Measuring the Efficiency of Public Hospitals in Kuwait: A Two-Stage Data Envelopment Analysis and a Qualitative Survey Study

Abstract

The recent drop in oil prices has challenged public sector financing in Kuwait. Technical and scale efficiency scores for fifteen public hospitals in Kuwait from 2010 to 2014 were estimated using a two-stage data envelopment analysis (DEA). Technical efficiency scores were regressed against institutional characteristics using Tobit regression to investigate the determinants of efficiency differences in hospitals. Semi-structured interviews were also carried out with fourteen public and private hospital managers to qualitatively explore their perceptions and experience about about factors affecting hospital efficiency.
 
 The mean technical efficiency score for all hospitals was 85.8%, an improvement of 2% since 2010. The mean pure technical efficiency score was 79.6%, improving from 75% in 2010 to 81.2% in 2014. The mean scale efficiency score was 91.8%, improving from 87.6% in 2010 to 94.2% in 2014. Only three hospitals were constantly technically and scale efficient. Tobit regression showed that hospital efficiency was significantly associated with the average length of patient stay. Hospitals with more than 400 beds were potentially more technically and scale efficient. The qualitative study revealed that external factors affecting efficiency commonly included implemention of legislative changes and decreasing bureaucracy, while internal factors included increasing bed capacity and improving qualifications and training of human resources.
 
 Most public hospitals in Kuwait were not technically and scale efficient, but improvements were observed. Potential factors that affected the efficiency of hospitals in Kuwait were identified. These findings are useful to decision-makers in Kuwait for developing strategies to improve public hospital efficiency.

Efficiency evaluation of public hospitals in Kuwait: an application of data envelopment analysis

“…Furthermore, the average VRS technical e ciency score was 0.85, which signi es a room for managerial improvements. The results of this study show that a higher per-centage of public hospitals were technically e cient when compared to the work of Al-sabah et al (11), where 20% of public hospitals were technically e cient in the period 2010-2014 in Kuwait.…”

“…Based on the use of similar variables in other studies (11,13,(36)(37)(38)(39)(40)(41), and the availability of domestic data, four input and two output variables were selected for the rst stage DEA. Input variables included the total number of beds (a widely used proxy for capital in hospital e ciency studies (40,42)) and three labour inputs including the total number of doctors, nurses and non-medical workers.…”

“…total number of beds), bed occupancy rate, average length of stay and the level of care for a hospital (secondary or tertiary) were the chosen independent variables. The criteria for choosing these variables was based on the availability of the data and their use in previous studies (11,22,37,39,(42)(43)(44).…”

Efficiency evaluation of public hospitals in Kuwait: An application of data envelopment analysis

“…Based on the use of similar variables in other studies (11,13,(36)(37)(38)(39)(40)(41), and the availability of domestic data, four input and two output variables were selected for the first stage DEA. Input variables included the total number of beds (a widely used proxy for capital in hospital efficiency studies (40,42)) and three labour inputs including the total number of doctors, nurses and non-medical workers.…”

“…There aren't any recent reports available that describe how much of the general Ministry of Health (MoH) budget is dedicated to fund public hospitals. However, previous research studies stated that, historically, more than 60% of the MoH budget is consumed by secondary and tertiary care public hospitals (11), and the remainder 40% of the MoH's budget is consumed by primary care and public health provision.…”