Dataset Information

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

ABSTRACT:

Background

While 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.

Methods

This 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.

Results

Despite 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?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.

SUBMITTER: Sultan WIM

PROVIDER: S-EPMC5975658 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

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

Sultan Wasim I M WIM Crispim José J

BMC health services research 20180529 1

<h4>Background</h4>While 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.<h4>Methods</h4>This study examined technical efficiency among 11 public hospitals in West Bank from 2010 through 2015 targe ...[more]

PMID: 29843732

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Project description:With the deepening of population aging, the expenditure of basic endowment insurance in China is increasing. The urban employees' basic endowment insurance(UEBEI) system for is an important part of China's basic social endowment insurance system, which is the most important institutional guarantee for the basic needs of employees after retirement. It not only relates to the living standards of retired employees but also relates to the stability of the whole society. Especially considering the acceleration of urbanization process, the financial sustainability of the basic endowment insurance for employees is of great significance for safeguarding the pension rights of retired employees and realizing the normal operation of the whole system, and the operation efficiency of urban employees' basic endowment insurance(UEBEI) fund inevitably becomes the focus of increasing attention. Based on the panel data of 31 provinces in China from 2016 to 2020, this paper established a three-stage DEA-SFA model, and compared the differences of comprehensive technical efficiency, pure technical efficiency and scale efficiency with radar chart, aiming to explore the operating efficiency of the UEBEI in China and how environmental factors affect it. The empirical results show that at present, the overall level of the expenditure efficiency of the UEBEI fund for urban workers is not high, and all provinces have not reached the efficiency frontier level, and there is still a certain space for efficiency improvement. Fiscal autonomy and elderly dependency ratio are negatively correlated with fund expenditure efficiency, while urbanization level and marketization level are positively correlated with fund expenditure efficiency. The regional difference of fund operation efficiency is significant, from high to low, it is East China, Central China and West China. Reasonable control of environmental variables and narrowing of regional economic development and fund expenditure efficiency differences can provide some enlightenment for better realization of common prosperity.

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Project description:BackgroundGlobally, the increased use of cesarean sections has become prevalent in high-income and low and middle-income countries. In Palestine, the rate had risen from 20.3% in 2014 to 25.1% in 2018. We have rates as high as 35.8% in some governmental hospitals and some as low as 15%. This study aimed to understand better why there is a variation in cesarean rates in governmental hospitals that use the same guidelines.MethodsA qualitative and quantitative research approach was used. In-depth interviews were conducted with 27 specialists, obstetrics and gynecologists, and midwives in five government hospitals. The hospitals were selected based on the 2017 Annual Health Report reported cesarean section rates. The interview guide was created with the support of specialists and researchers and was piloted. Questions focused mainly on adherence to the obstetric guidelines and barriers to the use, sources of information, training for healthcare providers, the hospital system, and the factors that affect decision-making. Each hospital's delivery records for one month were analyzed to determine the reason for each cesarean section.ResultsThe results indicated that each governmental hospital at the system level had a different policy on cesarean sections. The National Guidelines were found to be interpreted differently among hospitals. One obstetrician-gynecologist decided on a cesarean section at high-rate hospitals, while low-rate hospitals used collective decision-making with empowered midwives. At the professional level, all hospitals urged the importance of a continuous training program to refresh the medical team knowledge, in-house training of new members joining the hospital, and discussion of cases subjective to obstetrician-gynecologists interpretations.ConclusionSeveral institutional factors were identified to strengthen the implementation of the national obstetric guidelines. For example, encouraging collective decision-making between obstetrician-gynecologists and midwives, promoting the use of a second opinion, and mandatory training.

Project description:BACKGROUND:Eritrean gross national income of Int$610 per capita is lower than the average for Africa (Int$1620) and considerably lower than the global average (Int$6977). It is therefore imperative that the country's resources, including those specifically allocated to the health sector, are put to optimal use. The objectives of this study were (a) to estimate the relative technical and scale efficiency of public secondary level community hospitals in Eritrea, based on data generated in 2007, (b) to estimate the magnitudes of output increases and/or input reductions that would have been required to make relatively inefficient hospitals more efficient, and (c) to estimate using Tobit regression analysis the impact of institutional and contextual/environmental variables on hospital inefficiencies. METHODS:A two-stage Data Envelopment Analysis (DEA) method is used to estimate efficiency of hospitals and to explain the inefficiencies. In the first stage, the efficient frontier and the hospital-level efficiency scores are first estimated using DEA. In the second stage, the estimated DEA efficiency scores are regressed on some institutional and contextual/environmental variables using a Tobit model. In 2007 there were a total of 20 secondary public community hospitals in Eritrea, nineteen of which generated data that could be included in the study. The input and output data were obtained from the Ministry of Health (MOH) annual health service activity report of 2007. Since our study employs data that are five years old, the results are not meant to uncritically inform current decision-making processes, but rather to illustrate the potential value of such efficiency analyses. RESULTS:The key findings were as follows: (i) the average constant returns to scale technical efficiency score was 90.3%; (ii) the average variable returns to scale technical efficiency score was 96.9%; and (iii) the average scale efficiency score was 93.3%. In 2007, the inefficient hospitals could have become more efficient by either increasing their outputs by 20,611 outpatient visits and 1,806 hospital discharges, or by transferring the excess 2.478 doctors (2.85%), 9.914 nurses and midwives (0.98%), 9.774 laboratory technicians (9.68%), and 195 beds (10.42%) to primary care facilities such as health centres, health stations, and maternal and child health clinics. In the Tobit regression analysis, the coefficient for OPDIPD (outpatient visits as a proportion of inpatient days) had a negative sign, and was statistically significant; and the coefficient for ALOS (average length of stay) had a positive sign, and was statistically significant at 5% level of significance. CONCLUSIONS:The findings from the first-stage analysis imply that 68% hospitals were variable returns to scale technically efficient; and only 42% hospitals achieved scale efficiency. On average, inefficient hospitals could have increased their outpatient visits by 5.05% and hospital discharges by 3.42% using the same resources. Our second-stage analysis shows that the ratio of outpatient visits to inpatient days and average length of inpatient stay are significantly correlated with hospital inefficiencies. This study shows that routinely collected hospital data in Eritrea can be used to identify relatively inefficient hospitals as well as the sources of their inefficiencies.

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Dataset Information

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

Background

Methods

Results

Publications

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

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