Browsing by Author "Marques, Rui Cunha"
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- Ageing as a determinant of local government performance: myth or reality? the Portuguese experiencePublication . Ferreira, Diogo; Caldas, Paulo; Marques, Rui CunhaThe age structure of asociety has long been ahot topic in public administration, including in local government, where such discussion should, at the most obvious level, promote policies related to active ageing and the protection of the elderly. Ageing is asignificant issue in Portugal, putting pressure on local and central governments. Whether the population's aging is adeterminant of local government's overall performance is aquestion that finds few answers in the literature. Our results suggest that there is only atenuous relationship between ageing and some dimensions of council performance, particularly socio-economic development and financial sustainability. In life as awhole, ageing is seen as detrimental to performance; but it explains no more than atenth of the variance in councils' performance. Thus, individual councils may provide services efficiently regardless of the age structure of their communities. There are far more important dimensions for explaining performance by local government than ageing.
- An Incentive-Based Framework for Analyzing the Alignment of Institutional Interventions in the Public Primary Healthcare Sector: The Portuguese CasePublication . Pereira, Miguel Alves; Marques, Rui Cunha; Ferreira, Diogo Cunha; Ferreira, DiogoOver the years, the Portuguese National Health Service has undergone several reforms to face the challenges posed by internal and external factors on the access to and quality of its health services. One of its most recent reforms addressed the primary healthcare sector, where understanding the incentives behind the actors of the inherent institutional interventions and how they are aligned with the governing health policies is paramount for reformative success. With the purpose of acknowledging the alignment of the primary healthcare sector’s institutional interventions from an incentive-based perspective, we propose a framework resting on a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis, which was built in cooperation with a panel of decision-making actors from the Portuguese Ministry of Health. In the end, we derive possible policy implications and strategies. This holistic approach highlighted the positive impact of the primary healthcare reform in the upgrade of physical resources and human capital but stressed the geosocial asymmetries and the lack of intra- and inter-sectorial coordination. The proposed framework serves also as a guideline for future primary healthcare reforms, both national- and internationally.
- A critical look at the Portuguese public–private partnerships in healthcarePublication . Pereira, Miguel Alves; Ferreira, Diogo; Marques, Rui CunhaThe pre‐conceived idea that contracts in a public–private partnership (PPP) regime, in healthcare or in any other economic sector, are, as a rule, ruinous and appealing for only a share of the stakeholders, lacks a solid basis that confirms it. This idea, outset and nurtured by the media, has been instigating the distrust of the users who, in turn, demand a more rigorous and efficient utilisation of public resources. Being Portugal in the top of countries that resort to PPPs, it is urgent to inquire if its respective contracts originated an inefficient and ineffective management of resources. It is precisely this discussion that we address in this paper, focusing our efforts in the Portuguese healthcare sector
- Customer satisfaction in the presence of imperfect knowledge of dataPublication . Ferreira, Diogo; Soares, Rodrigo; Pedro, Maria Isabel; Marques, Rui CunhaEnsuring customer satisfaction is at the top of any manager's agenda wishing to keep or raise profits. To do so, conducting regular surveys is quintessential. However, provided the large number of questions that typically constitute those surveys, resulting data are plagued with imperfect knowledge. Data from these surveys are typically expressed in ordinal scales. No mathematical operation like addition or multiplication is allowed in these cases. Recognizing the limitations of existing alternatives in the literature to model imperfect knowledge, this work proposes an alternative model for the study of satisfaction and its determinants. Our approach is based on merging the Stochastic Multicriteria Acceptability Analysis and the Multicriteria Satisfaction Analysis (model). We explore the potential of this approach and apply it to an empirical case related to hospitality.
- Customer satisfaction in the presence of imperfect knowledge of dataPublication . Ferreira, Diogo; Soares, Rodrigo; Pedro, Maria Isabel; Marques, Rui CunhaEnsuring customer satisfaction is at the top of any manager’s agenda wishing to keep or raise profits. To do so, conducting regular surveys is quintessential. However, provided the large number of questions that typically constitute those surveys, resulting data are plagued with imperfect knowledge. Data from these surveys are typically expressed in ordinal scales. No mathematical operation like addition or multiplication is allowed in these cases. Recognizing the limitations of existing alternatives in the literature to model imperfect knowledge, this work proposes an alternative model for the study of satisfaction and its determinants. Our approach is based on merging the Stochastic Multicriteria Acceptability Analysis and the Multicriteria Satisfaction Analysis (model). We explore the potential of this approach and apply it to an empirical case related to hospitality.
- Customers satisfaction in pediatric inpatient services: A multiple criteria satisfaction analysisPublication . Ferreira, Diogo; Marques, Rui Cunha; Nunes, Alexandre Morais; Figueira, José RuiObjective: To assess customer satisfaction determinants in a public pediatric inpatient service and propose some strategies to enhance the consumer and customer experience. Methods: We applied a Multiple Criteria Customer Satisfaction Analysis to estimate the value functions associated with each satisfaction (sub)criterion and determine the corresponding weights. We characterized satisfaction criteria (according to the Kano’s model), estimated the customers’ demanding nature and the potential improvements, and proposed strategic priorities and opportunities to enhance customer satisfaction. Main findings: Strategies for satisfaction enhancement do not depend solely on the criteria with the lowest satisfaction levels and the estimated weights, each criterion’s nature, the customers’ demanding nature, and the technical margin for improvements. Conclusions: Areas deserving attention include clinical staff’s communication skills, the non-clinical professionals’ efficiency, availability, and kindness; food quality; visits’ scheduling and quantity; and facilities’ comfort.
- Data Envelopment Analysis models with imperfect knowledge of input and output values: An application to Portuguese public hospitalsPublication . Ferreira, Diogo; Figueira, José Rui; Greco, Salvatore; Marques, Rui CunhaAssessing the technical efficiency of a set of observations requires that the associated data composed of inputs and outputs are perfectly known. If this is not the case, then biased estimates will likely be obtained. Data Envelopment Analysis (DEA) is one of the most extensively used mathematical models to estimate efficiency. It constructs a piecewise linear frontier against which all observations are compared. Since the frontier is empirically defined, any deviation resulting from low data quality (imperfect knowledge of data or IKD) may lead to efficiency under/overestimation. In this study, we model IKD and, then, apply the so-called Hit & Run procedure to randomly generate admissible observations, following some prespecified probability density functions. Sets used to model IKD limit the domain of data associated with each observation. Any point belonging to that domain is a candidate to figure out as the observation for efficiency assessment. Hence, this sampling procedure must run a sizable number of times (infinite, in theory) in such a way that it populates the whole sets. The DEA technique is used during the execution of each iteration to estimate bootstrapped efficiency scores for each observation. We use some scenarios to show that the proposed routine can outperform some of the available alternatives. We also explain how efficiency estimations can be used for statistical inference. An empirical case study based on the Portuguese public hospitals database (2013–2016) was addressed using the proposed method.
- Economic Inefficiency Levels of Urban Solid Waste Management Services in PortugalPublication . Ferreira, Diogo; Marques, Rui Cunha; Pedro, Maria Isabel; Amaral, CarolinaKey performance indicators (KPI) are widely used tools to evaluate the economic (in)efficiency of services, including the ones devoted to urban solid waste management. Regulatory exercises are, then, mostly based on the outputs from KPIs, raising some questions about their validity. In theory, other more appropriate tools could be used to estimate those efficiency levels. This study evaluates the economic inefficiency level of urban solid waste management services in Portugal (2010–2017) through the adoption of partial frontier benchmarking models (order-m) coupled with weight restrictions. That way, the constructed model can evaluate the performance of those services under some regulatory and sustainability requirements. Then, estimated efficiency levels and some common KPIs are compared in order to understand if the latter are sufficient to explain the economic efficiency. The novelty of this research lies in two main aspects: (a) the utilization of a robust order-α model coupled with weight restrictions linked to regulatory and sustainability impositions to estimate efficiency, and (b) the comparison of economic efficiency and some commonly used KPIs, including waste fractions and recycling rate. Results point towards efficiency distributions that follow Weibull functions, with the average close to 50%; thus, nearly half of the resources have been well spent in municipal solid waste management services since 2010 onwards. Nonetheless, in an efficient system, that average would be close to 100%. Additionally, the considered management related KPIs do not exhibit any relationship with economic efficiency, which means that their interpretation and usefulness for regulatory issues are both limited and should be used carefully. In other words, those KPIs are not good performance drivers and carry no capacity to explain economic (in)efficiency in urban solid waste management services.
- A geometric aggregation of performance indicators considering regulatory constraints: An application to the urban solid waste managementPublication . Ferreira, Diogo; Caldas, Paulo; Varela, Miguel; Marques, Rui CunhaThere are several ways of aggregating partial performance indicators into composites, each of them with advantages but also shortcomings and caveats. The objectivity demanded for policy-making and regulation of utilities leads many researchers to build their analyses over the so-called Benefit-of-Doubt (BoD), which, in turn, results from the well-known Data Envelopment Analysis (DEA). In a compensatory manner, these models construct piecewise linear frontiers containing the benchmarks, but they disregard increasing marginal products and the existence of non-concavity regions, thus underestimating efficiency. Multiplicative approaches have been proposed to solve these problems; one of these is the geometric (rather than linear) aggregation of variables. But still they fail to solve some problems like the correct treatment of undesirable variables, the existence of regulatory constraints, and the existence of imperfect knowledge of data. Therefore, this paper builds upon a geometric aggregation of performance indicators and proposes some strategies to solve the aforementioned shortcomings of the existing models. The new framework is exemplified and tested with the Portuguese urban solid waste management utilities.
- Investment in drinking water and sanitation infrastructure and its impact on waterborne diseases dissemination: The Brazilian casePublication . Ferreira, Diogo Cunha; Graziele, Ingrid; Marques, Rui Cunha; Gonçalves, JorgeInvestment in sanitation and drinking water infrastructure is essential for universal access to these services in developing countries. Universal coverage of water and sanitation services (WSS) can prevent the dissemination of waterborne diseases and mitigate their adverse effects. These diseases are responsible for many deaths worldwide, especially among the disadvantaged population and children. A causal effect can be established between WSS investment and hospital admissions due to waterborne diseases. Therefore, we considered an innovative network-DEA approach that models the link between serially connected subsystems (upstream investment and downstream hospitalizations). This approach allowed us: to measure the efficiency of both subsystems; estimate the amount of (efficient) investment necessary to universalize the access to proper WSS infrastructure; and mitigate hospital admissions due to waterborne diseases. We used the Brazil case study to test our model. On average, Brazilian states could increase the number of people not requiring hospitalizations due to waterborne diseases by 157 thousand per R$100 million invested in sanitation and 26 thousand per R$100 million invested in drinking water. Our results suggest that relatively small (efficient) investment in those two infrastructure types has a massive impact on hospitalizations. This impact would be more significant than the investment in WSS coverage. Therefore, if safely managed, WSS would cover all citizens, and Brazil would come closer to developed countries.