Accounting for quality in the measurement of hospital performance: evidence from Costa Rica
研究了1997-2001年哥斯达黎加公立医院在改革压力下如何提升效率与质量，发现绩效改善主要源于质量提升，管理合同对小医院效果显著。
This paper provides insights into how Costa Rican public hospitals responded to the pressure for increased efficiency and quality introduced by the reforms carried out over the period 1997-2001. To that purpose we compute a generalized output distance function by means of non-parametric mathematical programming to construct a productivity index, which accounts for productivity changes while controlling for quality of care. Our results show an improvement in hospital performance mainly driven by quality increases. The adoption of management contracts seems to have contributed to such enhancement, more notably for small hospitals. Further, productivity growth is primarily due to technical and scale efficiency change rather than technological change. A number of policy implications are drawn from these results.