title: Impact of the Local Public Hospital Reform on the Efficiency of Medium-Sized Hospitals in Japan: An Improved Slacks-Based Measure Data Envelopment Analysis Approach.
abstract: To assess the change in efficiency and total factor productivity (TFP) of the local public hospitals in Japan after the local public hospital reform launched in late 2007, which was aimed at improving the financial capability and operational efficiency of hospitals.
  
  
  
  Secondary data were collected from the Ministry of Internal Affairs and Communications on 213 eligible medium-sized hospitals, each operating 100-400 beds from FY2006 to FY2011.
  
  
  
  The improved slacks-based measure nonoriented data envelopment analysis models (Quasi-Max SBM nonoriented DEA models) were used to estimate dynamic efficiency score and Malmquist Index.
  
  
  
  The dynamic efficiency measure indicated an efficiency gain in the first several years of the reform and then was followed by a decrease. Malmquist Index analysis showed a significant decline in the TFP between 2006 and 2011. The financial improvement of medium-sized hospitals was not associated with enhancement of efficiency. Hospital efficiency was not significantly different among ownership structure and law-application system groups, but it was significantly affected by hospital location.
  
  
  
  The results indicate a need for region-tailored health care policies and for a more comprehensive reform to overcome the systemic constraints that might contribute to the decline of the TFP.
authors.affiliation: Public Policy Program, National Graduate Institute for Policy Studies, Tokyo, Japan.|Life Science Department, FiNC Inc, Tokyo, Japan.
authors.forename: Xing
authors.initials: X
authors.lastname: Zhang
authors.affiliation: National Graduate Institute for Policy Studies, Tokyo, Japan.|National Dong Hwa University, Hualien County, Taiwan.|Heriot-Watt University, Edinburgh, United Kingdom.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Tone
authors.affiliation: Graduate School of International Corporate Strategy, Hitotsubashi University, Tokyo, Japan.|Corporate Finance Division, The Tokyo Star Bank, Ltd., Tokyo, Japan.
authors.forename: Yingzhe
authors.initials: Y
authors.lastname: Lu
mesh_terms: D017598:Efficiency, Organizational; D018166:Health Care Reform / Q000458:organization & administration* / Q000706:statistics & numerical data; D006276:Health Facility Size / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan; D010067:Ownership / Q000706:statistics & numerical data; D012111:Residence Characteristics / Q000706:statistics & numerical data
keywords: Malmquist Index, Japan; Public hospital; data envelopment analysis; organizational efficiency