Authors: António Rocha; Ana Sara Costa; José Rui Figueira; Diogo Cunha Ferreira; Rui Cunha Marques

Abstract:The Portuguese National Health Service (SNS) was created to provide universal, equal, and tendentiously free care. There are different levels of care (primary, secondary, continued, and palliative) and all of them should deliver quality care services. Quality in healthcare is assessed according to several criteria, such as patient safety, care appropriateness or access. However, over the last years political and economic events have had an impact on the SNS. Hence, structural reforms have occurred, and new healthcare policies have been implemented, mostly focused on improving efficiency and reducing costs. It associated to divestment can increment barriers to access, compromise infrastructures and equipment, and, above all, the service’s quality. This work aims to assess quality of the Portuguese public hospitals (secondary care providers) in this line. To this aim, we adopt a multiple criteria decision aiding approach, applying the Electre Tri-nC method to build a decision model with intervention of an expert, who acts as the decision maker. Hospitals are assessed and assigned to predefined categories, taking into account the hospitals’ performances on various criteria. Each criterion is characterized by different subcriteria, resulting in a complex criteria tree. Thus, to construct a multidimensional scale for each criterion, we propose an innovative approach using an Electre Tri-based method. The results are analyzed and the robustness of the model is tested. This work’s findings may have potential application to healthcare policy and hospital funding in the SNS, in which financial sustainability is a permanent challenge.

Keywords: Quality; Hospitals; National Health Service; Electre Tri-nC; Multiple criteria Decision Analysis; Multidimensional scales

[Bibliographic reference] Rocha, A.; Costa, A. S.; Figueira, J. R.; Ferreira, D. C.; and Marques, R. C. (2021). Quality assessment of the Portuguese public hospitals: A multiple criteria approach. Omega. https://doi.org/10.1016/j.omega.2021.102505

About the journal: Omega reports on developments in management, including the latest research results and applications. Original contributions and review articles describe the state of the art in specific fields or functions of management, while there are shorter critical assessments of particular management techniques. Other features of the journal are the “Memoranda” section for short communications and “Feedback”, a correspondence column. Omega is both stimulating reading and an important source for practising managers, specialists in management services, operational research workers and management scientists, management consultants, academics, students and research personnel throughout the world. The material published is of high quality and relevance, written in a manner which makes it accessible to all of this wide-ranging readership. Preference will be given to papers with implications to the practice of management. Submissions of purely theoretical papers are discouraged. The review of material for publication in the journal reflects this aim.

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Authors: Juan Carlos Leyva López; Jesús Jaime Solano Noriega; José Rui Figueira; Jun Liu; Diego Alonso Gastélum Chavira

Abstract: Electre III is a well-known multiple criteria decision aiding method based on pairwise comparisons. However, it cannot be applied to ranking problems involving many alternatives, because the number of pairwise comparisons can then be rather large. In this paper, we present an evolution-based approach for exploiting large fuzzy outranking relations and deriving a crisp outranking relation with desirable properties. Therefore, the utilization of a fuzzy outranking relation is modeled as a three-objective optimization problem, which is solved by an evolutionary algorithm. The proposed ranking algorithm is a hybrid of the elitist non-dominated sorting genetic algorithm-II (NSGA-II) and a reference point method with the repeated use of a choice mechanism. In addition, a method that portrays the obtained ranking in a Hasse diagram is used for recommendation purposes. We designate the new method RP²-NSGA-II+H. In our experiments, the proposed ranking procedure demonstrates a better performance in terms of ranking error rates than other ranking procedures based on multi-objective evolutionary algorithms. Our experimental results also demonstrate that, with the new procedure, this method can be scaled for hundreds of alternatives.

Keywords:  Multiple criteria analysisFuzzy outranking relationsMulti-objective evolutionary algorithmsRanking proceduresElectre III

[Bibliographic reference] Leyva-López, J.C.; Solano-Noriega, J.J.; Figueira, J.R.; Liu, J.; and Gastélum-Chavira, D.A. (2021) Non-dominated sorting genetic-based algorithm for exploiting a large-sized fuzzy outranking relation. European Journal of Operational Research. [in press]. https://doi.org/10.1016/j.ejor.2020.12.026

About the journal: The European Journal of Operational Research (EJOR) publishes high quality, original papers that contribute to the methodology of operational research (OR) and to the practice of decision making. EJOR contains the following types of papers:

• Invited Reviews, explaining to the general OR audience the developments in an OR topic over the recent years;
• Innovative Applications of OR, describing novel ways to solve real problems;
• Theory and Methodology Papers, presenting original research results contributing to the methodology of OR and to its theoretical foundations;
• Short Communications, if they correct important deficiencies of papers previously published in EJOR.

Authors: Salvatore Corrente; José Rui Figueira; Salvatore Greco

Abstract:  This paper deals with an improved version of the deck of cards method to render the construction of ratio and interval scales more “accurate” compared to the ones built in the original version. The improvement comes from the fact that we can account for a richer and finer preference information provided by the decision-maker, which permits a more accurate modeling of the strength of preference between different levels of a scale. Instead of considering only the number of blank cards between consecutive positions in the ranking of objects, such as criteria and scale levels, we consider also the number of blank cards between not consecutive positions in the ranking. This information is collected in a pairwise comparison table that is not necessarily built with precise values. We can consider imprecise information provided in the form of intervals and missing values. Since the provided information is not necessarily consistent, we propose also some procedures to help the decision-maker to make consistent her evaluations in a co-constructive way interacting with an analyst and reflecting and revising her judgments. A didactic example will illustrate the application of the method.

Keywords:  Multiple Criteria Analysis, Deck of cards method, Decision aiding, Robust information, Pairwise comparison tables.

[Bibliographic reference] Corrente, S.; Figueira, J.; Greco, S. (2020) Pairwise Comparison Tables within the Deck of Cards Method in Multiple Criteria Decision Aiding. European Journal of Operational Research. [in press]. https://doi.org/10.1016/j.ejor.2020.09.036

About the journal: The European Journal of Operational Research (EJOR) publishes high quality, original papers that contribute to the methodology of operational research (OR) and to the practice of decision making. EJOR contains the following types of papers:

• Invited Reviews, explaining to the general OR audience the developments in an OR topic over the recent years;
• Innovative Applications of OR, describing novel ways to solve real problems;
• Theory and Methodology Papers, presenting original research results contributing to the methodology of OR and to its theoretical foundations;
• Short Communications, if they correct important deficiencies of papers previously published in EJOR.

Authors: Diogo Cunha Ferreira; Alexandre Morais Nunes; Rui Cunha Marques

Abstract: Health care systems face resource scarcity that may jeopardise their financial sustainability as well as the quality of delivered health care. In view of that, the association between technical efficiency, access, and quality of services should be investigated, despite some past attempts that led to mixed, unclear, and perhaps biased results. We use a dataset composed of financial resources, hospital services, appropriateness and timeliness of care, patients’ clinical safety, access to health care services, demographics, and epidemiology variables to study the aforementioned link regarding the Portuguese public hospitals (operating between 2013 and 2016). Quality and access data are aggregated into three main composite indicators, through Grey Relational Analysis (GRA). Bias- and environmentally corrected efficiency scores are estimated via bootstrap-based directional Data Envelopment Analysis. A double bootstrap algorithm is employed, using GRA-based quality indicators as predictors of technical efficiency. Evidence suggests that (1) Portuguese public hospitals exhibit low performance in terms of quality, while the different indicators present considerable correlation among them and with hospital size and patients’ complexity characteristics; (2) patients’ clinical safety, appropriateness and timeliness, as well as access to health care services are consistent and significant predictors of technical efficiency; and (3) the association between efficiency, quality, and access depends on the interaction between appropriateness, timeliness, and access. Therefore, quality and access can be improved with no efficiency sacrifice and vice versa.

Keywords:  Hospitals; Efficiency; Quality; Access; Data Envelopment Analysis; Grey Relational Analysis.

[Bibliographic reference] Ferreira, D.; Nunes, A.; Marques, R. (2020) Operational efficiency vs clinical safety, care appropriateness, timeliness, and access to health care. Journal of Productivity Analysis, Vol. 53, pp. 355-375. https://doi.org/10.1007/s11123-020-00578-6

About the journal: The Journal of Productivity Analysis publishes theoretical and applied research addressing the measurement, analysis, and improvement of productivity. The journal’s empirical research papers apply theory and techniques to the measurement of productivity and set forth implications for managerial strategies and public policy to enhance productivity. The journal’s broad scope spans economics, management sciences, operations research, and business and public administration. A partial list of topics includes productivity theory, organizational design, index number theory, and related foundations of productivity analysis. The journal also publishes research on computational methods employed in productivity analysis and empirical research based on data at all levels of aggregation.

Authors: Miguel Aves Pereira; Inês Freire Machete; Diogo Cunha Ferreira; Rui Cunha Marques

Abstract: Health is one of the most fundamental human rights. In that sense, the creation of health systems attempted to provide the population with organisations, institutions, and resources to meet their needs. However, health inequalities are prevalent in all countries. Thus, evaluating health systems is vital to understand this issue. Accordingly, the aim of this work is to develop a multi-criteria decision analysis (MCDA) approach to innovatively rank nine of the European health systems with Beveridgian financing that would help determine the shortcomings of the Portuguese National Health Service and discern the operating “best practices”, in a close interaction with the Portuguese Ministry of Health. First, the panel of decision-making actors was guided through the design of a cognitive map to promote their learning process and help them identify eleven fundamental points of view. Second, their operationalisation was facilitated by selecting acceptable descriptors of performance. Finally, an MCDA approach was proposed to evaluate the chosen health systems using an additive model, which included a sensitivity and a robustness analysis. In the end, the model was perceived by the panel as being trustworthy and reliable. This framework can be used for further MCDA modelling in similar applications based on participatory procedures.

Keywords: Multi-criteria decision analysis; Problem structuring; Model structuring; Cognitive mapping; Health systems.

[Bibliographic reference] Pereira, M.; Machete, I.; Ferreira, D.; Marques, R. (2020) Using multi-criteria decision analysis to rank European health systems: The Beveridgian financing case. Socio-Economic Planning Sciences. https://doi.org/10.1016/j.seps.2020.100913

About the journal: During the last several years, there has been substantial and important growth in the application of quantitative analysis, i.e., operations research/management science, statistics, and related arenas, to interdisciplinary problems arising in the area of socio-economic planning and development. Socio-Economic Planning Sciences is an international journal devoted exclusively to research in this important, but under-represented area. It provides a medium for research that might not appear in more specialized journals, either because of the interdisciplinary or applied character of the study, or the mathematical/quantitative nature of the research. The journal thus serves as a focus for investigations that have hitherto appeared in widely-scattered sources and/or less-than-appropriate sources. Socio-Economic Planning Sciences strongly encourages contributions dealing with applications of quantitative models and techniques to important decision problems in the service and public sectors. Of particular interest are accounts of such studies carried out in developing countries and economically emerging regions of the world. Review articles in important methodological and substantive areas are also of interest.

Incorporating preference information in a range directional composite indicator: The case of Portuguese public hospitals.

Authors: Miguel Pereira; Ana Camanho; José Figueira; Rui Cunha Marques. Presented by Miguel Pereira.

Abstract: Understanding the complexity of an age when systems deal with increasing amounts of data is vital to the survival of public and private entities. Composite indicators (CIs) arise as aggregators of key performance indicators via a single measure, reflecting those quantitative and/or qualitative dimensions. Data envelopment analysis (DEA) is one way to build such measures. Some DEA models are employed to compute CIs, but only a handful of them can handle desirable and undesirable outputs and the preference information of decision-making actors at the same time. Building on the envelopment formulation of the ‘benefit of the doubt’ approach with weight restrictions, we propose using a range directional distance function to yield a single CI that assesses the performance of the Portuguese public hospitals according to two key points of view (the users’ and the providers’) across distinct perspectives that test its robustness. Ultimately, possible policy implications were withdrawn from this cooperative application with the Portuguese Ministry of Health.

About the venue: NAPW has long been established as a major biennial conference on the topics of productivity, efficiency and performance analysis. Following the successful NAPW X, we expect a large and diverse body of participants to attend NAPW XI in Miami. This year’s theme is especially important to the Miami Herbert Business School, Sustainable Productivity. Sustainable productivity encapsulates enduring growth and process improvements, a healthy workforce, and surrounding operational environment, a regular flow of new ideas and innovations, and an unwavering optimism about the direction of the firm. The school recently launched the only STEM certified Masters in Sustainable Business and the Miami Herbert Business School is the only academic building in the state of Florida to have achieved LEED Gold certification. Submission for presentation on all areas related to the measurement, assessment, and character of sustainable productivity are invited. Submissions on the theory and application of economics, econometrics, statistics, management science and operational research related to problems in the areas of productivity and efficiency measurement more broadly are highly encouraged. Our aim is to have a conference program that features all popular techniques and methodologies within the field, including stochastic frontier analysis and data envelopment analysis. We also welcome papers on broader issues related to measuring, understanding, incentivizing and improving the productivity and performance of firms, public services, and industries.

Website: https://www.bus.miami.edu/thought-leadership/business-conferences/napw/index.html

Program: https://www.bus.miami.edu/_assets/pdfs/thought-leadership/napw/napwxi_program.pdf

Authors: Diogo Cunha Ferreira; Rui Cunha Marques

Abstract: Public-private partnerships (PPPs) are widely spread long-term arrangements between governments and strategic private partner(s). One of their objectives is to reduce the financial pressure on the public treasury with regard to new investments. PPPs have been employed within the health care sector which, in turn, carries a huge social burden. In Portugal, for instance, PPPs in health care concern bundling hospital infrastructure and clinical services management. Notwithstanding the need to ensure sustainability and efficient use of hospital resources, it is clearly compulsory to guarantee that patients receive appropriate and timely care, with maximum security, and equitable manner. Still, little or even no attention has been paid in the literature to the clinical response capacity of PPP hospitals and to the populism arguing that these entities have a lower social performance than typical public hospitals. This study uses robust benchmarking methodologies alongside recent data about Portuguese hospitals (FY2012-FY2017) to demystify this idea and to demonstrate that, actually, PPP hospitals can deliver health care services with social performance levels at least as good as public hospitals.

Keywords: Health policy; Public-private partnerships; Public hospitals; Social performance; Benefit of doubt.

[Bibliographic reference] Ferreira, D.; Marques, R. (2020). Public-private partnerships in health care services: Do they outperform public hospitals regarding quality and access? Evidence from Portugal. Socio-Economic Planning Sciences. https://doi.org/10.1016/j.seps.2020.100798

About the journal: During the last several years, there has been substantial and important growth in the application of quantitative analysis, i.e., operations research/management science, statistics, and related arenas, to interdisciplinary problems arising in the area of socio-economic planning and development. Socio-Economic Planning Sciences is an international journal devoted exclusively to research in this important, but under-represented area. It provides a medium for research that might not appear in more specialized journals, either because of the interdisciplinary or applied character of the study, or the mathematical/quantitative nature of the research. The journal thus serves as a focus for investigations that have hitherto appeared in widely-scattered sources and/or less-than-appropriate sources. Socio-Economic Planning Sciences strongly encourages contributions dealing with applications of quantitative models and techniques to important decision problems in the service and public sectors. Of particular interest are accounts of such studies carried out in developing countries and economically emerging regions of the world. Review articles in important methodological and substantive areas are also of interest.

Authors: Alexandre Morais Nunes; Diogo Cunha Ferreira; Andreia de Matos; Rui Miranda Julião

Abstract: Brand-name medicines have dominated the Portuguese market for several decades with unquestionable exclusivity. This resulted particularly from the absence of a requirement of prescriptions by international non-proprietary name. To promote the enhancement of both efficiency and sustainability in the health system, the Portuguese government introduced the generics in Portugal by the 90 s. However, only in the first decade of the 21^st century were some policies implemented to increase their market share. Although some expectations were created, the use of generics has increased moderately during that period, in which policies to promote them were consolidated by imposing the austerity principles in the midst of the economic and social crisis. This study analyses the main policy measures already implemented as well as the incentives created for the replacement of brand-name medicines with generics. In addition, the present study also makes some recommendations to promote a broader and better use of generics in Portugal.

Keywords: Generics; Portugal; Economic crisis; Broadening use of generics.

[Bibliographic reference] Nunes, A.; Ferreira, D.; Matos, A.; Julião, R. (2020). The generic drugs market in Portugal: What’s next?. Health Policy. https://doi.org/10.1016/j.healthpol.2020.02.014

About the journal: Health Policy is intended to be a vehicle for the exploration and discussion of health policy and health system issues and is aimed in particular at enhancing communication between health policy and system researchers, legislators, decision-makers and professionals concerned with developing, implementing, and analysing health policy, health systems and health care reforms, primarily in high-income countries outside the U.S.A. Health care policies and reforms are made at an ever-increasing pace in countries around the world – and policy-makers are increasingly looking to other countries for solutions to their own problems. Health Policy is committed to support this international dialogue to ensure that policies are not just copied but used and adapted based on the specific problems and objectives as well as the respective context.

Authors: Ana Sara Costa; Salvatore Corrente; Salvatore Greco; José Rui Figueira; José Borbinha

Abstract: Cat-SD (Categorization by Similarity-Dissimilarity) is a multiple criteria decision aiding method for dealing with nominal classification problems (predefined and non-ordered categories). Actions are assessed according to multiple criteria and assigned to one or more categories. A set of reference actions is used to define each category. The assignment of an action to a given category depends on the comparison of the action to each reference set according to likeness thresholds. Distinct sets of criteria weights, interaction coefficients, and likeness thresholds can be defined per category. When applying Cat-SD to complex decision problems, may be useful to consider a hierarchy of criteria to give a more intelligible vision of the performances of the considered actions. We propose to apply Multiple Criteria Hierarchy Process to Cat-SD to take into account criteria structured in a hierarchical way. On the basis of the known deck of cards method, we also consider an imprecise elicitation of parameters permitting to consider interactions and antagonistic effects between criteria. The elicitation procedure we are proposing can be applied to any Electre method. With the purpose of exploring the assignments obtained by Cat-SD considering possible sets of parameters, we propose to apply the Stochastic Multicriteria Acceptability Analysis (SMAA). The SMAA methodology allows to draw statistical conclusions on the classification of the actions. The proposed method, SMAA-hCat-SD, helps the decision maker to check the effects of the variation of parameters on the classification at different levels of the hierarchy. We propose also a procedure, based on the concept of loss function, to get a deterministic classification fulfilling some requirements given by the decision maker and taking into account the hierarchy of criteria and the probabilistic assignments obtained through SMAA. Also this procedure can be applied to any classification Electre method. The application of the new proposal is shown through an example.

Keywords: Multiple criteria decision aiding; Hierarchy of criteria; Interaction effects; Deck of cards method; Robust optimization; Loss function; Deterministic classification.

[Bibliographic reference] Costa, AS; Corrente, S; Greco, S; Figueira, JR; Borbinha, J (2020). A robust hierarchical nominal multicriteria classification method based on similarity and dissimilarity. European Journal of Operational Research. https://doi.org/10.1016/j.ejor.2020.04.021

About the journal: The European Journal of Operational Research (EJOR) publishes high quality, original papers that contribute to the methodology of operational research (OR) and to the practice of decision making. EJOR contains the following types of papers:

• Invited Reviews, explaining to the general OR audience the developments in an OR topic over the recent years;
• Innovative Applications of OR, describing novel ways to solve real problems;
• Theory and Methodology Papers, presenting original research results contributing to the methodology of OR and to its theoretical foundations;
• Short Communications, if they correct important deficiencies of papers previously published in EJOR.