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Metafrontier frameworks for studying hospital productivity growth and quality changes.

Objective
The objective of this study was to evaluate productivity growth and quality changes among different levels of accredited hospitals.


Design
This study used an attribute-incorporating Malmquist productivity index (MPI) under the metafrontier framework. This is the first attempt to compare productivity changes among hospitals operating under different production frontiers.


Participants
The data consisted of 20 academic medical centers (AMCs), 61 metropolitan hospitals (MPs) and 112 local community hospitals (LCs) in Taiwan during the period 2007-2010.


Main outcome measures
This study measured productivity growth and further identified technological gaps and catch-ups in different groups of hospitals with respect to the metafrontier. At the same time, comparisons of changes in quality among different levels of hospitals were also examined.


Results
We found that the sample hospitals of AMCs and MPs experienced productivity improvements mainly due to technological progress, but their efficiency and technology gap ratio (TGR) deteriorated. As for LCs, progress in technology along with improvements in their efficiency and TGR led to the highest productivity upgrade among the three groups of hospitals. We also found that the sample hospitals among the three groups showed improvements in quality. Moreover, hospitals in the local community group exhibited greater quality progress than the AMCs and MPs over the sample period.


Conclusion
This paper presents a number of useful decompositions of the metafrontier MPI, which can provide useful insights into changes that are due to efficiency, quality improvements and/or technological changes in the healthcare sector.