Abstract
The recent drop in oil prices has challenged public sector financing in Kuwait. Technical and scale efficiency scores for fifteen public hospitals in Kuwait from 2010 to 2014 were estimated using a two-stage data envelopment analysis (DEA). Technical efficiency scores were regressed against institutional characteristics using Tobit regression to investigate the determinants of efficiency differences in hospitals. Semi-structured interviews were also carried out with fourteen public and private hospital managers to qualitatively explore their perceptions and experience about about factors affecting hospital efficiency. The mean technical efficiency score for all hospitals was 85.8%, an improvement of 2% since 2010. The mean pure technical efficiency score was 79.6%, improving from 75% in 2010 to 81.2% in 2014. The mean scale efficiency score was 91.8%, improving from 87.6% in 2010 to 94.2% in 2014. Only three hospitals were constantly technically and scale efficient. Tobit regression showed that hospital efficiency was significantly associated with the average length of patient stay. Hospitals with more than 400 beds were potentially more technically and scale efficient. The qualitative study revealed that external factors affecting efficiency commonly included implementation of legislative changes and decreasing bureaucracy, while internal factors included increasing bed capacity and improving qualifications and training of human resources. Most public hospitals in Kuwait were not technically and scale efficient, but improvements were observed. Potential factors that affected the efficiency of hospitals in Kuwait were identified. These findings are useful to decision-makers in Kuwait for developing strategies to improve public hospital efficiency.
Highlights
In 1962, the Constitution of the State of Kuwait was implemented, which included Articles 11 and 15 ensuring health provision (Sabah, 1962)
The mean pure technical efficiency score was around 80%, which improved from 75% in 2010 to 81% in 2014
At the second stage of the data envelopment analysis (DEA), technical efficiency scores estimated at the first stage were regressed against a group of hospital level variables, including type of hospital, number of beds, bed occupancy rate and average length of stay, in order to determine the factors affected the technical efficiency of the hospitals
Summary
In 1962, the Constitution of the State of Kuwait was implemented, which included Articles 11 and 15 ensuring health provision (Sabah, 1962). In accordance with the above-mentioned articles, a ‘Health for All’ policy was adopted by the government to provide access to comprehensive and high-level quality health services by all (Ministry of Health [MOH], 2016). A rapid increase in health expenditure in the country, due to increased demand for services, has made the situation more challenging (MOH, 2016). The increase in healthcare demand has been attributed to multiple factors, including an increase in the total population in the country from about 1.6 million in 1995 to 4.1 million in 2017, as well as an increase in the total life expectancy at birth from 72.7 to 74.8 for the same years (Databank, 2019). The increase in demand for advanced services is believed to be the result of the growing health awareness in the population (MOH, 2016)
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