Abstract
BackgroundIn recent years, there has been growing interest in measuring the efficiency of hospitals in Iran and several studies have been conducted on the topic. The main objective of this paper was to review studies in the field of hospital efficiency and examine the estimated technical efficiency (TE) of Iranian hospitals.MethodsPersian and English databases were searched for studies related to measuring hospital efficiency in Iran. Ordinary least squares (OLS) regression models were applied for statistical analysis. The PRISMA guidelines were followed in the search process.ResultsA total of 43 efficiency scores from 29 studies were retrieved and used to approach the research question. Data envelopment analysis was the principal frontier efficiency method in the estimation of efficiency scores. The pooled estimate of mean TE was 0.846 (±0.134). There was a considerable variation in the efficiency scores between the different studies performed in Iran. There were no differences in efficiency scores between data envelopment analysis (DEA) and stochastic frontier analysis (SFA) techniques. The reviewed studies are generally similar and suffer from similar methodological deficiencies, such as no adjustment for case mix and quality of care differences. The results of OLS regression revealed that studies that included more variables and more heterogeneous hospitals generally reported higher TE. Larger sample size was associated with reporting lower TE.ConclusionsThe features of frontier-based techniques had a profound impact on the efficiency scores among Iranian hospital studies. These studies suffer from major methodological deficiencies and were of sub-optimal quality, limiting their validity and reliability. It is suggested that improving data collection and processing in Iranian hospital databases may have a substantial impact on promoting the quality of research in this field.
Highlights
In recent years, there has been growing interest in measuring the efficiency of hospitals in Iran and several studies have been conducted on the topic
Data envelopment analysis was applied in all studies, with three studies using both data envelopment analysis (DEA) and stochastic frontier analysis (SFA) to estimate the efficiency scores
2010 was no longer significant and heterogeneity in type of hospital was significant at the 10% level. Another sensitivity analysis showed that no single study had a significant effect on our results. In this analysis, we reviewed studies that measured technical efficiency (TE) of hospitals in Iran and quantified the impact of model specifications on the reported efficiency scores using metaregression analysis based on 43 extracted observations from 29 different studies
Summary
There has been growing interest in measuring the efficiency of hospitals in Iran and several studies have been conducted on the topic. In comparison with international figures, these figures indicate technical inefficiency in hospitals in Iran and there is much scope for improvement This inefficiency has attracted the attention of policy-makers, resulting in measures such as formation of a Board of Trustees in hospitals, implementation of performance-based budgeting, establishing a hospital information system and maintenance management [5]. In response to this policy interest, a considerable body of literature has emerged to measure the efficiency of Iranian hospitals in recent years. As these studies are mainly policy-oriented, and aim to assist policy-making, the estimated efficiency scores should be robust to model specifications [6] or policy-makers should at least be aware of the effects of these specifications on estimated scores
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