[Efficiency after integrating a hospital with a 'new management model']

This study evaluates the efficiency of a hospital under two management models, private (2015-2018) and public (2019-2022), and examines the impact of the COVID-19 pandemic (2020-2021).

Hospital efficiency was evaluated using an output-oriented data envelopment analysis model with variable returns to scale. Outputs included consultations, emergency visits, surgical procedures, admissions, and inpatient stays, assuming a constant input (=1). Robustness was assessed using a parametric bootstrap (1,500 replications) to obtain bias-corrected efficiency scores and confidence intervals. An interrupted time series analysis was conducted to estimate a counterfactual scenario under continued private management and compare it with observed outcomes under public management.

Efficiency under private management remained consistently close to the frontier during 2015-2018. Under public management, efficiency declined sharply during the pandemic, reaching near-zero values in 2020-2021. Bootstrap results confirmed that these reductions were statistically significant and not random. A partial recovery was observed in 2022; however, efficiency remained below counterfactual projections.

While efficiency performed stably under private management, the public model was markedly affected by the pandemic, though showing signs of resilience thereafter. These findings highlight the sensitivity of hospital efficiency to external crises and governance structures, underscoring the need to strengthen resilience, digitalization, and sustainability to maintain efficiency and equity in future health system disruptions.