A Cohort Study of the Relationship between Active Collaboration and Operational Efficiency in Japanese Public Health Institutions.

Introduction: In recent years, public hospitals have seen an increasing need for management reform in light of increasing social security costs due to the aging population. This study investigated the relationship between collaboration with neighboring medical institutions and management efficiency in public hospitals. Methods: Data envelopment analysis was used to calculate the dependent variable. We used the referral rate for each public hospital as an independent variable to indicate active collaboration. Univariate and multivariate analyses examined the association between the two variables above. The adjustment variables in the multivariate analysis incorporated those variables that were considered significant in the univariate analysis when the significance level was 10% on a two-sided basis. The Tobit regression model was used in both univariate and multivariate analyses. Results: Ultimately, the analysis included 402 public hospitals. Approximately 8% fell into the high-collaboration group. Even after adjusting for significant variables from the univariate analysis, the inefficiency value was significantly lower in the high-collaboration group than in the low-collaboration group; namely, the efficiency value in the high-collaboration group was significantly higher than in the low-collaboration group. Moreover, hospitals with a higher ratio of subsidies to revenue had significantly lower values for management efficiency. Conclusions: The analysis of the relationship between efficiency value and the percentage of referred patients in Japan indicated that higher percentages of referred patients, that is, higher degrees of cooperation, were significantly associated with higher efficiency scores.