ABSTRACT
Background: Measuring the efficiency and productivity of hospitals is a key tool to cost contamination and management that is very important for any healthcare system for having an efficient system. Objective: The purpose of this study is to examine the effects of contextual factors on hospital efficiency in Iranian public hospitals. Methods: This was a quantitative and descriptive-analytical study conducted in two steps. First, we measured the efficiency score of teaching and non-teaching hospitals by using the Data Envelopment Analysis (DEA) method. Second, the relationship between efficiency score and contextual factors was analyzed. We used median statistics (first and third quarters) to describe the concentration and distribution of each variable in teaching and non-teaching hospitals, then the Wilcoxon test was used to compare them. The Spearman test was used to evaluate the correlation between the efficiency of hospitals and contextual variables (province area, province population, population density, and the number of beds per hospital). Results: On average, the efficiency score in non-teaching hospitals in 31 provinces was 0.67 and for teaching hospitals was 0.54. Results showed that there is no significant relationship between the efficiency score and the number of hospitals in the provinces (p = 0.1 and 0.15, respectively). The relationship between the number of hospitals and the population of the province was significant and positive. Also, there was a positive relationship between the number of beds and the area of the province in both types of teaching and non-teaching hospitals. Conclusion: Multilateral factors influence the efficiency of hospitals and to address hospital inefficiency multi-intervention packages focusing on the hospital and its context should be developed. It is necessary to pay attention to contextual factors and organizational architecture to improve efficiency.
Subject(s)
Efficiency, Organizational , Hospitals, Public , IranABSTRACT
BACKGROUND: Building upon decades of continuous reforms, Iran has been implementing various initiatives to reach universal health coverage (UHC). Improving efficiency is a crucial intermediate policy objective for UHC. Therefore, this article aimed to measure the efficiency and productivity changes of the Iranian health system in making progress towards UHC during 2010-2015 in comparison with 36 selected other upper-middle-income countries. METHODS: We used panel data to measure the variations in technical efficiency (TE) and total factor productivity (TFP) through an extended data envelopment analysis (EDEA) and Malmquist productivity index, respectively. General government health expenditure (GGHE) per capita (International dollar) was selected as the input variable. Service coverage of diphtheria, tetanus and pertussis; family planning; antiretroviral therapy; skilled attendants at birth; Tuberculosis treatment success rate; and GGHE as % of total health expenditure (THE) were considered as output variables. The data for each indicator were taken from the Global Health Observatory data repository and World Development Indicator database, for 6 years (2010-2015). RESULTS: The TE scores of Iran's health system were 0.75, 0.77, 0.74, 0.74, 0.97, and 0.84 in the period 2010-2015, respectively. TFP improved in 2011 (1.02), 2013 (1.01), and 2014 (1.30, generally). The overall efficiency and TFP increased in 2014. Changes made in CCHE per capita and GGHE/THE attributed to the increase of efficiency. CONCLUSION: There is a growing demand for efficiency improvements in the health systems to achieve UHC. While there are no defined set of indicators or precise methods to measure health system efficiency, EDEA helped us to draw the picture of health system efficiency in Iran. Our findings highlighted the essential need for targeted and sustained interventions, i.e., allocation of enough proportion of public funds to the health sector, to improve universal financial coverage against health costs aiming to enhance the future performance of Iran's health system, ultimately. Such tailored interventions may also be useful for settings with similar context to speed up their movement towards improving efficiency, which in turn might lead to more resources to reach UHC.
ABSTRACT
Unplanned growth of cities is a matter of concern these days. Lack of attention to proper patterns of urban development has left so many harmful effects on human health and the environment. One of the most effective methods that can be used to measure the efficiency of urban development is data envelopment analysis (DEA). The present study is an attempt to evaluate the performance and efficiency of development of Yazd City using the DEA over the years 1983-2013. In this regard, the ecological factors, affecting the growth of the city of Yazd in the study period, were identified initially. The factors include elevation, slope, aspect, geology, morphology, soil, water quantity, climatic features, and land cover. Next, using variable returns to scale (BCC) based on the output-oriented approach, the efficiency of development of Yazd City was calculated by GAMS software to recognize efficient and inefficient units. Then, Anderson-Peterson (AP) ranking method was used to rank the most efficient units in the development of Yazd City over the study years. The obtained results indicated that the DMUs 2 (1984), 3 (1986), 12 (1994), 15 (1997), 21 (2004), up to 30 (2013) were efficient and introduced as units with proper performance in terms of ecological indicators affecting the urban growth. According to the Anderson-Peterson method, DMU 3 (1986) was recognized as the most efficient unit, ranked the highest (with a score of 1.20319) among the other 30 units in terms of ecological indicators affecting development of the urban growth. The research findings could clarify the strength and weak points of the ecological characteristics of the city. According to which, a comprehensive understanding of the performance of the city could be given to relevant authorities in order to amend inefficient units of urban development or direct the orientation of the city growth toward the most efficient directions.
