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Diabetes prevalence is rising globally, especially in low- and middle-income countries like Mexico, posing challenges for healthcare systems that require efficient primary care to manage the disease. However, healthcare efficiency is influenced by factors beyond decision-makers, including socioeconomic and political conditions. This study aims to evaluate the technical efficiency of primary healthcare for diabetes patients in Mexico over a 12-year period and explore the impact of contextual variables on efficiency. A longitudinal analysis was conducted using administrative and socio-demographic data from 242 health jurisdictions between 2009 and 2020. Data envelopment analysis with bootstrapping and output orientation was used to measure the technical efficiency; health resources in infrastructure and human resources were used as inputs. As outcome, the number of patients receiving treatment for diabetes and the number of patients with controlled diabetes were considered. Machine learning algorithms were employed to analyse multiple factors affecting the provision of diabetes health services and assess heterogeneity and trends in efficiency across different health jurisdictions. The average technical efficiency in primary healthcare for diabetes patients was 0.44 (CI: 0.41-0.46) in 2009, reaching a peak of 0.71 (CI: 0.69-0.72) in 2016, and moderately declining to 0.60 (CI: 0.57-0.62) in 2020; these differences were statistically significant. The random forest analysis identified the marginalization index, primary healthcare coverage, proportion of indigenous population and demand for health services as the most influential variables in predicting efficiency levels. This research underscores the crucial need for the formulation of targeted public policies aimed at extending the scope of primary healthcare services, with a particular focus on addressing the unique challenges faced by marginalized and indigenous populations. According to our results, it is necessary that medical care management adjust to the specific demands and needs of these populations to guarantee equitable care in Mexico.

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ABSTRACT: Based on the goal of income increasing, this research uses the DEA-BCC model under the input and the output orientation to estimate the differences and changes in the technical efficiency of wheat production by farmers of different scales based on the survey data of 1669 farmers' wheat production from China's main wheat-producing regions. Results showed that there are significant differences in the technical efficiency of farmer's wheat production and the optimal scale of efficiency under the input and the output orientation. The relationship between farmers' planting scale and efficiency is characterized by U-shaped curves and inverted U-shaped curves respectively. The wheat production technical efficiency of farmers in most major grain production areas is in a DEA ineffective state, and agricultural technical efficiency needs to be improved.

RESUMO: Com base no objetivo de aumentar a renda, esta pesquisa utiliza o modelo DEA-BCC sob a orientação input e output para estimar as diferenças e mudanças na eficiência técnica da produção de trigo por agricultores de diferentes escalas, com base nos dados do levantamento da produção de trigo de 1669 de agricultores das principais regiões produtoras de trigo da China. Os resultados mostram que existem diferenças significativas na eficiência técnica da produção de trigo do agricultor e na escala ótima de eficiência sob a orientação de insumo e saída. A relação entre escala de plantio e eficiência dos agricultores é caracterizada por curvas em U e curvas em U invertidas respectivamente. A eficiência técnica da produção de trigo dos agricultores na maioria das principais áreas de produção de grãos está em um estado ineficaz DEA, e a eficiência técnica agrícola precisa ser melhorada.

RESUMO

Based on the goal of income increasing, this research uses the DEA-BCC model under the input and the output orientation to estimate the differences and changes in the technical efficiency of wheat production by farmers of different scales based on the survey data of 1669 farmers' wheat production from China's main wheat-producing regions. Results showed that there are significant differences in the technical efficiency of farmer's wheat production and the optimal scale of efficiency under the input and the output orientation. The relationship between farmers' planting scale and efficiency is characterized by U-shaped curves and inverted U-shaped curves respectively. The wheat production technical efficiency of farmers in most major grain production areas is in a DEA ineffective state, and agricultural technical efficiency needs to be improved.

Com base no objetivo de aumentar a renda, esta pesquisa utiliza o modelo DEA-BCC sob a orientação input e output para estimar as diferenças e mudanças na eficiência técnica da produção de trigo por agricultores de diferentes escalas, com base nos dados do levantamento da produção de trigo de 1669 de agricultores das principais regiões produtoras de trigo da China. Os resultados mostram que existem diferenças significativas na eficiência técnica da produção de trigo do agricultor e na escala ótima de eficiência sob a orientação de insumo e saída. A relação entre escala de plantio e eficiência dos agricultores é caracterizada por curvas em U e curvas em U invertidas respectivamente. A eficiência técnica da produção de trigo dos agricultores na maioria das principais áreas de produção de grãos está em um estado ineficaz DEA, e a eficiência técnica agrícola precisa ser melhorada.

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This research analyzed the efficiency situation of corn farms operating in the Adana province of Turkey. In this context, required farm management data were collected from 111 corn farmers by using face to face survey method during the 2019-2020 cultivation season. To determine the technical efficiency (TE) levels of corn farms, Data Envelopment Analysis (DEA) was applied. Furthermore, factors that cause the inefficiency in corn farms were detected by using the Tobit regression model. According to research results, the average TE levels of corn farms in the research area under the variable return to scale conditions are reported as 0.887 (111 farms). These results suggested that if farms reduced their input use by 11.3% on average, they can achieve the same output level and be able to reach full technical efficiency. The most ineffective source in terms of farms performance is machine expenditures with 68.2% of excessive use followed by labor use. In this regard, mechanization modernization, education and training of the labor force and more sensitive fertilizers and pesticide use can increase the efficiency of corn farms. Results of the Tobit regression model indicated that factors such as experience, education, number of tractors and size of the irrigated area positively influenced the TE, whereas family size in corn farming has a negative effect.

Esta pesquisa tem como objetivo analisar a situação de eficiência das fazendas de milho operando na província de Adana, na Turquia. Neste contexto, os dados necessários de gestão da fazenda foram coletados de 111 produtores de milho usando o método de pesquisa frente a frente durante a temporada de cultivo de 2019-2020. Para determinar os níveis de eficiência técnica (TE) das fazendas de milho, foi aplicada a Análise Envoltória de Dados (DEA). Além disso, os fatores que causam a ineficiência nas fazendas de milho foram detectados por meio do modelo de regressão Tobit. De acordo com os resultados da pesquisa, os níveis médios de TE das fazendas de milho na área de pesquisa sob as condições de retorno variável à escala são encontrados em 0,887 (111 fazendas). Esses resultados sugerem que, se as fazendas reduzirem o uso de insumos em 11,3% em média, podem atingir o mesmo nível de produção e alcançar eficiência técnica plena. A fonte mais ineficaz em termos de desempenho das fazendas são os gastos com máquinas, com 68,2% do uso excedente continuado com o uso de mão de obra. Nesse sentido, a mecanização, a modernização, a educação e o treinamento da força de trabalho e o uso de fertilizantes e pesticidas mais sensíveis podem ser sugeridos para aumentar a eficiência das fazendas de milho. Os resultados do modelo de regressão Tobit indicam que fatores como experiência, escolaridade, número de tratores e tamanho da área irrigada influenciaram positivamente no TE, enquanto o tamanho da família na cultura do milho tem efeito negativo.

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Few studies have assessed the efficiency and quality of HIV services in low-resource settings or considered the factors that determine both performance dimensions. To provide insights on the performance of outpatient HIV prevention units, we used benchmarking methods to identify best-practices in terms of technical efficiency and process quality and uncover management practices with the potential to improve efficiency and quality. We used data collected in 338 facilities in Kenya, Nigeria, Rwanda, South Africa, and Zambia. Data envelopment analysis (DEA) was used to estimate technical efficiency. Process quality was estimated using data from medical vignettes. We mapped the relationship between efficiency and quality scores and studied the managerial determinants of best performance in terms of both efficiency and quality. We also explored the relationship between management factors and efficiency and quality independently. We found levels of both technical efficiency and process quality to be low, though there was substantial variation across countries. One third of facilities were mapped in the best-performing group with above-median efficiency and above-median quality. Several management practices were associated with best performance in terms of both efficiency and quality. When considering efficiency and quality independently, the patterns of associations between management practices and the two performance dimensions were not necessarily the same. One management characteristic was associated with best performance in terms of efficiency and quality and also positively associated with efficiency and quality independently: number of supervision visits to HIV units.

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This study aims to evaluate the level of technical efficiency of companies that perform the integrated management of basic sanitation in Brazilian municipalities. A Multiple Data Envelopment Analysis (M-DEA) model was applied to estimate the performance of water supply and sewage services in 1628 municipalities covering more than 56% of the Brazilian population, identifying the factors that most influence the efficiency of the sector in the years 2008 and 2016. The M-DEA methodology is an extension of Data Envelopment Analysis (DEA) with multiple DEA executions considering all combinations of inputs and outputs to calculate efficiency scores. The methodology reduces possible biases in the selection of resources and products of the model, ability to support decision-making in favor of improvements in the sector's efficiency based on national regulatory framework. The analyses show that the companies analyzed can increase their operating results and attendance coverage by more than 60%, given the current levels of infrastructure, human and financial resources in the sector. Based on the simulation of potential efficiency gains in Brazilian basic sanitation companies, the estimates show that the coverage of the population with access to sanitary sewage would go from the current 59.9% to 76.5%. The evidence found provides indications to subsidize sanitation management in the country at the micro-analytical level, enabling a better competitive position in the sector for the integrated management of basic sanitation and its universalization in Brazil.

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RESUMEN En esta investigación se desarrolla un método que integra herramientas de análisis multivariado con el objetivo de identificar perfiles característicos de las pequeñas y medianas empresas exportadoras pequeñas y evaluar su eficiencia empresarial, de manera que se apoyen procesos de mejora en sus resultados. Para lo anterior se revisaron elementos teóricos asociados a la eficiencia empresarial y el cálculo estadístico multivariado, lo que permitió desarrollar una metodología que integra el análisis de conglomerados, análisis discriminante y análisis envolvente de datos para evaluar la eficiencia empresarial. Se analizaron 45 empresas pequeñas y medianas exportadoras de Cartagena-Colombia, en las que se identificaron 3 perfiles característicos con niveles promedio de eficiencia de 71,89% el uno, 70,93% el dos y 51,25% tres. El análisis discriminante mostró la pertinencia y relevancia de los perfiles identificados lográndose un 95,6% de clasificación correcta del modelo discriminante. Se concluye que las herramientas de cálculo multivariado analizadas en esta investigación son significativas para clasificar y evaluar la eficiencia de grupos empresariales. CLASIFICACIÓN JEL C19, O11, O32

ABSTRACT This research develops a method that integrates multivariate analysis tools with the aim of identifying characteristic profiles of small and medium-sized small exporting companies and evaluating their business efficiency so that improvement processes are supported in their results. For the above, theoretical elements associated with business efficiency and multivariate statistical calculation were reviewed, which develops a methodology that integrates cluster analysis, discriminant analysis and data envelopment analysis to evaluate business efficiency. 45 small and medium exporting companies from Cartagena-Colombia were analyzed, in which 3 characteristic profiles were identified with average efficiency levels of 71.89% for one, 70.93% for two and 51.25% for three. The discriminant analysis selected the relevance and relevance of the identified profiles, registering 95.6% of correct classification of the discriminant model. It is concluded that the multivariate calculation tools analyzed in this research are analyzed to classify and evaluate the efficiency of business groups. JEL CLASSIFICATION C19, O11, O32

RESUMO Nesta investigação é desenvolvido um método que integra ferramentas de análise multivariada com o objectivo de identificar perfis característicos das pequenas e médias empresas exportadoras e avaliar a sua eficiência empresarial, de forma a apoiar os processos de melhoria dos seus resultados. Para o efeito, foram revistos elementos teóricos associados à eficiência empresarial e ao cálculo estatístico multivariado, o que permitiu desenvolver uma metodologia que integra análise de clusters, análise discriminante e análise envolvente de dados para avaliar a eficiência empresarial. Foram analisadas quarenta e cinco pequenas e médias empresas de exportação em Cartagena-Colômbia, identificando três perfis característicos com níveis médios de eficiência de 71,89% para uma, 70,93% para duas e 51,25% para três. A análise discriminante mostrou a pertinência e relevância dos perfis identificados, atingindo 95,6% da classificação correcta do modelo discriminante. Conclui-se que as ferramentas de cálculo multivariado analisadas nesta investigação são significativas para classificar e avaliar a eficiência dos grupos empresariais. CLASSIFICAÇÃO JEL C19, O11, O32

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Ensuring regular and timely access to efficient and quality health services reduces the risk of maternal mortality. Specifically, improving technical efficiency (TE) can result in improved health outcomes. To date, no studies in Mexico have explored the connection of TE with either the production of maternal health services at the primary-care level or the maternal-mortality ratio (MMR) in populations without social security coverage. The present study combined data envelopment analysis (DEA), longitudinal data and selection bias correction methods with the purpose of obtaining original evidence on the impact of TE on the MMR during the period 2008-2015. The results revealed that MMR fell 0.36% (P < 0.01) for every percentage point increase in TE at the jurisdictional level or elasticity TE-MMR. This effect proved lower in highly marginalized jurisdictions and disappeared entirely in those with low- or medium-marginalization levels. Our findings also highlighted the relevance of certain social and economic aspects in the attainment of TE by jurisdictions. This clearly demonstrates the need for comprehensive, cross-cutting policies capable of modifying the structural conditions that generate vulnerability in specific population groups. In other words, achieving an effective and sustainable reduction in the MMR requires, inter alia, that the Mexican government review and update two essential elements: the criteria behind resource allocation and distribution, and the control mechanisms currently in place for executing and ensuring accountability in these two functions.

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Regulated water industries need to improve their technical efficiency and allocate their resources efficiently. This is the case of the water industry in England and Wales which was privatized in 1989, and the method of price cap regulation was implemented. This study uses an input distance function system approach to estimate the technical efficiency and distortions in the choice of input mixes for the English and Welsh water and sewerage companies (WaSCs) over the years 1991-2016. The results indicated that an average WaSC was 75.3% technically efficient which means that inputs could be reduced by 24.7% keeping the level of output constant. On average, the input mix was considered to be allocated inefficiently as there was an over-utilization of capital and other inputs relative to employment. Moreover, the low degree of substitutability among inputs implied that reducing allocative inefficiency could be costly. The findings of our study is of interest to policy makers who want to implement effective policies to improve efficiency in the water industry.

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This paper assesses the economic efficiency of Brazilian general hospitals that provide inpatient care for the Unified Health System (SUS). We combined data envelopment analysis (DEA) and spatial analysis to identify predominant clusters, measure hospital inefficiency and analyze the spatial pattern of inefficiency throughout the country. Our findings pointed to a high level of hospital inefficiency, mostly associated with small size and distributed across all Brazilian states. Many of these hospitals could increase production and reduce inputs to achieve higher efficiency standards. These findings suggest room for optimization, but inequalities in access and the matching of demand and supply must be carefully considered in any attempt to reorganize the hospital system in Brazil.

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Evaluating the performance of water companies is of great importance for both water utilities and water regulators. This paper explores comparative levels of technical efficiencies and technology gap ratios with the metafrontier concept by estimating an input distance function using stochastic frontier techniques. The metafrontier framework is employed in the water services of water and sewerage companies (WaSCs) and water-only companies (WoCs) in England and Wales. The results show that the English and Welsh water industry is an efficient industry, with WaSCs more efficient than WoCs. On average, a water company can increase its technical efficiency by operating in more densely populated areas and by investing in technology to reduce bursts in water mains. We also link the efficiency results with the regulatory cycle to assess the impact of regulation on the efficiency levels of water companies.

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The primary purpose of this study was to analyze the efficiency level of tea farms operated by owners and shareholders, and to explore the effect of different decisional, structural and management factors on efficiency. The data were collected from a stratified sample of 138 tea farmers operated in Rize province Turkey in 2017. The data envelopment analysis (DEA) program was used to estimate the efficiency scores. Tobit model was used to explore determinants of technical efficiency. Results disclosed that farmers can reduce their inputs use by 43% without compromising their yield level. However, they have low economic efficiency (0.41). Shareholder-operated farms were highly efficient (0.76) than the owner-operated farms. The factors such as old tea parcels, high land slope, and altitude were having a significant negative effect on farms efficiency. Applying fertilizer in the root zone or mixed with soil, terracing of farmland, and performing of soil test was positively and significantly contributing to efficiency. Generally, the efficiency of tea farmers is low, and mostly farm management and structure related factors were negatively affecting the farmers efficiency. The farmers should be aware of associated benefits with early replanting tea, fertilizer application in the root zone and terracing to control their production cost.(AU)

O estudo analisa o nível de eficiência de dois sistemas agrícolas diferentes, tais como proprietários e fazendas de chá operadas por acionistas, bem como explorar o efeito de diferentes fatores de decisão, estruturais e de gestão na eficiência. Total de 138 produtores de chá foram selecionados através do procedimento de amostragem estratificada na província de Rize. Os resultados revelaram que os agricultores podem reduzir o uso de insumos em 43% sem comprometer seu nível de produção. No entanto, eles têm baixa eficiência econômica (0,41). As fazendas operadas pelos acionistas eram altamente eficientes (0,76) do que as fazendas operadas pelos proprietários. Os fatores como antigas parcelas de chá, alta inclinação de terra e altitude estavam tendo um efeito negativo significativo sobre a eficiência das fazendas. A aplicação de fertilizantes na zona das raízes ou misturados com o solo, o terraceamento de terras agrícolas e a realização de testes de solo contribuíram de forma positiva e significativa para a eficiência. Geralmente, a eficiência dos produtores de chá é baixa, e principalmente os fatores relacionados à gestão e estrutura da fazenda afetavam negativamente a eficiência do agricultor. Os agricultores devem estar cientes dos benefícios associados ao replantio precoce do chá, aplicação de fertilizantes na zona de raízes, terraços para controlar seu custo de produção.(AU)

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OBJECTIVE: To analyze the formation of spatial clusters of technical efficiency (TE) in the production of outpatient maternal health services in México for the period 2008 to 2015. METHODS: We performed a longitudinal analysis of administrative and structural data related to the 243 Mexican health jurisdictions. We use window data envelopment analysis and spatial and econometric techniques. Structural correlates of each TE cluster obtained were identified estimating a pooled multinomial logit model. RESULTS: We observed an increase in the overall TE, accompanied by a reduction in its standard deviation. Furthermore, we identified positive TE spatial dependence both globally and locally. Multiple regression analysis showed that the maximum-performance TE cluster was composed of health jurisdictions located in the North of México and characterized by social marginalization, a reduced indigenous population, and a low demand for maternal health services. CONCLUSIONS: The identification of TE clusters can provide elements to induce decision makers to innovative in ways of allocating resources and manage their utilization. In México as other low- and middle-income countries, it is key to develop targeting strategies to implement specific health services innovations putting to the population to be served at the front of the strategy. This implies testing new modalities to strengthen primary health services, the empowerment of community participation, the training and allocation of health personnel that could respond adequately to population's demand, and the active involvement of competent state and local authorities in the assessment of the results of these innovations.

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The primary purpose of this study was to analyze the efficiency level of tea farms operated by owners and shareholders, and to explore the effect of different decisional, structural and management factors on efficiency. The data were collected from a stratified sample of 138 tea farmers operated in Rize province Turkey in 2017. The data envelopment analysis (DEA) program was used to estimate the efficiency scores. Tobit model was used to explore determinants of technical efficiency. Results disclosed that farmers can reduce their inputs use by 43% without compromising their yield level. However, they have low economic efficiency (0.41). Shareholder-operated farms were highly efficient (0.76) than the owner-operated farms. The factors such as old tea parcels, high land slope, and altitude were having a significant negative effect on farms’ efficiency. Applying fertilizer in the root zone or mixed with soil, terracing of farmland, and performing of soil test was positively and significantly contributing to efficiency. Generally, the efficiency of tea farmers is low, and mostly farm management and structure related factors were negatively affecting the farmer’s efficiency. The farmers should be aware of associated benefits with early replanting tea, fertilizer application in the root zone and terracing to control their production cost.

O estudo analisa o nível de eficiência de dois sistemas agrícolas diferentes, tais como proprietários e fazendas de chá operadas por acionistas, bem como explorar o efeito de diferentes fatores de decisão, estruturais e de gestão na eficiência. Total de 138 produtores de chá foram selecionados através do procedimento de amostragem estratificada na província de Rize. Os resultados revelaram que os agricultores podem reduzir o uso de insumos em 43% sem comprometer seu nível de produção. No entanto, eles têm baixa eficiência econômica (0,41). As fazendas operadas pelos acionistas eram altamente eficientes (0,76) do que as fazendas operadas pelos proprietários. Os fatores como antigas parcelas de chá, alta inclinação de terra e altitude estavam tendo um efeito negativo significativo sobre a eficiência das fazendas. A aplicação de fertilizantes na zona das raízes ou misturados com o solo, o terraceamento de terras agrícolas e a realização de testes de solo contribuíram de forma positiva e significativa para a eficiência. Geralmente, a eficiência dos produtores de chá é baixa, e principalmente os fatores relacionados à gestão e estrutura da fazenda afetavam negativamente a eficiência do agricultor. Os agricultores devem estar cientes dos benefícios associados ao replantio precoce do chá, aplicação de fertilizantes na zona de raízes, terraços para controlar seu custo de produção.

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BACKGROUND: While the world has made much global progress toward the reduction of new HIV infections, HIV continues to be an important public health problem. In the face of constantly constrained resources, donors and grantees alike must seek to optimize resources and deliver HIV services as efficiently as possible. While there is evidence that management practices can affect efficiency, this has yet to be rigorously tested in the context of HIV service delivery. METHODS: The present protocol describes the design of a cluster-randomized control trial to estimate the effect of management practices on efficiency. Specifically, we will evaluate the impact of an intervention focused on improving management practices among community-based organizations (CBOs), on the costs of HIV prevention services for female sex workers (FSW) in Nigeria. To design the intervention, we used a qualitative, design thinking-informed methodology that allowed us to understand management in its organizational context better and to develop a user-centered solution. After designing the suite of management tools, we randomly assigned 16 CBOs to the intervention group, and 15 CBOs to the control group. The intervention consisted of a comprehensive management training and a management "toolkit" to support better planning and organization of their work and better communication between CBOs and community volunteers. Both treatment and control groups received training to record data on efficiency-inputs used, and outputs produced. Both groups will be prospectively followed through to the end of the study, at which point we will compare the average unit cost per FSW served between the two groups using a quasi-experimental "difference-in-differences" (DiD) strategy. This approach identifies the effect of the intervention by examining differences between treatment and control groups, before and after the intervention thus accounting for time-constant differences between groups. Despite the rigorous randomization procedure, the small sample size and diversity in the country may still cause unobservable characteristics linked to efficiency to unbalanced between treatment and control groups at baseline. In anticipation of this possibility, using the quasi-experimental DiD approach allows any baseline differences to be "differenced out" when measuring the effect. DISCUSSION: This study design will uniquely add to the literature around management practices by building rigorous evidence on the relationship between management skills and practices and service delivery efficiency. We expect that management will positively affect efficiency. This study will produce valuable evidence that we will disseminate to key stakeholders, including those integral to the Nigerian HIV response.Trial registration This trial has been registered in Clinical Trials (NCT03371914). Registered 13 December 2018.

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The objective of this work was to estimate the technical efficiency scores of Brazilian agricultural establishments using Stochastic Frontier Analysis. For that purpose, microdata from the 2006 Brazilian Agricultural Census of the Brazilian Institute of Geography and Statistics (ibge) were used. The units of analysis are the agricultural establishments since they allow broad characterization, as well as minimization of possible bias caused by data aggregation at the municipal or state level. The value of production responded positively to increases in land, capital goods, labor and inputs, but negatively to the stock of animals on the property. The average estimated technical efficiency was 0.32. This low value observed suggests that Brazilian agricultural establishments were in general fairly inefficient. This result is important for agricultural policies since it suggests that policies aimed at reducing the technical inefficiency of agricultural establishments may be effective in increasing agricultural production.

O objetivo deste trabalho foi estimar os escores de eficiência técnica dos estabelecimentos agropecuários brasileiros utilizando o método da Fronteira Estocástica de Produção. Para tanto, foram utilizados os microdados do Censo Agropecuário 2006 do IBGE (Instituto Brasileiro de Geografia e Estatística), cujas unidades de pesquisa são os estabelecimentos agropecuários, visto que os mesmos permitem caracterizações amplas, bem como a minimização de possível viés causado pela agregação das informações em âmbito municipal ou estadual. Dentre os resultados, destaca-se que o valor da produção respondeu positivamente a aumentos nos fatores terra, bens de capital, trabalho e insumos, mas negativamente ao estoque de animais existente no estabelecimento. A média da eficiência técnica estimada foi de 0,32, sendo que esse baixo valor observado sugere que, em média, os estabelecimentos agropecuários brasileiros eram bastante ineficientes. Este resultado é de grande importância para as políticas agropecuárias, uma vez que sugerem que políticas voltadas para reduzir a ineficiência técnica dos estabelecimentos rurais podem ser eficazes para aumentar a produção agropecuária.

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The objective of this work was to estimate the technical efficiency scores of Brazilian agricultural establishments using Stochastic Frontier Analysis. For that purpose, microdata from the 2006 Brazilian Agricultural Census of the Brazilian Institute of Geography and Statistics (ibge) were used. The units of analysis are the agricultural establishments since they allow broad characterization, as well as minimization of possible bias caused by data aggregation at the municipal or state level. The value of production responded positively to increases in land, capital goods, labor and inputs, but negatively to the stock of animals on the property. The average estimated technical efficiency was 0.32. This low value observed suggests that Brazilian agricultural establishments were in general fairly inefficient. This result is important for agricultural policies since it suggests that policies aimed at reducing the technical inefficiency of agricultural establishments may be effective in increasing agricultural production.(AU)

O objetivo deste trabalho foi estimar os escores de eficiência técnica dos estabelecimentos agropecuários brasileiros utilizando o método da Fronteira Estocástica de Produção. Para tanto, foram utilizados os microdados do Censo Agropecuário 2006 do IBGE (Instituto Brasileiro de Geografia e Estatística), cujas unidades de pesquisa são os estabelecimentos agropecuários, visto que os mesmos permitem caracterizações amplas, bem como a minimização de possível viés causado pela agregação das informações em âmbito municipal ou estadual. Dentre os resultados, destaca-se que o valor da produção respondeu positivamente a aumentos nos fatores terra, bens de capital, trabalho e insumos, mas negativamente ao estoque de animais existente no estabelecimento. A média da eficiência técnica estimada foi de 0,32, sendo que esse baixo valor observado sugere que, em média, os estabelecimentos agropecuários brasileiros eram bastante ineficientes. Este resultado é de grande importância para as políticas agropecuárias, uma vez que sugerem que políticas voltadas para reduzir a ineficiência técnica dos estabelecimentos rurais podem ser eficazes para aumentar a produção agropecuária.(AU)

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Objetivo: Os hospitais públicos em Portugal apresentaram nos últimos anos uma melhoria dos seus resultados em termos de assistência. Porém, poucas têm sido as avaliações realizadas no âmbito do seu desempenho. Este estudo procura determinar a eficiência dos hospitais públicos em Portugal. Métodos: Este estudo considerou duas alternativas de modelos não paramétricos bidireccionais, baseados em Análise Envoltória de Dados e em Ordem-a. A utilização de ambos os modelos visa a validação da robustez dos resultados. Usaram-se quatro tipos de variáveis: custos totais, número de doentes atendidos ajustados ao risco, qualidade do serviço prestado, e o ambiente externo (demografia e epidemiologia). Com referência ao ano 2016, consideraram-se 27 hospitais e centros hospitalares públicos portugueses. Resultados: O nível de ineficiência médio, apenas para hospitais ineficientes, é aproximadamente 10%, correspondendo a cerca de €617 milhões desperdiçados. Conclusões: Os níveis de ineficiência variam conforme os modelos apresentados. A avaliação do desempenho deve considerar fatores como a presença de outliers, o número de variáveis, as condições externas desfavoráveis, bem como as características das fronteiras de eficiência. Um aspeto importante corresponde à convexidade da fronteira. Conclui-se que a melhor solução para avaliar o desempenho hospitalar é a abordagem por Ordem-a.

Objective: Portuguese public hospitals have exhibited an improvement of resources management in the past few years. However, only few analyses over their performance have been done. This study aims at find technical efficiency levels of Portuguese public hospitals using robust methods. Methods: This study has considered two different nonparametric alternatives for efficiency assessment. These methods are based on the Data Envelopment Analysis and on the Order-a frameworks. Four main variable categories were used: total expenses, risk-adjusted treated patients, delivered healthcare services' quality, and the epidemiologic and demographic conditions in which hospitals operate. A sample of 27 Portuguese public hospitals and hospital centres was used. Data regards the year of 2016. Results: Inefficient hospitals exhibit average technical inefficiency levels of about 10%, which corresponds to the waste of nearly €617 million. Conclusions: Inefficiency levels have a strong dependence on model features. Hence, performance evaluation should account for the existence of potential outliers, the number of variables, the existence of external factor affecting the hospitals' production process, as well as the characteristics of the achieved frontiers. An important aspect is the assumption of convexity of the frontier. A better solution for hospital performance assessment is, then, the Order-a method.

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BACKGROUND: Primary Health Care (PHC) is an efficient strategy to improve health outcomes in populations. Nevertheless, studies of technical efficiency in health care have focused on hospitals, with very little on primary health care centers. The objective of the present study was to use the Data Envelopment Analysis to estimate the technical efficiency of three women's health promotion and disease prevention programs offered by primary care centers in Bucaramanga, Colombia. METHODS: Efficiency was measured using a four-stage data envelopment analysis with a series of Tobit regressions to account for the effect of quality outcomes and context variables. Input/output information was collected from the institutions' records, chart reviews and personal interviews. Information about contextual variables was obtained from databases from the primary health program in the municipality. A jackknife analysis was used to assess the robustness of the results. RESULTS: The analysis was based on data from 21 public primary health care centers. The average efficiency scores, after adjusting for quality and context, were 92.4 %, 97.5 % and 86.2 % for the antenatal care (ANC), early detection of cervical cancer (EDCC) and family planning (FP) programs, respectively. On each program, 12 of the 21 (57.1 %) health centers were found to be technically efficient; having had the best-practice frontiers. Adjusting for context variables changed the scores and reference rankings of the three programs offered by the health centers. CONCLUSION: The performance of the women's health prevention programs offered by the centers was found to be heterogeneous. Adjusting for context and health care quality variables had a significant effect on the technical efficiency scores and ranking. The results can serve as a guide to strengthen management and organizational and planning processes related to local primary care services operating within a market-based model such as the one in Colombia.

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The public health system has restricted economic resources. Because of that, it is necessary to know how the resources are being used and if they are properly distributed. Several works have applied classical approaches based in Data Envelopment Analysis (DEA) and Stochastic Frontier Analysis (SFA) for this purpose. However, if we have hospitals with different casemix, this is not the best approach. In order to avoid biases in the comparisons, other works have recommended the use of hospital production data corrected by the weights from Diagnosis Related Groups (DRGs), to adjust the casemix of hospitals. However, not all countries have this tool fully implemented, which limits the efficiency evaluation. This paper proposes a new approach for evaluating the efficiency of hospitals. It uses a graph-based clustering algorithm to find groups of hospitals that have similar production profiles. Then, DEA is used to evaluate the technical efficiency of each group. The proposed approach is tested using the production data from 2014 of 193 Chilean public hospitals. The results allowed to identify different performance profiles of each group, that differs from other studies that employs data from partially implemented DRGs. Our results are able to deliver a better description of the resource management of the different groups of hospitals. We have created a website with the results ( bioinformatic.diinf.usach.cl/publichealth ). Data can be requested to the authors.

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