Measuring the efficiency of Palestinian public hospitals during 2010–2015: an application of a two-stage DEA method

Abstract

BackgroundWhile health needs and expenditure in the Occupied Palestinian Territories (OPT) are growing, the international donations are declining and the economic situation is worsening. The purpose of this paper is twofold, to evaluate the productive efficiency of public hospitals in West Bank and to study contextual factors contributing to efficiency differences.MethodsThis study examined technical efficiency among 11 public hospitals in West Bank from 2010 through 2015 targeting a total of 66 observations. Nationally representative data were extracted from the official annual health reports. We applied input-oriented Data Envelopment Analysis (DEA) models to estimate efficiency scores. To elaborate further on performance, we used Tobit regression to identify contextual factors whose impact on inefficient performance is statistically significant.ResultsDespite the increase in efficiency mean scores by 4% from 2010 to 2015, findings show potential savings of 14.5% of resource consumption without reducing the volume of the provided services. The significant Tobit model showed four predictors explaining the inefficient performance of a hospital (p < 0.01) are: bed occupancy rate (BOR); the outpatient-inpatient ratio (OPIPR); hospital’s size (SIZE); and the availability of primary healthcare centers within the hospital’s catchment area (PRC). There is a strong effect of OPIPR on efficiency differences between hospitals: A one unit increase in OPIPR will lead a decrease of 19.7% in the predicted inefficiency level holding all other factors constant.ConclusionTo date, no previous studies have examined the efficiency of public hospitals in the OPT. Our work identified their efficiency levels for potential improvements and the determinants of efficient performance. Based on the measurement of efficiency, the generated information may guide hospitals’ managers, policymakers, and international donors improving the performance of the main national healthcare provider. The scope of this study is limited to public hospitals in West Bank. For a better understanding of the Palestinian market, further research on private hospitals and hospitals in Gaza Strip will be useful.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3228-1) contains supplementary material, which is available to authorized users.

Hospital performance and clinical leadership: new evidence from Iran

“…Its chief limitation is that it is an inherently parametric approach and is necessarily based on explicit assumptions about the underlying production technology. Some previous literature in health economics has used this method to assess the efficiency of hospitals 26–29. Because the SFA method implicitly requires the construction of an efficient production-frontier function, detailed information on input prices, output prices and other input costs is, in principle, required.…”

“…The approach of DEA is to view a production possibilities frontier (a data envelopment or efficient frontier) using combinations of inputs and outputs from best performing hospitals 28 29. Thus, we define a…”

“…The model effectively focuses on the desirability of the minimisation of inputs with given outputs, with the character of an efficient non-profit organisation. Some previous empirical research has used an input-orientation model for the evaluation of hospital efficiency 26–29. These were used to guide our selection of variables 26–29…”

Efficiency and scale effect of county public hospitals in Shandong Province, China: a cross-sectional study

“…The variables were determined under the guidance of previous empirical studies. [13][14][15][16][17] The calculation process was implemented using DEAP V.2.1 software. The specific indicators are explained in table 1.…”

Palestinian doctors’ views on patient-centered care in hospitals

“…To date, no studies have examined the Palestinian doctors’ views on the provision of PCC, therefore, our work addresses a major gap in the literature by empirically investigating the perceived importance of PCC among doctors in a developing and unstable country, namely, Palestine. Previous studies are limited to describe the health reform initiatives in Palestine [ 22 , 23 ] or to describe the status of healthcare [ 24 – 30 ]. To elaborate further on the challenges of implementing PCC, we examine the associations between doctors’ views and contextual factors (structural attributes in the workplace).…”