Performance and congestion analysis of the Portuguese hospital services

The health care services have been characterized by a growing demand by the citizens leading to the need of more and more resources. Population aging, new pathologies, drugs, as well as new treatments are some of the major factors for this. However, in hospitals, for example, consumption of a large number of inputs has not frequently corresponded to the production of the same or more proportion of outputs. Sometimes, the outputs even decline with the increase of inputs due to the influence of the congestion effect on efficiency. The heavy burden of the health sector on the state budget brings about the interest of research over its efficiency. This paper aims to assess the performance of the Portuguese hospitals and particularly the contribution of the congestion effect. We use the non‐parametric technique of data envelopment analysis for this purpose and a double‐bootstrap procedure to take into account the influence of operational environment on efficiency. Afterwards, by comparing three different approaches, we determine the importance of congestion in efficiency measurement and discuss its computation methodologically. The results suggest significant levels of inefficiency in 68 major Portuguese hospitals for the year 2005 and more than half of them were found to be congested.