iafor The International Academic Forum

Transcription

1 The Study of Servce Qualy and Costs of Hospals n Socal Secury System n Thaland Nantarat Tangvoontham, Srnakharnwrot Unversy, Thaland Papusson Chawat, Kng Mongkut s The Asan Conference on the Socal Scences 2015 Offcal Conference Proceedngs Abstract Ths research ams to study factors nfluence the medcal servce qualy of hospals n the Socal Secury System. Also, consders the problems and obstacles of the servces. Addonally, cost-effcency analyss s ncluded by usng the quantatve and qualatve analyss. The study found that hospals n the Socal Secury System have hgh servce qualy and can acheve the hgh satsfacton level from nsurers. The study found that the satsfactons on the exstng medcal and healthcare servces are less than the expected level, but more than the mnmum acceptable level. These revealed that the hospals n the Socal Secury System stll have to develop ther servce qualy to meet the nsurers needs. Cost-effcency analyss of the hospals revealed the oppose relatonshp between servce qualy and costs of healthcare. As a result, hospals can reduce costs of management whle provdng better qualy of healthcare servces to the nsurers and ncreasng nsurers satsfactons by obtanng proper medcal servces. Hospal can provde better servces and the nsurer can gan hgher satsfactons when there are an avalably and adequacy of medcal servces, effectvely managng ther costs, and properly allocatng all ther resources. However, some hospals have problems to provde good medcal servces. The major lmaton of the large-szed hospals s budget lmatons whle the medum-szed hospals face the unavalably of the facly. The small-szed hospals have drawback n terms of unavalably of equpment and medcal technology lmatons. Consderng on type of hospal, the major lmatons of publc hospal Keywords: health economcs, servce qualy ndex, hospal s cost effcency analyss afor The Internatonal Academc Forum

2 Introducton Socal Secury Offce (SSO) of Thaland provdes several nsurance servces to assure a mnmum secury to the people. However, some servces such as provdng medcal and health care servces cannot be performed by the SSO self. Therefore, the coordnaton wh hospals s necessary. The SSO has contracts wh several major hospals devoted to provdng medcal servces to more than 10 mllon nsurers. In order to accommodate the ncreasng n the number of nsurers, currently has a total of 243 hospals n the socal secury system natonwde. Inally, these hospals must pass the nspecton requrements such as the servce qualy standards n order to guarantee the servce qualy of the hospals to the nsurers. Therefore, the man objectve of ths research s to study the qualy of servce as well as cause of problems and obstacles of mprovng the servce qualy are ncluded. The analyss of factors affectng the qualy of medcal servces s also examned. Moreover, the study expands the analyss on the ncentve to mprove the servce qualy of the hospal. Certanly, prof s the major ncentve, so rasng ncome and mnmum cost management are the man purposes of the hospals operatons. Analyzng the cost-effectveness of health care facles s ntegrated n order to provde gudelnes for the hospal management plan as well as to contnuously encourage the development of medcal and health care servces qualy whle gan benef from better resource allocaton. Methodology The study separates the analyss nto 2 parts. Frst, the servce qualy and nsurers satsfactons are examned. Second part s the estmaton of the cost effcency of hospals n the Socal Secury System. SERVQUAL To determne servce qualy and satsfacton, the study use SERVQUAL. It s a multple em scale for measurng consumer perceptons of servce qualy. It s an effectve approach has been studed and s role n the analyss of the dfference between customer expectatons and perceptons. The essence of ths tool s to fnd the qualy of products and servces n order to satsfy customers. The SERVQUAL nstrument has been the predomnant method used to measure consumers perceptons of medcal servce qualy n ths study. It has fve generc dmensons or factors, whch are stated as follows. (1) Tangbles: Physcal facles, equpment and appearance of personnel. (2) Relably: Ably to perform the promsed servce dependably and accurately. (3) Responsveness: Wllngness to help patents and provde prompt servce. (4) Assurance (ncludng competence, courtesy, credbly and secury): Knowledge and courtesy of employees and ther ably to nspre trust and confdence. (5) Empathy (ncludng access, communcaton, understandng the customer): Carng and ndvdualzed attenton that the hospal provdes to s patents. The SERVQIAL concept s to use gap analyss. The study determnes the gap between three varables, whch the lowest servce qualy, whch patents can accept

3 (the mnmum acceptable servce: Mnmum), the desred servce qualy (the servce s expected to receve: Expectaton) and the perceved servce qualy (the servce has actually been: Percepton). The servce rato scale s also appled. Servce Qualy of Expectaton (SQE) = Percepton (P) / Expectaton (E). Servce Qualy of Mnmum (SQM) = Percepton (P) / Mnmum (M). Servce Qualy Index (SQI) = SQE * SQM Table 1: Servce qualy analyss SQE<1 SQE=1 SQE>1 SQM<1 SQM=1 SQM>1 2) The percepton s less than the expectaton but equal the mnmum of acceptable level. The nsurers are dssatsfed, but acceptable. 1) The percepton s less than the expectaton and the mnmum of acceptable level. The nsurers are very dssatsfed. 4) The percepton equals the expectaton, but less than the mnmum of acceptable level. The nsurers are dssatsfed, but accept the lmaton of the hospals. 7) The percepton more than the expectaton, but less than the mnmum of acceptable level. The nsurers may be dssatsfed, and do not expect on the servce qualy. 5) The percepton equals the expectaton and the mnmum of acceptable level. The nsurers feel neutral. 8) The percepton more than the expectaton, but equals the mnmum of acceptable level. The nsurers are satsfed 3) The percepton s less than the expectaton but more than the mnmum of acceptable level. The nsurers are dssatsfed, but acceptable. Insurers ask for mprovement. 6) The percepton equal the expectaton, but more than the mnmum of acceptable level. The nsurers are satsfed and do not expect on the servce qualy. 9) The percepton more than the expectaton and the mnmum of acceptable level. The nsurers are very satsfed snce the servce qualy s more than the expectaton. Source: Authors There are 9 crera to analyze the servce qualy. If the results are n 1, 2, 3, 4 and 7 crera, means the nsurers are not satsfed snce the SQI wll be less than 1. Thus, the hospals must mprove the servces n order to ncrease the satsfactons.

4 Cost Effcency To estmate the cost effcency, the Stochastc Fronter Analyss (SFA), ntroduced by Agner, Lovell and Schmdt and Meeusen and van den Broeck, s appled. There are two terms nvolved n the equaton. Frst part s tradonal random error (V ) and another s shows neffcency effects (U ). Thus the hospals costs also wll be away from the boundary as long as they contnue operatng neffcency. In order to determne the cost effcency functon by usng stochastc fronter, ths paper modfes the error term as ( V + U) follows Schmdt, Schmdt and Lovell and Battese and Coell. They defned the cost effcency functon as follows: C = β a + + ( V U The cost neffcency effect, U n the stochastc fronter equaton could be defned as U = ζ b + W Where C = Total cost of hospal at tme t a = Input prce and other explanatory varables at tme t β = Unknown parameters V = Random varables (Independent wh the normal dstrbuton whch assumed to be d N(0, σ 2 ) random errors, and ndependently dstrbuted of the U s) U = Non negatve random varables (Ineffcency effects whch are assumed to be ndependently dstrbuted as truncatons at zero of the normal dstrbuton) b = Specfc cost neffcency varables ζ = Coeffcents of specfc cost neffcency varables W =The random varable follows truncated normal dstrbuton wh mean zero and varance 2 σ U s the cost neffcency, whch conssts of posve departures from the cost fronter. It presents the dstance above the cost fronter. If hospals effectvely managed ther costs, the costs wll be lower and close to the boundary lne. However, the costs of hospals wh neffcent management are hgher and further from the cost fronter. Results The study dvded hospal nto three types whch are 1) small-szed hospals wh less than 100 beds, 2) medum-szed hospal wh beds and 3) large-szed hospals wh 250 beds or more. The populaton s 238 hospals. The study uses quota samplng. The samplng of the large-szed hospals s 67 places, 44 medumszed hospals and 39 small-szed hospals. )

5 SERVEQUAL analyss Table 2: Servce qualy ndex of hospals n Socal Secury System Lst Servce Qualy SERVQUAL Mean Qualy SQE SQM SQI Overall Servce Qualy Hgh Tangbles Hgh Relably Hgh Responsveness Hgh Assurance Hgh Empathy Hgh Source: Authors The servce qualy ndex of hospals n the Socal Secury System s presented n table 2. The results show that the overall medcal servces qualy ndex (SQI) s averagely The value s greater than 1 ndcates that the nsurers access to hgh medcal servce qualy. As well as the mean score of lkert scale s whch are hgher than the mnmum acceptable qualy level (69.50), but below the expected servce qualy level (83.19). Thus, the mean score s consderably hgh. Consderng on each element of SQI, they are found that the ndex remans at a hgh level. The relably s the hghest at Compared wh other elements, the study reveals that the nsurers have the most confdence n the consstence of hospal (Relably), followed by staff compasson (Empathy), doctors and nurses knowledge (Assurance), staff s wllngness to serve (Responsveness), and physcal attrbutes (Tangble), respectvely. The study of hospals servce qualy evaluaton found that there are 9.82 percent of hospals (16 hospals), whch ther nsurers feel that the qualy of health care facles s good. The nsurers have hgh satsfactons. The hospals medcal and health care servces are above the expectaton. The nsurers of percent or 81 hospals have medum level of satsfacton snce the perceved servce qualy s below ther expectaton even they agree that the servce qualy s good. A percent of hospals (44 hospals), where nsurers stll do not feel satsfed, snce the servce qualy s too dfference from ther expectatons. However, they agree that the qualy s stll acceptable. There s percent (22 hospals), where receves dssatsfed because the level of qualy s lower than the mnmum acceptable level. Thus, the hospals n ths group should urgently mprove ther servce qualy. The characters of nsurers are also nfluent the satsfacton level. The study states female feels that the medcal and health care servce qualy, whch one receved, are not dfference to the expectaton more than male; especally, the empathy element. One reason supports ths evdence s most of the staffs n the hospal are female. Indeed, a gender ssue has mpact on the coordnaton and understandng between the servce provders and the recpents. Addonally, the research ndcates that the attudes on servce qualy are better n the elderly group. The elderly has more

6 patents and understands the lmatons and obstacles of provdng health care servces more than the young. Insurers who are under socal secury system less than 1 year have hgh expectatons due to less experence. The longer they stay n the system, the less expectaton on servce qualy. However, the one, who s n the system for a long tme, has more understandng on the hospals management and always has more relably on the hospals. The nsurers, who have chronc dsease, agree that the hospals provde hgh servce qualy; n partcularly, they well perceve on empathy element. The study found that the score of perceved servce qualy almost reaches the expectaton level. The frequency and number of vss also mpact the dfference between perceved and expected qualy. Insurers, who vs once n a whle, trend to have hgher expectaton and slghtly less perceved of the qualy whle the one, who often vss, has hgher perceved servce qualy. Total Cost and cost effcency estmaton The study uses panel data of hospals n the socal secury system from year 2009 to year The ndependent varables are 1) Servce Qualy Index (SQI) whch s the results from the frst part, 2) wage per staff of the hospals, 3) nvestment expenses per nsurer whch compute from deprecaton per year of the hospals. Ths varable reflects the nvestment n capal goods such as nfrastructure, buldngs, facles, techncal equpment, and other medcal equpment. 4) Servce expenses per nsurer. The total cost (C ) and the cost effcency functon (SFC ) are presented as follows: where C SFC SQI PL EK ES C = f SFC = ( SQI, PL, EK, ES ) f ( SQI, PL, EK, ES = Cost of hospal = Stochastc fronter of hospals cost = Servce Qualy Index of hospal = wage per staff of hospal = nvestment expenses per nsurer of hospal = servce expenses per nsurer of hospal ) The equatons of cost functon and stochastc fronter functon are presented as follows. Cost functon: lnc = α0 + α1 lnsqi + α 2 ln PL + α3 ln EK + α 4 ln ES + e Stochastc fronter functon (Cost effcency): lnsfc = α 0 + α1 lnsqi + α2 lnpl + α3 lnek + α4 lnes + ( V + U) Table 3: The estmaton of cost functon and stochastc fronter of the hospals n Socal Secury System

7 Ordnary Least Square Stochastc Fronter Analyss Varable Coeffcent SD. Coeffcent SD. (Constant) *** *** lnsqi *** lnpl *** *** lnek *** *** lnes *** *** R-Square Adjusted R-Square Log lkelhood functon LR test of the one-sded error Source: Estmated by Authors Table 3 shows the health care s cost estmaton of hospals n the socal secury system by usng Ordnary Least Square (OLS). The results reveal that most of the man varables are statstcally sgnfcant. The cost estmaton states that the R- squared s The servce costs per nsurer such as secury provson, cleanlness expenses, meals and drnks expenses have the posve mpacts on the cost of hospals. Also, has the most effects on the total cost wh the coeffcent of Wage has posve effects on the total cost as well. If servce costs and wages ncrease, the total cost wll ncrease. However, the costs of capal per nsurer are related n the oppose drecton wh the total cost. The capal costs reflect the nvestment of the hospal. The ncrease of nvestment results n a decrease n total costs. Lke capal costs, the SQI has negatve nfluence to the cost, but not sgnfcant. Ths study uses Stochastc Fronter Analyss (SFA) to estmates the cost effcency of health care provson of hospals n the socal secury system. The results ndcate that all varables are statstcally sgnfcant as expected, wh the log lkelhood of , whch s consderably hgh. All expenses such as wages, nvestment, and servce expenses have posve mpacts to the cost effcency. The SQI has the oppose drecton to the cost fronter. Ths s n lne wh the estmaton of the OLS estmaton. When wages ncrease, costs wll rse. When nvestng n medcal care and health care capal rse, wll result ncreasng n cost effcency as well as the servce costs. The target varable s SQI. SQI has a coeffcent of When the nsurers are satsfed, SQI ncreases, but wll reduce the total cost of healthcare. Ths reveals that when hospals can provde better servces to the nsurer whle decreasng the total cost of medcal servces. If the nsurer can be satsfed, can reduce costs by about 2.5 tmes. Thus, the spendng n other categores drves to the hgher costs. However, spendng on mprovng servce qualy and satsfacton generates awareness of the nsurer and reduces the overall costs. In other words, managng to the cost effcency wll be able to satsfy the patent and can lead to medcal servce provson at the lowest cost and better resource allocaton.

8 Concluson The hospals n Socal Secury System must pass the servce qualy nspecton n order to guarantee the servce qualy of the hospals to the nsurers. Therefore, the man objectve of ths research s to study the qualy of servce. The analyss of factors affectng the qualy of medcal servces s also examned. Analyzng the costeffectveness of health care facles s ntegrated n order to provde gudelnes for the hospal management plan as well as to contnuously encourage the development of medcal and health care servces qualy whle gan benef from better resource allocaton. The study dvded hospal nto three types whch are 1) small-szed hospals wh less than 100 beds, 2) medum-szed hospal wh beds and 3) large-szed hospals wh 250 beds or more. The populaton s 238 hospals. The study uses quota samplng. The samplng of the large-szed hospals s 67 places, 44 medumszed hospals and 39 small-szed hospals. The results of servce qualy reveal that the nsurers access to hgh medcal servce qualy. The study found that the ndex remans at a hgh level. The relably s the hghest followed by empathy, assurance, responsveness, and tangble, respectvely. Moreover, the results state that most of the nsurers satsfy and thnk that the servce qualy of the hospals s acceptable. Only percent receves dssatsfed because the level of qualy s lower than the mnmum acceptable level. Addonally, the characters of nsurers such as gender, age, the frequency of vss, and the length of stayng n the system are also nfluent the satsfacton level. The cost effcency analyss uses panel data of hospals n the socal secury system from year 2009 to year The estmaton shows the wage and servce costs per nsurer such as secury provson, cleanlness expenses, meals and drnks expenses have the posve mpacts on the cost of hospals. However, the costs of capal per nsurer are related n the oppose drecton wh the total cost. The Stochastc Fronter Analyss of the cost effcency of health care provson ndcates that all varables are statstcally sgnfcant as expected, wh the log lkelhood of All expenses such as wages, nvestment, and servce expenses have posve mpacts to the cost effcency. The SQI has the oppose drecton to the cost fronter. Ths reveals that when hospals can provde better servces to the nsurer whle decreasng the total cost of medcal servces. If the nsurer can be satsfed, can reduce costs by about 2.5 tmes. Thus, managng to the cost effcency wll be able to satsfy the patent and can lead to medcal servce provson at the lowest cost and better resource allocaton.

9 References Agner, D.J. and Chu, S.F. (1968). On estmatng the ndustry producton functon. Amercan Economc Revew 58: Agner, D.J, Lovell, C.A.K. and Schmdt, P.J. (1977). Formulaton and estmaton of stochastc fronter producton functon models. Journal Econometrcs 6: Afrat, S.N. (1972). Effcency estmaton of producton functon. Internatonal Economc Revew. 13: Battese G.E. and Coell T.J. (1993) A Stochastc Fronter Producton Functon Incorporatng a Model for Techncal neffcency effects, Department of Econometrcs, Unversy of New England, Armdale, NSW, September. Bell, L. (2004). Developng servce qualy n mental health servces. Internatonal Journal of Health Care Qualy Assurance. 17(7): Boyer, L., Franc os, P., Doutre, E., Wel, G. and Labarere, J. (2006). Percepton and use of the results of patent satsfacton surveys by care provders n a French teachng hospal. Internatonal Journal for Qualy n Health Care. 18(5): Clemes, M.D., Ozanne, L.K. and Laurensen, W.L. (2001). Patents perceptons of servce qualy dmensons: an emprcal examnaton of health care n New Zealand. Health Marketng Quarterly. 19(1): Cronn, J.J.J., Brady, M.K. and Hult, G.T.M. (2000). Assessng the effects of qualy, value, andcustomer satsfacton on consumer behavoral ntentons n servce envronments. Journal of Retalng. 76(2): Crowe, R., Gage, H., Hampson, S., Hart, J., Kmber, A., Storey, L. and Thomas, H. (2002). The measurement of satsfacton wh healthcare: mplcatons for practce from a systematc revew of the lerature. Health Technology Assessment. 6(32): Donabedan, A. (1980). The defnon of qualy and approaches to s assessment. Exploratons n Qualy Assessment and Monorng. NO.1, Health Admnstraton Press, Ann Arbor, MI. Farrel, M.J. (1957). The measurement of a productve effcency. Journal of the Royal Statstcal Socety, Seres A. General 120. No. 3: Glbert, G.R. and Veloutsou, C. (2006). A cross-ndustry comparson of customer satsfacton. The Journal of Servces Marketng. 20(5): Gonzalez, N., Quntana, J.M., Blbao, A., Escobar, A., Azpuru, F., Thompson, A., Esteban, C., Sebastan, J.A.S. and de la Serra, E. (2005). Development and valdaton of an n-patent satsfacton questonnare. Internatonal Journal for Qualy n Health Care. 17(6):

10 Hawthorne, G. (2006). Revew of Patent Satsfacton Measures. Australan Government Department of Health and Ageng. Canberra. Hedegger, T., Saal, D. and Nueblng, M. (2006). Patent satsfacton wh anaesthesa care: what s patent satsfacton, how should be measured, and what s the evdence for assurng hgh patent satsfacton. Best Practce and Research Clncal Anaesthesology. 20(2): Hll, N. and Alexander, J. (1997). Handbook of Customer Satseacton and Loyalty Measurement. 2 nd ed. Hampshne:Gower Publshng Lmed. Hood, C. (1995). The new publc management n the 1980s: varatons on a theme. Journal of Accountng, Organzatons and Socety. 20(2/3): Kenagy, J.W., Berwck, D.M. and Shore, M.F. (1999). Servce qualy n health care. Journal of the Amercan Medcal Assocaton. 281(7): Kotler, P. (1998). Marketng Management. 11 th ed. Upper Saddle Rver, NL:Pactce Hall. Lnder-Pelz, S. (1982). Toward a theory of patent satsfacton. Socal Scence & Medcne. 16(5): Matzler, K. and Herhuber, H. (1998). How to make Product Development Projects More Sucessful by ntegrstng Kano s Model of Customer Satsfacton nto Qualy Functon Development. Technovaton. 18, 1: Meeusen, W. and Broeck, J. (1977). Effcency estmaton from Cobb-Douglas producton functons wh composed error. Internatonal Economc Revew. 18(2): O Connor, S.J. and Shewchuk, R. (2003). Commentary patent satsfacton: what s the pont? Health Care Management Revew. 28(1): Pascoe, G.C. (1983). Patent satsfacton n prmary health care: a lerature revew and analyss. Evaluaton and Program Plannng. 6(3-4): Schmdt, P. (1976). Econometrcs. New York: Marccll Dekker. Schmdt P. and Lovell C.A.K. (1979). Estmatng techncal and allocatve neffcency relatve to stochastc producton and cost fronters. Journal of Econometrcs 9: Strasser, S., Aharony, L. and Greenberger, D. (1993). The patent satsfacton process: movng toward a comprehensve model. Medcal Care Revew. 50(2): Urden, K.D Patent satsfacton measurement: current ssues and mplcatons. Outcomes Management. 6(6):

11 Ware, J.E., Snyder, M.K., Wrght, W.R. and Daves, A.R. (1983). Defnng and measurng patentsatsfacton wh medcal care. Evaluaton and Program Plannng. 6(3-4): Wllams, B. (1994). Patent satsfacton: a vald concept? Socal Scence & Medcne. 38(4): Contact emal: nantarat.tang@gmal.com Contact emal: ntploy@yahoo.com