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Hospitals' efficiency in Iran: A systematic review and meta-analysis
Somayeh Mahdiyan1, Ali Dehghani2, Arefe Dehghani Tafti2
1Management of Health Services, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Journal of Education and Health Promotion
|July 24, 2019
Summary
This meta-analysis found that Data Envelopment Analysis (DEA) reported higher hospital technical efficiency scores (0.885) compared to Stochastic Frontier Analysis (SFA) (0.809) in Iran. Policymakers should establish clear efficiency indices for better evaluation.
Area of Science:
- Healthcare Management
- Operations Research
- Health Economics
Background:
- Measuring hospital efficiency is crucial for improving healthcare quality.
- Technical efficiency scores range from 0 to 1, with scores below 1 indicating inefficiency.
- This study focuses on hospital efficiency in Iran, utilizing Data Envelopment Analysis (DEA) and Stochastic Frontier Analysis (SFA).
Purpose of the Study:
- To determine the mean technical efficiency scores of hospitals in Iran.
- To compare efficiency scores based on hospital type, activity, and orientation (input/output).
- To analyze returns to scale using DEA and SFA methods.
Main Methods:
- A systematic review and meta-analysis of studies measuring hospital efficiency in Iran from 2001 to 2017.
- Searched 11 databases for studies using DEA and SFA, identifying 24 relevant articles.
- Employed random-effect and fixed-effect models, investigating heterogeneity with Q-Cochran test and I² index, and meta-regression.
Main Results:
- The average technical efficiency scores were 0.885 for DEA and 0.809 for SFA.
- DEA scores for input-oriented, output-oriented, general, specialized, and constant returns were 0.885, 0.891, 0.952, and 0.913, respectively.
- SFA scores were 0.733, 0.664, 0.641, and 0.802, indicating that inputs and outputs significantly affect efficiency measurement.
Conclusions:
- DEA is a flexible tool for measuring hospital efficiency, handling multiple inputs/outputs simultaneously.
- DEA has been more widely used in Iranian studies compared to SFA.
- While DEA showed higher efficiency in governmental educational hospitals, establishing specific efficiency indices is recommended for comprehensive evaluation.