5. Discussion
The performance evaluation of health care sector, including diagnostic
services, is an important issue. In this paper, we proposed a NDEA
approach to measure the efficiency of medical diagnostic laboratories.
Here we presented a case study that used the NDEA model. Application of
the model showed which laboratories were efficient and how they can be
compared with inefficient laboratories so that managers can seek out
strategies for improving their laboratories by understanding the causes
of inefficiency.
The model results show that the inefficiencies of laboratories can be
identified for the following reasons: (1) 71% of laboratories are
private in Tehran. Thus, the type of competition and the monopoly amount
in the private sector is very different from that of the public sector
since a large number of small and medium laboratories are operating in
the absence of large laboratories that form the industry. (2) The type
of services offered by laboratories is almost the same. In fact, the
additional services, service quality and service cost have caused
distinction between competitors. According to experts, laboratories that
have less than 42 patients per day are non-economic, while more than
60% of the existing laboratories accept less than 42 patients per day.
(3) Factors such as currency fluctuations, price increases of kits, and
the cost of implementing quality standards indicate the laboratories
need to control and manage costs. On average, 45% of the total cost
required is due to the consumables in each laboratory. Therefore, the
management cost has a significant role in the enhancement of efficiency.
)4) A broad geographic coverage of lab services is the distinction of a
laboratory in service coverage. The large laboratories, due to the
increase in amount and diversity and the capacity of the tests, expand
their services by providing services to smaller laboratories.
Considering the reasons mentioned for increasing the efficiency of
laboratories, we propose the following solutions: )1) Reviewing all of
medical diagnostic laboratory processes, including the pre-test process,
the testing process, and the post-test process, will lead to reduced
cost and increased quality. )2) The operation management approach by
identifying and eliminating unnecessary factors leads to the reduction
in the cost of additional of laboratory and increased productivity. )3)
Better and more accurate monitoring and control on inputs will lead to
savings in input resources. )4) Extensive coverage of services
(geographic coverage) using extensive sampling units and utilizing the
information and communication technology lead to an increase in the
efficiency of the laboratories.
A limitation exists in this research. In this study, the number of
samples (as an intermediate measure) is limited exclusively to patients
are going to laboratories and we ignored the samples sent to the labs.
Hence there is a potential limitation in this study. The revenues
related to the samples sent to the labs are excluded from the analysis
that can affect the actual profitability of the laboratory. Therefore,
this restriction affects the two outputs (Income from admission and Lab
profit) that are in the first and third stages, respectively, which
ultimately are affected the efficiency scores of the laboratories.