Research

12 pages, 825 KiB

Open AccessArticle

Comparing Hospital Efficiency: An Illustrative Study of Knee and Hip Replacement Surgeries in Spain

by Sophie Gorgemans, Micaela Comendeiro-Maaløe, Manuel Ridao-López and Enrique Bernal-Delgado

Int. J. Environ. Res. Public Health 2023, 20(4), 3389; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20043389 - 15 Feb 2023

Viewed by 1175

Abstract

WHO’s Health Systems Performance Assessment framework suggests monitoring a set of dimensions. This study aims to jointly assess productivity and quality using a treatment-based approach, specifically analyzing knee and hip replacement, two prevalent surgical procedures performed with consolidated technology and run in most [...] Read more.

WHO’s Health Systems Performance Assessment framework suggests monitoring a set of dimensions. This study aims to jointly assess productivity and quality using a treatment-based approach, specifically analyzing knee and hip replacement, two prevalent surgical procedures performed with consolidated technology and run in most acute-care hospitals. Focusing on the analysis of these procedures sets out a novel approach providing clues for hospital management improvements, covering an existing gap in the literature. The Malmquist index under the metafrontier context was used to estimate the productivity in both procedures and its decomposition in terms of efficiency, technical and quality change. A multilevel logistic regression was specified to obtain the in-hospital mortality as a quality factor. All Spanish public acute-care hospitals were classified according to their average severity attended, dividing them into three groups. Our study revealed a decrease in productivity mainly due to a decrease in the technological change. Quality change remained constant during the period with highest variations observed between one period to the next according to the hospital classification. The improvement in the technological gap between different levels was due to an improvement in quality. These results provide new insights of operational efficiency after incorporating the quality dimension, specifically highlighting a decreasing operational performance, confirming that the technological heterogeneity is a critical question when measuring hospital performance. Full article

(This article belongs to the Special Issue Environmental and Healthcare Efficiency)

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21 pages, 2167 KiB

Open AccessArticle

Assessing the Impact of Green Transformation on Ecological Well-Being Performance: A Case Study of 78 Cities in Western China

by Chuansheng Wu, Yuyue Li and Lingling Qi

Int. J. Environ. Res. Public Health 2022, 19(18), 11200; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191811200 - 06 Sep 2022

Cited by 5 | Viewed by 1371

Abstract

The contradiction between the endless pursuit of material possessions and finite natural resources hampers ecological well-being performance (EWP) improvement. Green transformation, recognized as an emerging strategy in sustainable development, can help to coordinate ecological, social, and economic growth by optimizing resource usage, with [...] Read more.

The contradiction between the endless pursuit of material possessions and finite natural resources hampers ecological well-being performance (EWP) improvement. Green transformation, recognized as an emerging strategy in sustainable development, can help to coordinate ecological, social, and economic growth by optimizing resource usage, with the ultimate objective of enhancing EWP. This research quantifies how green transformation influences EWP by using panel data from 78 prefecture-level cities in western China from 2012 to 2019. Using the super-SBM and entropy weight models, we assess the EWP and green transformation index (GTI) of 78 prefecture-level cities in western China. On this basis, we quantify the spatial characteristics of EWP by an analysis of the Theil index and spatial autocorrelation. Finally, we examine how GTI affects EWP using the Spatial Durbin model. The results demonstrate that the GTI can raise the EWP of local and nearby cities in western China. According to a GTI analysis of internal indicators, the industrial solid waste usage, harm-less treatment rate of domestic waste, savings level, and R&D expenditure significantly affect EWP. In contrast, the soot emission and consumption levels impede EWP advancement. The analysis of effect decomposition indicates that the sewage treatment rate, expenditure on science and technology, and green patents have a significant spatial spillover effect on the improvement of EWP. Full article

(This article belongs to the Special Issue Environmental and Healthcare Efficiency)

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19 pages, 2061 KiB

Open AccessArticle

A Two-Stage SEM—Artificial Neural Network Analysis of the Rewards Effects on Self Perceived Performance in Healthcare

by Claudiu George Bocean, Cristina Claudia Rotea, Anca Antoaneta Vărzaru, Andra-Nicoleta Ploscaru and Cătălin-Ștefan Rotea

Int. J. Environ. Res. Public Health 2021, 18(23), 12387; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182312387 - 25 Nov 2021

Cited by 2 | Viewed by 2219

Abstract

Healthcare managers consider the rewards and performances of employees as central elements of their activities due to the challenges caused by the phenomenon of healthcare employees’ emigrating to higher-income countries, which has reduced patient satisfaction and led to a negative image of hospitals. [...] Read more.

Healthcare managers consider the rewards and performances of employees as central elements of their activities due to the challenges caused by the phenomenon of healthcare employees’ emigrating to higher-income countries, which has reduced patient satisfaction and led to a negative image of hospitals. In this context, this paper analyzes how employee rewards influence the employees’ self-perceived performances in the hospital units of the emergency medical system in Romania. Using structural equation modeling, we analyzed the relationships between the investigated variables, showing that financial motivation and the recognition of employees’ merits are central to employees’ self-perceived performances. Ensuring equity also has a positive impact on how the reward package is established and managed. While financial rewards are the most important incentives to increase efforts to exhibit higher performances, recognition has a long-term motivational effect. Full article

(This article belongs to the Special Issue Environmental and Healthcare Efficiency)

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26 pages, 2227 KiB

Open AccessArticle

Pathway of Green Development of Yangtze River Economics Belt from the Perspective of Green Technological Innovation and Environmental Regulation

by Tifang Ye, Hao Zheng, Xiangyu Ge and Keling Yang

Int. J. Environ. Res. Public Health 2021, 18(19), 10471; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph181910471 - 05 Oct 2021

Cited by 21 | Viewed by 2051

Abstract

The eco-efficiency of the Yangtze River Economic Belt from 2005 to 2019 has been evaluated by the super-efficiency SBM window model, the results of which are taken as the measurement standard for green development. Next, more attempts have been done to figure out [...] Read more.

The eco-efficiency of the Yangtze River Economic Belt from 2005 to 2019 has been evaluated by the super-efficiency SBM window model, the results of which are taken as the measurement standard for green development. Next, more attempts have been done to figure out the impacts of green technological innovation on the green development in urban clusters of the Yangtze River Economic Belt by a systematic GMM model, further confirming the moderation effect of dual environmental regulations on the relationship between green technological innovation and green development and the heterogeneity in different urban clusters of the Yangtze River Economic Belt. Finally, it is a fact that a cascade has been pointed out in green development of the Yangtze River Economic Zone. With an empirical analysis, it has been found that green technological innovation has a positive moderating effect on green development in the downstream regions, and the relationship between green technological innovation and green development is positively affected by the formal environmental regulations in the overall Yangtze River Economic Zone and the midstream region. Meanwhile, informal environmental regulations play a positive role in moderating the links between green technological innovation and green development in the overall Yangtze River Economic Zone, as well as the upstream, midstream and downstream regions. Based on the conclusions of the research, some policy suggestions of a multi-environmental regulation governance system and regional differentiated environmental regulation are given at last. Full article

(This article belongs to the Special Issue Environmental and Healthcare Efficiency)

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14 pages, 3406 KiB

Open AccessArticle

Greenhouse Gas Emission Inefficiency Spillover Effects in European Countries

by Levent Kutlu and Ran Wang

Int. J. Environ. Res. Public Health 2021, 18(9), 4479; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18094479 - 23 Apr 2021

Cited by 7 | Viewed by 1945

Abstract

In our study, we examine whether spatial spillover effects exist for greenhouse gas emission efficiency for 38 European countries between 2005 and 2014. We find that inefficiencies of other countries would lead to lower efficiency levels for a country. This negative inefficiency spillover [...] Read more.

In our study, we examine whether spatial spillover effects exist for greenhouse gas emission efficiency for 38 European countries between 2005 and 2014. We find that inefficiencies of other countries would lead to lower efficiency levels for a country. This negative inefficiency spillover effect goes down till 2008 then goes up till 2011, then stays relatively stable after 2011. Any strategy to reduce inefficiencies of other countries could potentially improve the efficiency levels. We find that human development index shows significant positive impact on greenhouse gas emission efficiency levels. In particular, one standard deviation increase in human development index would lead to a 11.12 percentage points increase in the greenhouse gas emission efficiencies on average. Different countries show different efficiency levels and efficiency growth patterns over time. However, the pattern of spatial spillover is quite similar among all countries over time. Full article

(This article belongs to the Special Issue Environmental and Healthcare Efficiency)

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17 pages, 1437 KiB

Open AccessArticle

Eco-Efficiency of the English and Welsh Water Companies: A Cross Performance Assessment

by Ramon Sala-Garrido, Manuel Mocholi-Arce, Maria Molinos-Senante, Michail Smyrnakis and Alexandros Maziotis

Int. J. Environ. Res. Public Health 2021, 18(6), 2831; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18062831 - 10 Mar 2021

Cited by 14 | Viewed by 1832

Abstract

Analyzing costs and greenhouse gas (GHG) emissions could be of great importance for the water utilities to supply water services in a healthy and sustainable manner. In this study, we measured the eco-efficiency of several water utilities in England and Wales by incorporating [...] Read more.

Analyzing costs and greenhouse gas (GHG) emissions could be of great importance for the water utilities to supply water services in a healthy and sustainable manner. In this study, we measured the eco-efficiency of several water utilities in England and Wales by incorporating GHG as an undesirable output. For the first time, we evaluated the eco-efficiency of the water production process using robust cross-efficiency data envelopment analysis (DEA) techniques. The further use of clustering and regression techniques allowed us to better understand the drivers of eco-efficiency. The results showed that the mean eco-efficiency of the water sector was 0.748, which indicates that costs and GHG emissions could be reduced by 25.2% to generate the same level of output. Large water companies with high energy costs and levels of GHG emissions belonged to the less eco-efficient group. Environmental factors related to density, topography, and treatment complexity further impacted eco-efficiency. Finally, we linked our results to the regulatory cycle and discuss some policy implications. Full article

(This article belongs to the Special Issue Environmental and Healthcare Efficiency)

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11 pages, 3209 KiB

Open AccessArticle

Greenhouse Gas Emission Efficiencies of World Countries

by Levent Kutlu

Int. J. Environ. Res. Public Health 2020, 17(23), 8771; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17238771 - 25 Nov 2020

Cited by 25 | Viewed by 2901

Abstract

Greenhouse gas emissions have increased rapidly since the industrial revolution. This has led to an unnatural increase in the global surface temperature, and to other changes in our environment. Acknowledging this observation, the United Nations Framework Convention on Climate Change started an international [...] Read more.

Greenhouse gas emissions have increased rapidly since the industrial revolution. This has led to an unnatural increase in the global surface temperature, and to other changes in our environment. Acknowledging this observation, the United Nations Framework Convention on Climate Change started an international environmental treaty. This treaty was extended by Kyoto protocol, which was adopted on 11 December 1997. Using the stochastic frontier analysis, we analyze the efficiencies of countries in terms of achieving the lowest greenhouse gas emission levels per GDP output in the years between 1990–2015. We find that the average greenhouse gas emission efficiencies of world countries for the time periods 1990–1997, 1998–2007, 2008–2012, and 2013–2015 are 82.40%, 90.37%, 89.54%, and 84.81%, respectively. Moreover, compared to the 1990–1997 period, 92.50%, 79.51%, and 59.84% of the countries improved their greenhouse gas emission efficiencies in the 1998–2007, 2008–2012, and 2013–2015 periods, respectively. Hence, the Kyoto protocol helped in increasing greenhouse emission efficiency. However, this efficiency-boosting effect faded away over time. Full article

(This article belongs to the Special Issue Environmental and Healthcare Efficiency)

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12 pages, 339 KiB

Open AccessArticle

Smallholders’ Agricultural Production Efficiency of Conservation Tillage in Jianghan Plain, China—Based on a Three-Stage DEA Model

by Xin Yang and Guangyin Shang

Int. J. Environ. Res. Public Health 2020, 17(20), 7470; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17207470 - 14 Oct 2020

Cited by 14 | Viewed by 1988

Abstract

Based on interviews with 695 smallholders in Jianghan Plain, this paper introduced the three-stage data envelopment analysis (DEA) model to analyze the agricultural production efficiency of conservation tillage adopters and explored the impact of environmental factors on agricultural production efficiency. The empirical results [...] Read more.

Based on interviews with 695 smallholders in Jianghan Plain, this paper introduced the three-stage data envelopment analysis (DEA) model to analyze the agricultural production efficiency of conservation tillage adopters and explored the impact of environmental factors on agricultural production efficiency. The empirical results showed the following (1) Planting area, seed consumption, labor input, pesticide usage, chemical fertilizer usage, agricultural film usage were selected as input indicators, agricultural output was chosen as an output indicator, and the traditional DEA model was used to calculate the production efficiency of smallholders, and the agricultural production efficiency of smallholders was found to be at a low level. In addition, environmental and random factors both have significant impacts on efficiency, so they should be stripped. (2) After excluding environmental factors and random factors, the drop in pure technical efficiency of smallholders in the third stage was higher than the drop in scale efficiency when compared with the first stage. Moreover, the true technical efficiency was the main restricting factor for the agricultural production efficiency. (3) Educational level of smallholders, policy support, and information acquisition were the factors that affect the technical efficiency significantly. Improving the efficiency of agricultural production technology for smallholders requires strengthening rural basic education, improving subsidy policies for conservation agricultural technology, and establishing and improving rural information technology services. Full article

(This article belongs to the Special Issue Environmental and Healthcare Efficiency)

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