Advancing Hospital Sustainability: A Multidimensional Index Integrating ESG and Digital Transformation

Takeda, Midori and Xie, Jun and Kurita, Kenichi and Managi, Shunsuke (2024): Advancing Hospital Sustainability: A Multidimensional Index Integrating ESG and Digital Transformation.

Abstract

Today, most healthcare costs in Japan depend on insurance premiums and public funds. Since the working population supports both groups, it will be difficult to maintain medical expenses in the future due to further declining birth rates and an aging society. Therefore, the sustainability of hospitals is a serious issue. While many methods have been developed to evaluate hospital performance and effectiveness, only some have been used to evaluate sustainability. Against this background, this study develops a comprehensive evaluation system that integrates ESG and digital transformation (DX) into a hospital efficiency and effectiveness assessment. We utilize open databases on hospital performance, financial reports, and scraped information disclosed on hospital websites. SBM (slack-based model)-DEA and super efficiency SBM-DEA were combined to assess hospital sustainability, including overall sustainability and three dimensions of hospital efficiency, effectiveness, and ESG/DX. The results showed that ESG/DX performance, efficiency, and effectiveness positively correlated with hospital sustainability in all groups of hospitals. It also showed that while effectiveness and ESG/DX performance positively contribute to operational efficiency in smaller hospitals, ESG/DX performance negatively contributes to profitability. In rehabilitation hospitals, effectiveness contributes negatively to profitability, indicating that improving effectiveness requires more significant costs than in other hospitals. These findings indicated that while ESG, DX, and effectiveness improve hospital sustainability, the costs of promoting ESG/DX are significant for smaller and rehabilitation hospitals. This index could benefit hospital management and policy recommendations regarding promoting ESG and DX.

• Item Type: MPRA Paper
• Language: English
• Keywords: Hospital; Sustainability; ESG; SBM-DEA; Super-efficiency DEA
• Subjects: D - Microeconomics > D2 - Production and Organizations > D24 - Production ; Cost ; Capital ; Capital, Total Factor, and Multifactor Productivity ; Capacity; M - Business Administration and Business Economics ; Marketing ; Accounting ; Personnel Economics > M1 - Business Administration > M14 - Corporate Culture ; Diversity ; Social Responsibility

References

1. OECD (2022) OECD Health Statistics 2022.

2. Organization WH (2022) Global spending on health: rising to the pandemic’s challenges.

3. Sasaki T, Izawa M, Okada Y (2015) Current trends in health insurance systems: OECD countries vs. Japan. Neurol Med Chir (Tokyo) 55:267-275. https://doi.org/10.2176/nmc.ra.2014-0317

4. Ministry of Health LaW (2021) Overview of the Japanese Health Care System. https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/iryouhoken/iryouhoken01/index.html.

5. Ferreira D, Marques R (2019) Do quality and access to hospital services impact on their technical efficiency? Omega 86:218-236.

6. Kao C, Pang R-Z, Liu S-T, Bai X-J (2021) Most productive types of hospitals: An empirical analysis. Omega 99:102310.

7. Pederneiras YM, Pereira MA, Figueira JR (2023) Are the Portuguese public hospitals sustainable? A triple bottom line hybrid data envelopment analysis approach. International Transactions in Operational Research 30:453-475.

8. Henke RM, Fingar KR, Jiang HJ, Liang L, Gibson TB (2021) Access To Obstetric, Behavioral Health, And Surgical Inpatient Services After Hospital Mergers In Rural Areas: Study examines access to care in rural areas where hospitals have merged. Health Affairs 40:1627-1636. https://doi.org/10.1377/hlthaff.2021.00160

9. Alshqaqeeq F, Esmaeili MA, Overcash M, Twomey J (2020) Quantifying hospital services by carbon footprint: a systematic literature review of patient care alternatives. Resources, Conservation and Recycling 154:104560. https://doi.org/10.1016/j.resconrec.2019.104560

10. McGain F, Naylor C (2014) Environmental sustainability in hospitals–a systematic review and research agenda. Journal of health services research & policy 19:245-252. https://doi.org/10.1177/1355819614534836

11. Shimshak DG, Lenard ML, Klimberg RK (2009) Incorporating quality into data envelopment analysis of nursing home performance: a case study. Omega 37:672-685.

12. Henriques C, Gouveia M (2022) Assessing the impact of COVID-19 on the efficiency of Portuguese state-owned enterprise hospitals. Socio-Economic Planning Sciences 84:101387. https://doi.org/10.1016/j.seps.2022.101387

13. Staat M (2006) Efficiency of hospitals in Germany: a DEA-bootstrap approach. Applied Economics 38:2255-2263.

14. Chang H-H (1998) Determinants of hospital efficiency: the case of central government-owned hospitals in Taiwan. Omega 26:307-317. https://doi.org/10.1016/S0305-0483(98)00014-0.

15. Chang S-J, Hsiao H-C, Huang L-H, Chang H (2011) Taiwan quality indicator project and hospital productivity growth. Omega 39:14-22. https://doi.org/10.1016/j.omega.2010.01.006.

16. Brown LD (2003) Comparing health systems in four countries: lessons for the United States. Am J Public Health 93:52-56. https://doi.org/10.2105/ajph.93.1.52

17. Office. UGA. (2017). Federal low-income programs: eligibility and benefits differ for selected programs due to complex and varied rules.

18. Services. CfMM Monthly Medicaid & CHIP application, eligibility determination, and enrollment reports & data. https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-chip-enrollment-data/monthly-medicaid-chip-application-eligibility-determination-and-enrollment-reports-data/index.html. 2023

19. Collaborators GUHC (2020) Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396:1250-1284. https://doi.org/10.1016/s0140-6736(20)30750-9

20. Hatanaka T, Eguchi N, Deguchi M, Yazawa M, Ishii M (2015) Study of Global Health Strategy Based on International Trends: -Promoting Universal Health Coverage Globally and Ensuring the Sustainability of Japan's Universal Coverage of Health Insurance System: Problems and Proposals. Japan Med Assoc J 58:78-101.

21. Ministry of Health LaW (2018) Overview of the Revision of Medical Fees in FY 2008.

22. Ikegami N, Yoo BK, Hashimoto H et al (2011) Japanese universal health coverage: evolution, achievements, and challenges. Lancet 378:1106-1115. https://doi.org/10.1016/s0140-6736(11)60828-3

23. Shibuya K, Hashimoto H, Ikegami N et al (2011) Future of Japan's system of good health at low cost with equity: beyond universal coverage. Lancet 378:1265-1273. https://doi.org/10.1016/s0140-6736(11)61098-2

24. Ministry of Finance J Increasing social security-related expenses due to the aging of society. https://www.mof.go.jp/zaisei/social-security-and-finance/index.html. 2023

25. Matsumoto T, Strachan L, Oyama S, Ishiguro Y, Lee SS (2023) Current Medical Technology Reimbursement System in Japan. Value Health Reg Issues 34:118-124. https://doi.org/10.1016/j.vhri.2022.12.002

26. Ikegami N, Campbell JC (1995) Medical care in Japan. N Engl J Med 333:1295-1299. https://doi.org/10.1056/nejm199511093331922

27. Okamura S, Kobayashi R, Sakamaki T (2005) Case-mix payment in Japanese medical care. Health Policy 74:282-286. https://doi.org/10.1016/j.healthpol.2005.01.009

28. Fetter RB, Shin Y, Freeman JL, Averill RF, Thompson JD (1980) Case mix definition by diagnosis-related groups. Med Care 18:iii, 1-53.

29. Ozcan YA (2014) Health care benchmarking and performance evaluation. Springer

30. Chen P-C, Yu M-M, Chang C-C, Hsu S-H, Managi S (2015) The enhanced Russell-based directional distance measure with undesirable outputs: numerical example considering CO2 emissions. Omega 53:30-40.

31. Toloo M, Tone K, Izadikhah M (2023) Selecting slacks-based data envelopment analysis models. European Journal of Operational Research 308:1302-1318. https://doi.org/https://doi.org/10.1016/j.ejor.2022.12.032

32. Banker RD, Charnes A, Cooper WW (1984) Some models for estimating technical and scale inefficiencies in data envelopment analysis. Management science 30:1078-1092. https://doi.org/https://doi.org/10.1287/mnsc.30.9.1078

33. Barros CP, Managi S, Matousek R (2012) The technical efficiency of the Japanese banks: non-radial directional performance measurement with undesirable output. Omega 40:1-8.

34. Du J, Wang J, Chen Y, Chou S-Y, Zhu J (2014) Incorporating health outcomes in Pennsylvania hospital efficiency: an additive super-efficiency DEA approach. Annals of Operations Research 221:161-172. https://doi.org/10.1007/s10479-011-0838-y

35. Tone K (2001) A slacks-based measure of efficiency in data envelopment analysis. European Journal of Operational Research 130:498-509. https://doi.org/doi.org/10.1016/S0377-2217(99)00407-5

36. Tone K (2010) Variations on the theme of slacks-based measure of efficiency in DEA. European Journal of Operational Research 200:901-907. https://doi.org/doi.org/10.1016/j.ejor.2009.01.027

37. Cooper WW, Seiford LM, Tone K (2000) Data envelopment analysis: a comprehensive text with models, applications, references and DEA-solver software. Springer

38. Halkos G, Petrou KN (2019) Treating undesirable outputs in DEA: A critical review. Economic Analysis and Policy 62:97-104. https://doi.org/https://doi.org/10.1016/j.eap.2019.01.005

39. Tone K (2002) A slacks-based measure of super-efficiency in data envelopment analysis. European Journal of Operational Research 143:32-41. https://doi.org/https://doi.org/10.1016/S0377-2217(01)00324-1

40. Tone K (2017) On the Consistency of Slacks-based Measure-max Model and Super-slacks-based Measure Model. Universal Journal of Management 5:160-165. https://doi.org/DOI: 10.13189/ujm.2017.050307.

41. Carini E, Gabutti I, Frisicale EM et al (2020) Assessing hospital performance indicators. What dimensions? Evidence from an umbrella review. BMC Health Serv Res 20:1038. https://doi.org/10.1186/s12913-020-05879-y

42. Keeley AR, Chapman AJ, Yoshida K et al (2022) ESG metrics and social equity: Investigating commensurability. Frontiers in Sustainability 3:920955.

43. Xie J, Tanaka Y, Keeley AR, Fujii H, Managi S (2023) Do investors incorporate financial materiality? Remapping the environmental information in corporate sustainability reporting. Corporate Social Responsibility and Environmental Management.

44. Davis P, Milne B, Parker K et al (2013) Efficiency, effectiveness, equity (E3). Evaluating hospital performance in three dimensions. Health Policy 112:19-27. https://doi.org/10.1016/j.healthpol.2013.02.008

45. Gok MS, Sezen B (2013) Analyzing the ambiguous relationship between efficiency, quality and patient satisfaction in healthcare services: the case of public hospitals in Turkey. Health policy 111:290-300.