Examples of the output standard forms include patient’s history, diagnosis results, and billing. In this instance, IT employment can provide information in the form and standard as specified in advance and thus help managing usability dependency between activities. Previous works concerning the effect of IT on hospital efficiency rely on both anecdotal and empirical evidence. Stollman, Matthews, and Cline (2002), in his case study, found that hospital efficiency and financial performance could be improved by introducing IT for San Francisco General Hospital. Parente and Dunbar (2001), in their empirical work, found that hospitals with the integrated IT system have higher total and operating margins compared with hospitals without the integrated IT system. Solovy (2001) showed that, for U.S. hospitals, IT had stronger relationship with productivity and expense management for hospitals with intensive use of IT compared with hospitals that were less IT intensive. There have been several studies using DEA technique to measure the effects of size or IT on hospital efficiency. Register and Bruning (1987) found that small hospitals tend to have higher efficiency in hospital care compared with the large ones for U.S. hospitals. Ferrier and Valdmanis (1996) found that large and small hospitals are relatively more efficient in production and in the utilization of inputs than medium-sized hospitals for rural U.S. hospitals. The analysis of McCallion et al. (1999) found that larger hospitals display higher efficiency in terms of cost, input employment, and productivity for hospitals in Northern Ireland. IT impact on hospital efficiency was analyzed by Lee and Menon (2000) in their study of IT contributions to efficiency of U.S. hospitals. The results showed that hospitals that are highly technically efficient use a greater amount of IT capital compared with those that have low technical efficiency.
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4. The analytical framework
To examine the effects of size and IT on hospital efficiency using DEA, the framework used involves three steps: (1) measurement of hospital efficiency, (2) examination of size effects on efficiency, and (3) assessment of IT impacts on efficiency. Each is discussed further in this section. DEA technique has several unique advantages over other traditional techniques such as ratio and regression analysis. First, DEA technique can deal with multiple inputs and outputs, which is problematic for ratio and regression analysis. This feature can capture the essential characteristics of hospitals that accommodate an array of inputs to produce an array of services. Second, the