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.