Efficiency measurement in Welsh National Health Service trusts

Reductions in government funding and the setting of more performance targets have resulted in efficiency issues in the National Health Service becoming increasingly important. This thesis describes the development of several data envelopment analysis models, which are applied to a case study in which the models are used to assess efficiency in seventeen acute National Health Service trusts located in Wales. Data envelopment analysis is chosen as the most appropriate technique for this case study in a comparative study of ratio analysis, multiple regression analysis and data envelopment analysis. A survey is described in which health service managers and doctors chose the efficiency measures used in the assessment. The data envelopment analysis is performed in layers. Initially, the trusts are analysed using annual trust level data for 1995/96 and 1996/97. The resulting efficiency scores, combined with a peer analysis, enabled the researcher to identify the most efficient trusts in Wales. The results obtained are compared with performance measures that are currently used in the National Health Service. This allowed the identification of trusts that were both relatively efficient and achieving government set performance targets. A comparison is also made with English trusts using a model with data collected from Wales and the Northern Health Authority. A further trust level analysis is described in which quarterly data is used to identify any seasonal effects. Finally, the trusts are analysed at speciality level to provide an in-depth analysis enabling the trust managers to target inefficient specialities.