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BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Research article

A systematic review on hospital inefficiency in the Eastern Mediterranean Region: sources and solutions

Authors: Hamid Ravaghi, Mahnaz Afshari, Parvaneh Isfahani, Victoria D. Bélorgeot

Published in: BMC Health Services Research | Issue 1/2019

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Abstract

Background

Evaluating hospital efficiency is a process to optimize resource utilization and allocation. This is vital due to hospitals being the largest financial cost in a health system. To limit avoidable uses of hospital resources, it is important to identify the sources of hospital inefficiencies and to put in place measures towards their reduction and elimination. Thus, the purpose of this research is to examine the sources of hospital inefficiency in the Eastern Mediterranean Region, and existing strategies tackling this issue.

Methods

In this study, the electronic databases MEDLINE (via PubMed), Web of Science, Embase, Google, Google Scholar, and reference lists of selected articles, were explored. Studies on inefficiency, sources of inefficiency, and strategies for inefficiency reduction in the Eastern Mediterranean region hospitals, published between January 1999 and May 2018, were identified. A total of 1466 articles were selected using the initial criteria. After further reviews based on the inclusion and exclusion criteria, 56 studies were eligible for this study. The chosen studies were conducted in Iran (n = 35), Saudi Arabia (n = 5), Tunisia (n = 5), Jordan (n = 4), Pakistan (n = 2), the United Arab Emirates, Palestine, Iraq, Oman, and Afghanistan (n = 1 each). These studies were analyzed using content analysis in MAXQDA 10.

Results

The analysis showed that approximately 41% of studies used data envelopment analysis (DEA) to measure hospital efficiency. Sources of hospital inefficiency were divided into four categories for analysis: Hospital products and services, hospital workforce, hospital services delivery, and hospital system leakages.

Conclusion

This study has revealed some sources of inefficiency in the Eastern Mediterranean Region hospitals. Inefficiencies are thought to originate from excess workforce, excess beds, inappropriate hospital sizes, inappropriate workforce composition, lack of workforce motivation, and inefficient use of health system inputs. It is suggested that health policymakers and managers use this evidence to develop appropriate strategies towards the reduction of hospital inefficiency.
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Literature
1.
2.
Mosadeghrad AM, Esfahani P, Nikafshar M. Hospitals’ efficiency in Iran: a systematic review and meta-analysis of two decades of research. J Payavard Salamat. 2017;11(3):318–31.
3.
Parker D, Newbrander W. Tackling wastage and inefficiency in the health sector; 1994.
4.
5.
World Health Organization. Improving hospital performance in the Eastern Mediterranean Region, 2009.
6.
Abdullatif AA. Hospital care in WHO Eastern Mediterranean Region; an agenda for change. In: International Hospital Federation Reference Book 2005/2006. Ferney Voltaire: International Hospital Federation; 2005.
7.
Pourreza A, Alipour V, Arabloo J, Bayati M, Ahadinezhad B. Health production and determinants of health systems performance in WHO Eastern Mediterranean Region. East Mediterr Health J. 2017;23(5):368–74.PubMed
8.
9.
10.
11.
Pabon LH. Evaluating hospital performance through simultaneous application of several indicators; 1986.
12.
13.
14.
15.
Hatam N. The role of Data Envelopment Analysis (DEA) pattern in the efficiency of social security hospitals in Iran. Iran Red Crescent Med J. 2008;10(3):211–7.
16.
17.
OECD. Health at a glance: Europe 2018: Organization for economic. Paris: OECD; 2018.
18.
OECD Health Data 2001. A comparative analysis of 30 countries; data sources, definitions and methods. Paris: OECD; 2001.
19.
Al-Shammari M. A multi-criteria data envelopment analysis model for measuring the productive efficiency of hospitals. Int J Oper Prod Man. 1999;19(9):879–91.
20.
21.
22.
Goshtasebi A, Vahdaninia M, Gorgipour R, Samanpour A, Maftoon F, Farzadi F, et al. Assessing hospital performance by the Pabon lasso model. Iran J Public Health. 2009;38(2):119–24.
23.
Jandaghi G, Matin HZ, Doremami M, Aghaziyarati M. Efficiency evaluation of Qom public and private hospitals using data envelopment analysis. Eur J Econ Finance Adm Sci. 2010;22(2):83–91.
24.
Hatam N, Moslehi S, Askarian M, Shokrpour N, Keshtkaran A, Abbasi M. The efficiency of general public hospitals in Fars Province, Southern Iran. Iran Red Crescent Med J. 2010;12(2):138.
25.
26.
27.
28.
Al-Shayea AM. Measuring hospital’s units efficiency: a data envelopment analysis approach. Int J Eng Technol. 2011;11(6):7–19.
29.
Ahmadkiadaliri A, Haghparast-Bidgoli H, Zarei A. Measuring efficiency of general hospitals in the south of Iran. World Appl Sci J. 2011;13(6):1310–6.
30.
Osmani AR. Technical efficiency of district hospitals in Afghanistan: a data envelopment analysis approach: Chulalongkorn University; 2012.
31.
Farzianpour F, Hosseini S, Amali T, Hosseini S, Hosseini SS. The evaluation of relative efficiency of teaching hospitals. Am J Appl Sci. 2012;9(3):392.
32.
33.
Marnani AB, Sadeghifar J, Pourmohammadi K, Mostafaie D, Abolhalaj M, Bastani P. Performance assessment indicators: how DEA and Pabon lasso describe Iranian hospitals’ performance. Health Med. 2012;6(7):791–6.
34.
Sheikhzadeh Y, Roudsari AV, Vahidi RG, Emrouznejad A, Dastgiri S. Public and private hospital services reform using data envelopment analysis to measure technical, scale, allocative, and cost efficiencies. Health Promot Perspect. 2012;2(1):28.PubMedPubMedCentral
35.
Yusefzadeh H, Ghaderi H, Bagherzade R, Barouni M. The efficiency and budgeting of public hospitals: case study of Iran. Iran Red Crescent Med J. 2013;15(5):393.PubMedPubMedCentral
36.
37.
38.
Ajlouni M, Zyoud A, Jaber B, Shaheen H, Al-Natour M, Anshasi RJ. The relative efficiency of Jordanian public hospitals using data envelopment analysis and Pabon Lasso diagram. Glob J Bus Res. 2013;7(2):59–72.
39.
Abouel-Seoud M. Measuring efficiency of reformed public hospitals in Saudi Arabia: an application of data envelopment analysis. Int J Econ Manag Sci. 2013;2(9):44–53.
40.
Bastani P, Vatankhah S, Salehi M. Performance ratio analysis: a national study on Iranian hospitals affiliated to ministry of health and medical education. Iran J Public Health. 2013;42(8):876.PubMedPubMedCentral
41.
Younsi M. Performance of Tunisian public hospitals: a comparative assessment using the Pabon Lasso model. Hosp Res. 2014;3(4):159–66.
42.
Torabipour A, Najarzadeh M, Mohammad A, Farzianpour F, Ghasemzadeh R. Hospitals productivity measurement using data envelopment analysis technique. Iran J Public Health. 2014;43(11):1576.PubMedPubMedCentral
43.
44.
45.
46.
Lotfi F, Kalhor R, Bastani P, Zadeh NS, Eslamian M, Dehghani MR, et al. Various indicators for the assessment of hospitals’ performance status: differences and similarities. Iran Red Crescent Med J. 2014;16(4):e12950.
47.
Kalhor R, Salehi A, Keshavarz A, Bastani P, Orojloo P. Assessing hospital performance in Iran using the Pabon Lasso model. Asia Pac J Health Manage. 2014;9(2):77.
48.
49.
Askari R, Farzianpour F, Goudarzi R, Shafii M, Sojaei S. Efficiency evaluation of hospitals affiliated with Yazd University of Medical Sciences using quantitative approach of data envelopment analysis in the year 2001 to 2011. Pensee J. 2014;76:416–25.
50.
Adham D, Issac B, Sadeghi G, Mohammad P, Hossein A, Salarkhah E. Contemporary use of hospital efficiency indicators to evaluate hospital performance using the Pabon Lasso model. Eur J Bus Soc Sci. 2014;3(2):1–8.
51.
Imamgholi S, Khatami Firouzabadi SMA, Goharinezhad S, Fadaei Dehcheshmeh N, Heidarinejad A, Azmal M. Assessing the efficiency of hospitals by using Pabon lasso graphic model. J Res Health. 2014;4(4):890–7.
52.
53.
54.
55.
56.
Mohammadi H, Meskarpour-Amiri M. Estimation production function of inpatient services and input productivity: a cross-sectional study of Iran selected public hospitals. Hosp Pract Res. 2016;1(3):91–3.
57.
58.
59.
Kakeman E, Forushani AR, Dargahi H. Technical efficiency of hospitals in Tehran. Iran Iran J Public Health. 2016;45(4):494.PubMed
60.
61.
62.
Nabilou B, Yusefzadeh H, Rezapour A, Azar FEF, Safi PS, Asiabar AS, et al. The productivity and its barriers in public hospitals: case study of Iran. Med J Islam Repub Iran. 2016;30:316.PubMedPubMedCentral
63.
64.
65.
66.
Helal SMA, Elimam HA. Measuring the efficiency of health services areas in Kingdom of Saudi Arabia using data envelopment analysis (DEA): a comparative study between the years 2014 and 2006. Int J Health Care Finance Econ. 2017. https://​doi.​org/​10.​5539/​ijef.​v9n4p172.
67.
68.
Moradi G, Piroozi B, Safari H, Nasab NE, Bolbanabad AM, Yari A. Assessment of the efficiency of hospitals before and after the implementation of health sector evolution plan in Iran based on Pabon Lasso model. Iran J Public Health. 2017;46(3):389.PubMedPubMedCentral
69.
70.
Ali AM, Kassam A. Efficiency analysis of healthcare sector. Eng Technol J. 2017;35(5 Part (A) Engineering):509–15.
71.
72.
73.
74.
Goudarzi R, RjabiGilan N, Ghasemi SR, Reshadat S, Askari R, Ahmadian M. Efficiency measurement using econometric stochastic frontier analysis (SFA) method, case study: hospitals of Kermanshah University of Medical Sciences. J Kermanshah Univ Med Sci. 2014;17(10):666–72.
75.
Eastern Mediterranean Regional Office, World Health Organization. Health systems in the Eastern Mediterranean Region: situation, challenges and gaps. High Level Expert Meetingon Health Priorities in the Eastern Mediterranean Region1–2March 2012. RDO/WP/12.5. 2012.
76.
77.
78.
Waheb Y, Kamel L, Mena R. Cost analysis and efficiency indicators for health care: report number 3, summary output for El Gamhuria General Hospital, 1993–1994; 1997.
79.
80.
World Health Organization (WHO). National Health Accounts database. Geneva: WHO; 2009.
81.
82.
World Health Organization (WHO). The world health report 2006 - working together for health. Geneva: World Health Organization; 2006.
83.
84.
Mosadeghrad AM, Esfahani P, Afshari M. Strategies to improve hospital efficiency in Iran: A scoping review. Payesh. 2019;18(1):7–21.
85.
86.
87.
88.
Yong K, Harris AH. Efficiency of hospitals in Victoria under casemix funding: a stochastic frontier approach. Australia: Centre for Health Program Evaluation; 1999.
89.
90.
91.
92.
Walker S, Mason AR, Claxton K, Cookson R, Fenwick E, Fleetcroft R, et al. Value for money and the quality and outcomes framework in primary care in the UK NHS. Br J Gen Pract. 2010;60(574):e213–e20.PubMedPubMedCentral
Metadata
Title
A systematic review on hospital inefficiency in the Eastern Mediterranean Region: sources and solutions
Authors
Hamid Ravaghi
Mahnaz Afshari
Parvaneh Isfahani
Victoria D. Bélorgeot
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4701-1

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