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 efficiency of hospital care. The subsequent development of their health care system also was very similar, but no longer entirely identical. 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 efficiency and of changes in the production possibilities frontier have become the key methods for evaluating the over time efficiency evolution. To model technical efficiency, 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 differences in the efficiency 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 efficient 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 significant 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 efficiency. CONCLUSIONS: It should be recommended to the state- and regional-level governments to refrain from unilaterally preferring the orientation of public policies on the efficiency 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.

Department of Public Economics Faculty of Economics VSB Technical University of Ostrava Sokolská třída 33 702 00 Ostrava 1 Czech Republic

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Nemec J, Pavlík M, Malý I, Kotherová Z. Health policy in the Czech Republic: general character and selected interesting aspects. Central European Journal of Public Policy. 2015;9(1):102–125. doi: 10.1515/cejpp-2016-0005. DOI

Ministry of Health of the Czech Republic. Zdraví 2030. Strategický rámec rozvoje péče o zdraví v České republice do roku 2030. 2021. https://www.mzcr.cz/wp-content/uploads/wepub/18700/40551/Zdravi2030_FINAL16122019.pdf.pdf. Accessed 13 February 2021.

Ministry of Finance of the Slovak Republic. Value for Money. 2021. https://www.mfsr.sk/sk/financie/hodnota-za-peniaze/implementacia/. Accessed 13 February 2021.

WHO. Health at a Glance: Europe. 2020. https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-europe_23056088. Accessed 29 January 2021.

OECD. The territorial impact of COVID-19: Managing the crisis across levels of government. 2020. https://read.oecd-ilibrary.org/view/?ref=128_128287-5agkkojaaa&title=The-territorial-impact-of-covid-19-managing-the-crisis-across-levels-of-government. Accessed 10 March 2021.

Vrabková I, Vaňková I. Evaluation models of efficiency and quality of bed care in hospitals. Ostrava: VSB-Technical University Ostrava; 2015.

Gavurová B, Kováč V, Fedačko J. Regional disparities in medical equipment distribution in the Slovak Republic – a platform for a health policy regulatory mechanism. Heal Econ Rev. 2017;7:39. doi: 10.1186/s13561-017-0176-0. PubMed DOI PMC

Sendek S. Efficiency evaluation of hospitals in the environment of the Slovak Republic. Acta Universitatis Agriculturae et Silviculturae Mendelianae Brunensis. 2014;62(4):697–706. doi: 10.11118/actaun201462040697. DOI

Charnes A, Cooper WW, Rhodes E. Measuring the efficiency of decision-making units. Eur J Oper Res. 1978;2(6):429–444. doi: 10.1016/0377-2217(78)90138-8. DOI

Banker RD, Charnes A, Cooper WW. Some models for estimating technical and scale inefficiencies in data envelopment analysis. Manag Sci. 1984;30(9):1078–1092. doi: 10.1287/mnsc.30.9.1078. DOI

Kohl S, Schoenfelder J, Fügener A, et al. The use of data envelopment analysis (DEA) in healthcare with a focus on hospitals. Health Care Management Science. 2019;22:245–286. doi: 10.1007/s10729-018-9436-8. PubMed DOI

Adelman D. An efficient frontier approach to scoring and ranking hospital performance. Oper Res. 2020;68(3):762–779. doi: 10.1287/opre.2019.1972. DOI

An Q, Tao X, Xiong B. Benchmarking with data envelopment analysis: An agency perspective. Omega. 2021;101:102235. doi: 10.1016/j.omega.2020.102235. DOI

Chen Y, Wang J, Zhu J, et al. How the great recession affects performance: a case of Pennsylvania hospitals using DEA. Ann Oper Res. 2019;278:77–99. doi: 10.1007/s10479-017-2516-1. DOI

Li Y, Lei X, Morton A. Performance evaluation of nonhomogeneous hospitals: the case of Hong Kong hospitals. Health Care Management Science. 2019;22:215–228. doi: 10.1007/s10729-018-9433-y. PubMed DOI

Kočišová K, Hass-Symotiuk M, Kludacz-Alessandri M. Use of the DEA method to verify the performance model for hospitals. E & M ekonomie a management. 2018;21(4):125–140. 10.15240/tul/001/2018-4-009.

Štefko R, Gavurová B, Kočišová K. Healthcare efficiency assessment using DEA analysis in the Slovak Republic. Heal Econ Rev. 2018. 10.1186/s13561-018-0191-9. PubMed PMC

Abolghasem S, Toloo M, Amezquita S. Cross-efficiency evaluation in the presence of flexible measures with an application to healthcare systems. Health Care Management Science. 2019;22(3):512–533. doi: 10.1007/s10729-019-09478-0. PubMed DOI

Buljan A, Deskar-Skrbic M, Simovic H. Determinants of public health care, education and administration efficiency in central, eastern and South Eastern Europe. Croatian and Comparative Public Administration. 2019;19(4):537–563.

Kozuń-Cieślak G. Is the efficiency of the healthcare system linked to the country's economic performance? Beveridgeans versus Bismarckians Acta oeconomica. 2020;70(1):1–17. doi: 10.1556/032.2020.00001. DOI

Lee S, Kim C. Estimation of Association between Healthcare System Efficiency and Policy Factors for Public Health. Appl Sci (Basel). 2018;8(12). 10.3390/app8122674.

Dlouhý M, Jablonský J, Zýková P. Analýza obalu dat. Praha: Professional Publishing; 2018.

Ozcan AY. Health care benchmarking and performance evaluation. An assessment using data envelopment analysis. New York: Springer; 2014.

Weng SJ, Blackhurst J, Mackulak G. An extended DEA model for hospital performance evaluation and improvement. Health Services and Outcomes Research Methodology. 2009;9(1):39–53. doi: 10.1007/s10742-008-0042-y. DOI

Flokou A, Aletras V, Niakas D. A window-DEA based efficiency evaluation of the public hospital sector in Greece during the 5-year economic crisis. PLoS One. 2017;12(5):e0177946. doi: 10.1371/journal.pone.0177946. PubMed DOI PMC

Jia T, Yuan H. The application of DEA (data envelopment analysis) window analysis in the assessment of influence on operational efficiencies after the establishment of branched hospitals. BMC Health Serv Res. 2017;17:265. doi: 10.1186/s12913-017-2203-6. PubMed DOI PMC

Fuentes R, Ferrándiz-Gomis R, Fuster-Garcia B. Efficiency of acute public hospitals in the region of Murcia, Spain. J Comp Eff Res. 2019;8(11):929–46. 10.2217/cer-2018-0150. PubMed

Ghahremanloo M et al. A novel DEA model for hospital performance evaluation based on the measurement of efficiency, effectiveness, and productivity. J Eng Manage Prod Serv. 2020;12(1). 10.2478/emj-2020-0001.

Miszczynska K, Miszczyński PM. Measuring the efficiency of the healthcare sector in Poland – a window-DEA evaluation. Int J Product Perform Manag. 2021. 10.1108/IJPPM-06-2020-0276.

IHIS CR. Czech Health Statistics Yearbook. 2009;2021:2021.

NHIC SR. Slovak health statistics yearbook 2009–2018. 2021. http://www.nczisk.sk/en/Publications/Health_Statistics_Yearbooks/Pages/default.aspx. Accessed 5 February 2021.

NHIC SR. Bed fund 2009–2018. 2021. http://www.nczisk.sk/Statisticke_vystupy/Tematicke_statisticke_vystupy/Postelovy_fond/Pages/default.aspx. Accessed 5 February 2021.

IHIS CR. Trends in evolution of health data in the SR and the CR, 1994–2004. 2021.

Ravaghi H, Alidoost S, Mannion R, Bélorgeot DV. Models and methods for determining the optimal number of beds in hospitals and regions: a systematic scoping review. BMC Health Serv Res. 2020. 10.1186/s12913-020-5023-z. PubMed PMC

Vrabková I, Vaňková I. Efficiency of Human Resources in Public Hospitals: An Example from the Czech Republic. Int J Environ Res Public Health. 2021;18(9). 10.3390/ijerph18094711. PubMed PMC

Trebble MT, Heyworth N, Clarke N, Powell T, Hockey MP. Managing hospital doctors and their practice: what can we learn about human resource management from non-healthcare organisations? BMC Health Serv Res. 2014;14:566. doi: 10.1186/s12913-014-0566-5. PubMed DOI PMC

Winkelmann J, Muench U, Maier BC. Time trends in the regional distribution of physicians, nurses and midwifes in Europe. BMC Health Serv Res. 2020;20:937. doi: 10.1186/s12913-020-05760-y. PubMed DOI PMC

Bouckaert N, Van den Heede K, Van de Voorde C. Improving the forecasting of hospital services: a comparison between projections and actual utilization of hospital services. Health Policy. 2018;122(7):728–736. doi: 10.1016/j.healthpol.2018.05.010. PubMed DOI

Paulus F, Kellner J. Využitelnost DEA modelů při hodnocení efektivnosti bezpečnostních složek. Žilina: In 23. mezinárodná vedecká konferencia, Riešenie krizových situacií v špecifickom prostredí. 2018.

Cooper WW, Seiford LM. Tone K data envelopment analysis: a comprehensive text with models, applications, references and DEA-solver software. New York: Springer; 2007.

Zhu J. Quantitative models for performance evaluation and benchmarking. Data envelopment analysis with spreadsheets. 3rd ed. New York: Springer; 2014.

Jablonský J, Dlouhý M. Modely hodnocení efektivnosti a alokace zdrojů. Praha: Professional Publishing; 2015.

Cooper WW, Seiford ML, Zhu J. Handbook on data envelopment analysis. New York: Spinger; 2011.

Ministry of Health of the Czech Republic. Press releases COVID-19. 2021. https://www.mzcr.cz/tiskove-centrum/tiskove-zpravy/. Accessed 20 April 2021.

Ministry of Health of the Slovak Republic. Health status in the regions. 2021. https://www.health.gov.sk/Hladat?q=situ%u00e1cia+v+krajoch. Accessed 20 April 2021.

Mafrolla E, D'Amico E. Patients’ mobility as an indicator for (in)efficiency: a panel data analysis on Italian health care authorities. Health Econ Rev. 2013;3:3. doi: 10.1186/2191-1991-3-3. PubMed DOI PMC

Gutiérrez-Hernández P, Abásolo-Alessón I. The health care sector in the economies of the European Union: an overview using an input–output framework. Cost Eff Resour Alloc. 2021;19:4. doi: 10.1186/s12962-021-00258-8. PubMed DOI PMC

Dooren VW, Bouckaert G, Halligan J. Performance Management in the Public Sector. 2. London: Routlege; 2015.

Martin R, editor. Health economics: concepts, tools and applications. New York: Hayle Medical; 2020.

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