<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0213-9111</journal-id>
<journal-title><![CDATA[Gaceta Sanitaria]]></journal-title>
<abbrev-journal-title><![CDATA[Gac Sanit]]></abbrev-journal-title>
<issn>0213-9111</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Española de Salud Pública y Administración Sanitaria (SESPAS)]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0213-91112019000400325</article-id>
<article-id pub-id-type="doi">10.1016/j.gaceta.2018.02.005</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Análisis multinivel de la eficiencia técnica de los hospitales del Sistema Nacional de Salud español por tipo de propiedad y gestión]]></article-title>
<article-title xml:lang="en"><![CDATA[Multilevel analysis of the technical efficiency of hospitals in the Spanish National Health System by property and type of management]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pérez-Romero]]></surname>
<given-names><![CDATA[Carmen]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ortega-Díaz]]></surname>
<given-names><![CDATA[M. Isabel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ocaña-Riola]]></surname>
<given-names><![CDATA[Ricardo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Martín-Martín]]></surname>
<given-names><![CDATA[José Jesús]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Escuela Andaluza de Salud Pública  ]]></institution>
<addr-line><![CDATA[Granada ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad de Jaén Departamento de Economía Aplicada ]]></institution>
<addr-line><![CDATA[Jaén ]]></addr-line>
<country>Spain</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Instituto de Investigación Biosanitaria de Granada  ]]></institution>
<addr-line><![CDATA[Granada ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Universidad de Granada Departamento de Economía Aplicada ]]></institution>
<addr-line><![CDATA[Granada ]]></addr-line>
<country>Spain</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>08</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>08</month>
<year>2019</year>
</pub-date>
<volume>33</volume>
<numero>4</numero>
<fpage>325</fpage>
<lpage>332</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_arttext&amp;pid=S0213-91112019000400325&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_abstract&amp;pid=S0213-91112019000400325&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_pdf&amp;pid=S0213-91112019000400325&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Objetivo Analizar la eficiencia técnica por tipo de propiedad y gestión de los hospitales generales del Sistema Nacional de Salud español (2010-2012) y sus variables explicativas hospitalarias y regionales.  Método Se estudian 230 hospitales combinando el análisis envolvente de datos y modelos transversales de regresión lineal multinivel de efectos fijos. Con el análisis envolvente de datos se miden la eficiencia técnica global, pura y de escala, y con los modelos multinivel, las variables explicativas de eficiencia.  Resultados El índice medio de eficiencia técnica global de los hospitales sin personalidad jurídica es inferior al de los hospitales con personalidad jurídica (0,691 y 0,876 en 2012). Existe una importante variabilidad en eficiencia técnica pura (ETP) por formas de gestión directa, indirecta y mixta. Un 29% de la variabilidad en la ETP es atribuible a diferencias entre comunidades autónomas. La dotación de personalidad jurídica del hospital aumenta en 11,14 puntos la ETP. Por otra parte, la mayoría de las formas de gestión alternativas al modelo tradicional aumentan en porcentajes variables la ETP. En el ámbito regional, según el escenario considerado, la insularidad y la renta media por hogar son variables explicativas de la ETP.  Discusión Tener personalidad jurídica favorece la eficiencia técnica. El marco de regulación y gestión de los hospitales, más que la propiedad pública o privada, parecen explicar la eficiencia técnica. Las características regionales explican de forma relevante la variabilidad en la ETP.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Objective To analyze technical efficiency by type of property and management of general hospitals in the Spanish National Health System (2010-2012) and identify hospital and regional explanatory variables.  Method 230 hospitals were analyzed combining data envelopment analysis and fixed effects multilevel linear models. Data envelopment analysis measured overall, technical and scale efficiency, and the analysis of explanatory factors was performed using multilevel models.  Results The average rate of overall technical efficiency of hospitals without legal personality is lower than hospitals with legal personality (0.691 and 0.876 in 2012). There is a significant variability in efficiency under variable returns (TE) by direct, indirect and mixed forms of management. The 29% of the variability in TE es attributable to the Region. Legal personality increased the TE of the hospitals by 11.14 points. On the other hand, most of the forms of management (different to those of the traditional hospitals) increased TE in varying percentages. At regional level, according to the model considered, insularity and average annual income per household are explanatory variables of TE.  Discussion Having legal personality favours technical efficiency. The regulatory and management framework of hospitals, more than public or private ownership, seem to explain technical efficiency. Regional characteristics explain the variability in TE.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Eficiencia]]></kwd>
<kwd lng="es"><![CDATA[Análisis envolvente de datos]]></kwd>
<kwd lng="es"><![CDATA[Análisis multinivel]]></kwd>
<kwd lng="es"><![CDATA[Sistema Nacional de Salud]]></kwd>
<kwd lng="es"><![CDATA[Hospitales]]></kwd>
<kwd lng="es"><![CDATA[Colaboración público-privada]]></kwd>
<kwd lng="es"><![CDATA[Empresas públicas hospitalarias]]></kwd>
<kwd lng="en"><![CDATA[Efficiency]]></kwd>
<kwd lng="en"><![CDATA[Data envelopment analysis]]></kwd>
<kwd lng="en"><![CDATA[Multilevel analysis]]></kwd>
<kwd lng="en"><![CDATA[National health service]]></kwd>
<kwd lng="en"><![CDATA[Hospitals]]></kwd>
<kwd lng="en"><![CDATA[Public-private partnership]]></kwd>
<kwd lng="en"><![CDATA[Public hospital enterprises]]></kwd>
</kwd-group>
</article-meta>
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