A metafrontier Global Malmquist framework for hospitals productivity and quality measurement: Evidence from the Greek economic recession

The main purpose of the study is to examine how the global economic crisis has affected the hospital productivity growth and quality performance of public hospitals in Greece. Through the nonparametric estimation of a quality-adjusted metafrontier Malmquist index, the study accounts the heterogeneity of hospitals according to the hierarchical levels of the healthcare system (primary, secondary and tertiary care) to examine the trends of efficiency change, innovation change, and leadership change during the period 2009-2013. The proposed approach relies on a novel methodological framework for measuring quality into a separate component of the metafrontier Malmquist. To understand the effect of the economic crisis in healthcare the study further explores the association between productivity and quality in the hospital sector. The results show that the implemented austerity measures have had a negative impact particularly on the quality of the tertiary hospitals that exhibited an overall productivity regress.