisionPublication . Kalinichenko, Olena; Amado, Carla; Santos, Sérgio Pereira dosIn this paper we explore the potential use of Data Envelopment Analysis (DEA) for enhancing pay-for-performance (P4P) in health care provision. Firstly, based on the literature review, we reflect on the state of the art in the P4P design, focusing on some of the controversial issues in the literature and discussing the potential contribution of DEA to addressing these issues. Secondly, we analyse the P4P programme applied to Portuguese Family Health Units (FHUs) to conclude about the possible use of DEA for its improvement.
- Performance assessment in primary health care: a systematic review of the literature and a new research agendaPublication . Kalinichenko, Olena; Amado, Carla; Santos, Sérgio Pereira dosThe aim of this research is to carry out a systematic review of the studies devoted to the performance assessment of primary health care providers. Focusing on the peculiarities of performance evaluation in the public sector, we examine performance measurement categories, dimensions and techniques in order to provide a holistic picture of the main developments and opportunities in the referred domain and to identify future research directions.
- Ageism in health care: A systematic review of operational definitions and inductive conceptualizationsPublication . São José, José; Amado, Carla; Ilinca, Stefania; Buttigieg, Sandra Catherine; Larsson, Annika TaghizadehPurpose International and national bodies have identified tackling ageism in health care as an urgent goal. However, health professionals, researchers, and policy makers recognize that it is not easy to identity and fight ageism in practice, as the identification of multiple manifestations of ageism is dependent on the way it is defined and operationalized. This article reports on a systematic review of the operational definitions and inductive conceptualizations of ageism in the context of health care. Design and Methods We reviewed scientific articles published from January 1995 to June 2015 and indexed in the electronic databases Web of Science, PubMed, and Cochrane. Electronic searches were complemented with visual scanning of reference lists and hand searching of leading journals in the field of ageing and social gerontology. Results The review reveals that the predominant forms of operationalization and inductive conceptualization of ageism in the context of health care have neglected some components of ageism, namely the self-directed and implicit components. Furthermore, the instruments used to measure ageism in health care have as targets older people in general, not older patients in particular. Implications The results have important implications for the advancement of research on this topic, as well as for the development of interventions to fight ageism in practice. There is a need to take into account underexplored forms of operationalization and inductive conceptualizations of ageism, such as self-directed ageism and implicit ageism. In addition, ageism in health care should be measured by using context-specific instruments.