Abstract
Purpose: Aging, chronic diseases, and development of expensive and advanced technologies has increased hospitals costs which have necessitated their efficiency in utilization of resources. This systematic review and meta-analysis study has assessed the efficiency of Iranian hospitals before and after the 2011 Health Sector Evolution Plan (HSEP).Methods: Internal and external databases were searched using specified keywords without considering time limitations. The retrieved articles were entered into EndNote considering inclusion and exclusion criteria, and the final analysis was performed after removing duplicates. Heterogeneity between the studies was assessed using Q and I2 tests. A forest plot with 95% confidence intervals (CI) was used to calculate different types of efficiency. The data were analyzed using STATA 14.Results: Random pooled estimation of hospitals technical, managerial, and scale efficiencies were 0.84 (95%CI = 0.78, 0.52), 0.9 (95%CI = 0.85, 0.94), and 0.88 (95%CI = 0.84, 0.91), respectively. Sub-group analysis on the basis of study year (before and after HSEP in 2011) indicated that random pool estimation of technical (0.86), managerial (0.91), and scale (0.90) efficiencies of Iranian hospitals for 2011 and before were better than technical (0.78), managerial (0.86), and scale (0.74) efficiencies after 2011.Conclusion: Type of hospital ownership was effective on hospital efficiency. However, HSEP has not improved hospital efficiency, so it is necessary for future national plans to consider all aspects.
Highlights
Hospitals have an undeniable role in providing healthcare services to society but their increasing costs have become an important challenge for many countries
Search query used for PubMed was: (((data envelopment analysis) OR DEA) AND hospital) AND Iran)))
The results indicated that technical efficiency of Iranian hospitals had high variation, so that it ranged from 0.34 in the Mahfoozpor et al study to 1 in Raeisian et al and Najafi et al On the basis of random effects modeling, random pooled estimation of hospital technical efficiency was 0.84 (Table 3, Figure 2)
Summary
Hospitals have an undeniable role in providing healthcare services to society but their increasing costs have become an important challenge for many countries. Utilization of technologies and new methods of diagnosis and treatment of diseases and increasing numbers of elderly citizens, increasing chronic diseases, increasing demands for healthcare services and specialists, and hospital errors have increased health system costs (1, 2). Because of these issues and problems, hospitals always encounter human and financial resource constraints which have necessitated efficiency in consuming resources more than ever (3). Technical efficiency means using the lowest amount of input to produce a specified amount. Managerial efficiency means hard working, correct policymaking, application of the correct number of employees, and the correct combination of production factors (4)
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