# Robust Additive Value-Based Efficiency Analysis
## 5 Case Study concerning Evaluation of Healthcare System in Poland  
This section reports the results of a case study concerning an assessment of the quality of the healthcare system in Poland. This sector faces the challenge of improving the quality of provided services. This can be attained by advancing some indicators reflecting both the system's functioning and the perception by patients. We consider sixteen vivodeships (provinces) in Poland as DMUs (see Table 1). These administrative areas govern their healthcare independently, so it makes sense to highlight their differences using a uniformly computed set of indicators. Such an evaluation is critical, given the rapid development of new technologies and major transformations in the healthcare sector. Following [29], we consider three main categories of factors representing desirable characteristics in the complex healthcare system. Two areas--health improvement and financial management--are based on objective indicators and parameters, whereas the system's evaluation by patients is, to some extent, subjective. In particular, improving health is the ultimate aim of the healthcare system. In this regard, it is relevant to consider the example dimensions of the health status that are affected by how the system is operated, given the ever-growing needs of patients. Financial management is essential in healthcare, as this sector experiences the availability of limited resources. Hence, it is vital to assess the financial situation of medical facilities, the management of infrastructure, and the economic efficiency of treatments and therapies. Finally, consumer satisfaction is becoming more and more important in evaluating the healthcare sector. Thus, it is desirable to consider the quality of services, comfort in using patients' services, and patient rights. The hierarchy of inputs and outputs for the case study is presented in Figure 4. Among the nine factors, there are six outputs (\(H_{1}\), \(H_{3}\), \(F_{1}\), \(F_{3}\), \(S_{2}\), and \(S_{3}\)) and three inputs (\(H_{2}\), \(F_{2}\), and \(S_{1}\)). The selected indicators are representative of the three dimensions and the viewpoints of the most important stakeholders. The indicators in the health improvement category (\(H\)) are representative of the dimensions of preventing diseases (\(H_{1}\)), their exacerbation (\(H_{2}\)), and deaths (\(H_{3}\)). The factors considered in the financial management category stand for the financial situation of healthcare units (\(F_{1}\)) and infrastructure management (\(F_{2}\) and \(F_{3}\)). The inputs and outputs in the system's evaluation category (\(S\)) represent the waiting time (\(S_{1}\)), official quality system (\(S_{2}\)), and patient satisfaction (\(S_{3}\)). Moreover, we verified that the trends that these indicators confirm also represent other factors that could be considered in the three categories. Note that analysis including over 40 indicators available for assessing the healthcare system in Poland [29] would not make much sense in the context of DEA, as the number of inputs and outputs would be too large compared to the number of DMUs. Typically, such analyses indicate that all or almost all units are efficient, as even the worst performers tend to specialize in some particular aspects. Hence, we opted for an analysis with a reduced--though carefully selected--set of indicators. The performances of the sixteen voivodeships in terms of nine considered factors are given in Table 1.