Abstract
Jordan is committed to providing healthcare services for more than a million refugees coming from bordering countries in the last five years and face increasing demand for the services of public hospitals. Their efficiency is a key success factor to manage the unique and complex context effectively. This research investigated the technical and scale efficiency of the Jordanian Public Hospitals. The study applied constant and variable returns to scale input-oriented DEA models to rank hospitals and allocate the factors associated with inefficient operations. The work tested 27 general public hospitals from 2010 to 2014, in total, 135 observations were examined with respect to four input-measures and three output-measures. The output-measures characterize three functional areas; inpatient, outpatient, and ambulance and emergency departments. Further, decomposing the technical efficiency allowed considering for scale effects. Findings revealed that 25 observations out of 135 ones were efficient and constructed the efficient frontier. Eight hospitals in 2014 were on the frontier, but weakly efficient and all suffered slacks. Targets and reference sets were identified to guide improvements. Hospitals were sorted into five performance patterns; promising, declining, stable good, stable poor, and unstable. The number of physicians and outpatient services recorded high slacks. On average, 2013 scored the best performance. Scale analysis shows that a capacity of 160 beds is an optimal production size in Jordan. Inefficient and weakly efficient hospitals can target areas of opportunities for performance improvements. The efficiency of Public hospitals in Jordan was not investigated since 1992. The study was limited to public hospitals from 2010 to 2014.
Highlights
The operational environment in Jordan continues to be considerably affected by the security situation in Syria and the influx of the Syrian refugees into the country, as well as by the development in Iraq and Gaza in 2014 (UNHCR, 2016)
If θ*= 1.0 the hospital is on the frontier and cannot reduce its input proportionally when θ* < 1.0 the hospital is dominated by the frontier and able to reduce all its inputs proportionally by (1.0 - θ*) to become efficient
To bypass the equal ranking of efficient hospitals by the Constant Return to Scale (CRS) model in stage (1), we used the holistic ranking model proposed by Andersen & Petersen (1993) that discriminates among the efficient DMUs
Summary
The operational environment in Jordan continues to be considerably affected by the security situation in Syria and the influx of the Syrian refugees into the country, as well as by the development in Iraq and Gaza in 2014 (UNHCR, 2016). Due to regional political unsteadiness, there is an unpredictable movement of refugees which places greater demands on the country’s infrastructure and health services (Lozi, 2013). Jordan has granted the Syrian refugees access to services as health and education. The Jordanian Ministry of Health is an operational partner with UNHCR to respond to the refugees’ needs (MoH, 2015). Thereby, the Jordanian public hospitals expect more workloads and need to cope with the government commitments toward the refugees; their efficiency becomes a key component of their role
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