Skip to main content
Top
Published in: Conflict and Health 1/2018

Open Access 01-12-2018 | Research

Are public hospitals reforming efficiently in West Bank?

Authors: Wasim I. M. Sultan, José Crispim

Published in: Conflict and Health | Issue 1/2018

Login to get access

Abstract

Background

The structure, function, and capacity of the health care system in the Occupied Palestinian Territories (OPT) had been largely shaped by the complex political history of the country. Since the establishment of the Palestinian Authority in 1994, the reform efforts were subsidized much by the international aids to rebuild the country’s institutional capacity. No previous studies have provided a realistic evaluation of Palestinian achievements in the conduct of public healthcare, we examine the relative productive efficiency of public hospitals (their managers’ success in the usage of resources) during 2010–2015 within West Bank and Jordan. Then, we estimate the efficiency of policies within which managers operate (the program efficiency) across the two countries.

Methods

We employ the Data Envelopment Analysis (DEA) models to distinguish between within-country managerial efficiencies and public policy “program” efficiencies across the two countries. The study follows two key steps, the first step evaluates managerial efficiencies and explores trends in performance within each country. Then, we examine the program efficiencies across the two countries.

Results

Public hospitals improved their year-specific overall efficiency from 75 to 80% in the West Bank and from 78 to 86% in Jordan in 2010 and 2015 respectively. Changes in efficiency are driven by scale effects in West Bank and by managerial enhancements in Jordan. Program efficiency in West Bank outperformed Jordan during 2010–2012, there was no significant difference in mean program efficiencies between the two countries during 2013–2015.

Conclusions

This work addresses a gap in the DEA literature by empirically investigating the efficiency of public hospitals as distinct from program efficiency in a developing country, namely, Palestine. Findings stimulate hospital managers to enhance potential improvements, policymakers to allocate resources, and international donors to focus on the right adoption of new technology to get better benefits from their considerable investments in public hospitals.
Appendix
Available only for authorised users
Literature
1.
go back to reference Giacaman R, et al. Health status and health services in the occupied Palestinian territory. Lancet. 2009;373.9666:837–49.CrossRef Giacaman R, et al. Health status and health services in the occupied Palestinian territory. Lancet. 2009;373.9666:837–49.CrossRef
2.
go back to reference Hamdan M, Defever M. A ‘transitional’ context for health policy development: the Palestinian case. Health Policy. 2002;59.3:193–207.CrossRef Hamdan M, Defever M. A ‘transitional’ context for health policy development: the Palestinian case. Health Policy. 2002;59.3:193–207.CrossRef
3.
go back to reference Shehada Y. Does Foreign Aid Accelerate Corruption? The Case of the Palestinian National Authority. J Holy L Palest Stud. 2015;14:165–87 Edinburgh University Press 22 George Square, Edinburgh EH8 9LF UK.CrossRef Shehada Y. Does Foreign Aid Accelerate Corruption? The Case of the Palestinian National Authority. J Holy L Palest Stud. 2015;14:165–87 Edinburgh University Press 22 George Square, Edinburgh EH8 9LF UK.CrossRef
4.
go back to reference Giacaman R, Abdul-Rahim HF, Wick L. Health sector reform in the occupied Palestinian territories (OPT): targeting the forest or the trees? Health Policy Plan. 2003;18:59–67 Oxford Univ Press.CrossRef Giacaman R, Abdul-Rahim HF, Wick L. Health sector reform in the occupied Palestinian territories (OPT): targeting the forest or the trees? Health Policy Plan. 2003;18:59–67 Oxford Univ Press.CrossRef
5.
go back to reference Hamdan M, Saleem AA. Assessment of patient safety culture in Palestinian public hospitals. Int J Qual Heal care. 2013;25:167–75.CrossRef Hamdan M, Saleem AA. Assessment of patient safety culture in Palestinian public hospitals. Int J Qual Heal care. 2013;25:167–75.CrossRef
6.
go back to reference Charnes A, Cooper WW, Rhodes E. Evaluating program and managerial efficiency: an application of data envelopment analysis to program follow through. Manage. Sci. INFORMS. 1981;27:668–97. Charnes A, Cooper WW, Rhodes E. Evaluating program and managerial efficiency: an application of data envelopment analysis to program follow through. Manage. Sci. INFORMS. 1981;27:668–97.
7.
go back to reference Johnson AL, Kuosmanen T. One-stage and two-stage DEA estimation of the effects of contextual variables. Eur. J. Oper. Res. Elsevier. 2012;220:559–70.CrossRef Johnson AL, Kuosmanen T. One-stage and two-stage DEA estimation of the effects of contextual variables. Eur. J. Oper. Res. Elsevier. 2012;220:559–70.CrossRef
8.
go back to reference Banker RD, Charnes A, Cooper WW. Some models for estimating technical and scale inefficiencies in data envelopment analysis. Manage Sci INFORMS. 1984;30:1078–92. Banker RD, Charnes A, Cooper WW. Some models for estimating technical and scale inefficiencies in data envelopment analysis. Manage Sci INFORMS. 1984;30:1078–92.
9.
go back to reference Valdmanis VG, Rosko MD, Leleu H, Mukamel DB. Assessing overall, technical, and scale efficiency among home health care agencies. Health Care Manag Sci Springer. 2017;20:265–75.CrossRef Valdmanis VG, Rosko MD, Leleu H, Mukamel DB. Assessing overall, technical, and scale efficiency among home health care agencies. Health Care Manag Sci Springer. 2017;20:265–75.CrossRef
11.
go back to reference Sultan WIM, Crispim J. Measuring the efficiency of Palestinian public hospitals during 2010-2015: An application of a two-stage DEA method. BMC Health Serv Res. 2018:18. Sultan WIM, Crispim J. Measuring the efficiency of Palestinian public hospitals during 2010-2015: An application of a two-stage DEA method. BMC Health Serv Res. 2018:18.
12.
go back to reference Batniji R, Rabaia Y, Nguyen–Gillham V, Giacaman R, Sarraj E, Punamaki R, et al. Health as human security in the occupied Palestinian territory. Lancet. 2009;373:1133–43 Elsevier.CrossRef Batniji R, Rabaia Y, Nguyen–Gillham V, Giacaman R, Sarraj E, Punamaki R, et al. Health as human security in the occupied Palestinian territory. Lancet. 2009;373:1133–43 Elsevier.CrossRef
14.
go back to reference Haj-Yahia MM, Sousa C, Alnabilsy R, Elias H. The influence of Palestinian physicians’ patriarchal ideology and exposure to family violence on their beliefs about wife beating. J Fam Violence Springer. 2015;30:263–76.CrossRef Haj-Yahia MM, Sousa C, Alnabilsy R, Elias H. The influence of Palestinian physicians’ patriarchal ideology and exposure to family violence on their beliefs about wife beating. J Fam Violence Springer. 2015;30:263–76.CrossRef
15.
go back to reference Thanassoulis E, Shiraz RK, Maniadakis N. A cost Malmquist productivity index capturing group performance. Eur. J. Oper. Res. Elsevier. 2015;241:796–805.CrossRef Thanassoulis E, Shiraz RK, Maniadakis N. A cost Malmquist productivity index capturing group performance. Eur. J. Oper. Res. Elsevier. 2015;241:796–805.CrossRef
16.
go back to reference Verdonk P, Harting A, Lagro-Janssen TLM. Does equal education generate equal attitudes? Gender differences in medical students’ attitudes toward the ideal physician. Teach Learn Med Taylor & Francis. 2007;19:9–13.CrossRef Verdonk P, Harting A, Lagro-Janssen TLM. Does equal education generate equal attitudes? Gender differences in medical students’ attitudes toward the ideal physician. Teach Learn Med Taylor & Francis. 2007;19:9–13.CrossRef
17.
go back to reference Shahawy S, Diamond M. Attitudes of Palestinian medical students on the geopolitical barriers to accessing hospitals for clinical training: a qualitative study. Confl Health BioMed Central. 2016;10:1. Shahawy S, Diamond M. Attitudes of Palestinian medical students on the geopolitical barriers to accessing hospitals for clinical training: a qualitative study. Confl Health BioMed Central. 2016;10:1.
19.
go back to reference Abu-Odeh A, Delvoie LA. Jordanians, Palestinians & the Hashemite Kingdom in the Middle East Peace Process. Int J. 2000;55:669 Sage Publications Ltd. Abu-Odeh A, Delvoie LA. Jordanians, Palestinians & the Hashemite Kingdom in the Middle East Peace Process. Int J. 2000;55:669 Sage Publications Ltd.
20.
go back to reference Al Madfai MR, Al MR. Jordan, the United States and the Middle East peace process. Cambridge University Press. 1993;28:1974–91. Al Madfai MR, Al MR. Jordan, the United States and the Middle East peace process. Cambridge University Press. 1993;28:1974–91.
21.
go back to reference Karolyi P. Update on conflict and diplomacy. J Palest Stud University of California Press Journals. 2017;46:121–59. Karolyi P. Update on conflict and diplomacy. J Palest Stud University of California Press Journals. 2017;46:121–59.
22.
go back to reference Ashton NJ. The Middle East: intractable conflict?: Jordan’s unavoidable stake in the Middle East peace process. London School of Economics and Political Science: LSE IDEAS; 2009. Ashton NJ. The Middle East: intractable conflict?: Jordan’s unavoidable stake in the Middle East peace process. London School of Economics and Political Science: LSE IDEAS; 2009.
23.
go back to reference Al-Din ASN, Kurdi A, Mubaidin A, El-Khateeb M, Khalil RW, Wriekat A-L. Epidemiology of multiple sclerosis in Arabs in Jordan: a comparative study between Jordanians and Palestinians. J Neurol Sci Elsevier. 1996;135:162–7.CrossRef Al-Din ASN, Kurdi A, Mubaidin A, El-Khateeb M, Khalil RW, Wriekat A-L. Epidemiology of multiple sclerosis in Arabs in Jordan: a comparative study between Jordanians and Palestinians. J Neurol Sci Elsevier. 1996;135:162–7.CrossRef
25.
go back to reference Farrell MJ. The measurement of productive efficiency. J R Stat Soc Ser A. 1957:253–90.CrossRef Farrell MJ. The measurement of productive efficiency. J R Stat Soc Ser A. 1957:253–90.CrossRef
26.
go back to reference Charnes A, Cooper WW, Rhodes E. Measuring the efficiency of decision making units. Eur J Oper Res. 1978;2:429–44.CrossRef Charnes A, Cooper WW, Rhodes E. Measuring the efficiency of decision making units. Eur J Oper Res. 1978;2:429–44.CrossRef
27.
go back to reference Liu JS, Lu LYY, Lu W-M. Research fronts in data envelopment analysis. Omega. Elsevier. 2016;58:33–45.CrossRef Liu JS, Lu LYY, Lu W-M. Research fronts in data envelopment analysis. Omega. Elsevier. 2016;58:33–45.CrossRef
28.
go back to reference Førsund FR, Hjalmarsson L. On the measurement of productive efficiency. Swedish J Econ JSTOR. 1974:141–54.CrossRef Førsund FR, Hjalmarsson L. On the measurement of productive efficiency. Swedish J Econ JSTOR. 1974:141–54.CrossRef
29.
go back to reference Chilingerian JA, Sherman HD. Health-care applications: from hospitals to physicians, from productive efficiency to quality frontiers: Springer; 2011. p. 445–93. Handb data Envel Anal Chilingerian JA, Sherman HD. Health-care applications: from hospitals to physicians, from productive efficiency to quality frontiers: Springer; 2011. p. 445–93. Handb data Envel Anal
30.
go back to reference Hollingsworth B. The measurement of efficiency and productivity of health care delivery. Health Econ Wiley Online Library. 2008;17:1107–28. Hollingsworth B. The measurement of efficiency and productivity of health care delivery. Health Econ Wiley Online Library. 2008;17:1107–28.
31.
go back to reference Chen S, Wu Y, Chen Y, Zhu H, Wang Z, Feng D, et al. Analysis of operation performance of general hospitals in Shenzhen, China: a super-efficiency data envelopment analysis. Lancet. 2016;388:S57 Elsevier.CrossRef Chen S, Wu Y, Chen Y, Zhu H, Wang Z, Feng D, et al. Analysis of operation performance of general hospitals in Shenzhen, China: a super-efficiency data envelopment analysis. Lancet. 2016;388:S57 Elsevier.CrossRef
32.
go back to reference Liu JS, Lu LYY, Lu W-M, Lin BJY. A survey of DEA applications. Omega Elsevier. 2013;41:893–902.CrossRef Liu JS, Lu LYY, Lu W-M, Lin BJY. A survey of DEA applications. Omega Elsevier. 2013;41:893–902.CrossRef
33.
go back to reference Zere E. Hospital efficiency in sub-Saharan Africa. Evidence from South Africa. 2000. Zere E. Hospital efficiency in sub-Saharan Africa. Evidence from South Africa. 2000.
34.
go back to reference Ozcan YA, Luke RD. Health care delivery restructuring and productivity change: assessing the Veterans Integrated Service Networks (VISNs) using the Malmquist approach. Med. Care Res. Rev. 2011;68:20S–35S SAGE Publications Sage CA: Los Angeles, CA.CrossRef Ozcan YA, Luke RD. Health care delivery restructuring and productivity change: assessing the Veterans Integrated Service Networks (VISNs) using the Malmquist approach. Med. Care Res. Rev. 2011;68:20S–35S SAGE Publications Sage CA: Los Angeles, CA.CrossRef
35.
go back to reference van Ineveld M, van Oostrum J, Vermeulen R, Steenhoek A, van de Klundert J. Productivity and quality of Dutch hospitals during system reform. Health Care Manag. Sci. 2015:1–12. van Ineveld M, van Oostrum J, Vermeulen R, Steenhoek A, van de Klundert J. Productivity and quality of Dutch hospitals during system reform. Health Care Manag. Sci. 2015:1–12.
36.
go back to reference Ozcan YA, Khushalani J. Assessing efficiency of public health and medical care provision in OECD countries after a decade of reform. Cent Eur J Oper Res Springer. 2017;25:325–43.CrossRef Ozcan YA, Khushalani J. Assessing efficiency of public health and medical care provision in OECD countries after a decade of reform. Cent Eur J Oper Res Springer. 2017;25:325–43.CrossRef
37.
go back to reference Samut PK, Cafrı R. Analysis of the efficiency determinants of health systems in OECD countries by DEA and panel tobit. Soc Indic Res Springer. 2016;129:113–32.CrossRef Samut PK, Cafrı R. Analysis of the efficiency determinants of health systems in OECD countries by DEA and panel tobit. Soc Indic Res Springer. 2016;129:113–32.CrossRef
39.
go back to reference Dyson RG, Allen R, Camanho AS, Podinovski VV, Sarrico CS, Shale EA. Pitfalls and protocols in DEA. Eur J Oper Res Elsevier. 2001;132:245–59.CrossRef Dyson RG, Allen R, Camanho AS, Podinovski VV, Sarrico CS, Shale EA. Pitfalls and protocols in DEA. Eur J Oper Res Elsevier. 2001;132:245–59.CrossRef
40.
go back to reference Golany B, Roll Y. An application procedure for DEA. Omega Elsevier. 1989;17:237–50.CrossRef Golany B, Roll Y. An application procedure for DEA. Omega Elsevier. 1989;17:237–50.CrossRef
41.
go back to reference Boussofiane A, Dyson RG, Thanassoulis E. Applied data envelopment analysis. Eur J Oper Res Elsevier. 1991;52:1–15.CrossRef Boussofiane A, Dyson RG, Thanassoulis E. Applied data envelopment analysis. Eur J Oper Res Elsevier. 1991;52:1–15.CrossRef
42.
go back to reference Lindlbauer I, Schreyögg J, Winter V. Changes in technical efficiency after quality management certification: a DEA approach using difference-in-difference estimation with genetic matching in the hospital industry. Eur J Oper Res Elsevier. 2016;250:1026–36.CrossRef Lindlbauer I, Schreyögg J, Winter V. Changes in technical efficiency after quality management certification: a DEA approach using difference-in-difference estimation with genetic matching in the hospital industry. Eur J Oper Res Elsevier. 2016;250:1026–36.CrossRef
43.
go back to reference Narcı HÖ, Ozcan YA, Şahin İ, Tarcan M, Narcı M. An examination of competition and efficiency for hospital industry in Turkey. Health Care Manag Sci Springer. 2015;18:407–18.CrossRef Narcı HÖ, Ozcan YA, Şahin İ, Tarcan M, Narcı M. An examination of competition and efficiency for hospital industry in Turkey. Health Care Manag Sci Springer. 2015;18:407–18.CrossRef
44.
go back to reference Cook WD, Tone K, Zhu J. Data envelopment analysis: prior to choosing a model. Omega Elsevier. 2014;44:1–4.CrossRef Cook WD, Tone K, Zhu J. Data envelopment analysis: prior to choosing a model. Omega Elsevier. 2014;44:1–4.CrossRef
45.
go back to reference Kawaguchi H, Tone K, Tsutsui M. Estimation of the efficiency of Japanese hospitals using a dynamic and network data envelopment analysis model. Health Care Manag Sci. 2014;17:101–12.CrossRef Kawaguchi H, Tone K, Tsutsui M. Estimation of the efficiency of Japanese hospitals using a dynamic and network data envelopment analysis model. Health Care Manag Sci. 2014;17:101–12.CrossRef
46.
go back to reference Viola C, Benvenuto M. Data envelopment analysis (DEA) for the evaluation of public healthcare structures. Electron J Appl Stat Anal Decis Support Syst Serv. Evaluation. 2014;5:67–82. Viola C, Benvenuto M. Data envelopment analysis (DEA) for the evaluation of public healthcare structures. Electron J Appl Stat Anal Decis Support Syst Serv. Evaluation. 2014;5:67–82.
47.
go back to reference Chowdhury H, Zelenyuk V, Laporte A, Wodchis WP. Analysis of productivity, efficiency and technological changes in hospital services in Ontario: how does case-mix matter? Int J Prod Econ. 2014;150:74–82.CrossRef Chowdhury H, Zelenyuk V, Laporte A, Wodchis WP. Analysis of productivity, efficiency and technological changes in hospital services in Ontario: how does case-mix matter? Int J Prod Econ. 2014;150:74–82.CrossRef
48.
go back to reference Ozgen H, Ozcan YA. Longitudinal analysis of efficiency in multiple output dialysis markets. Health Care Manag Sci Springer. 2004;7:253–61.CrossRef Ozgen H, Ozcan YA. Longitudinal analysis of efficiency in multiple output dialysis markets. Health Care Manag Sci Springer. 2004;7:253–61.CrossRef
49.
go back to reference Chowdhury H, Zelenyuk V. Performance of hospital services in Ontario: DEA with truncated regression approach. Omega Elsevier. 2016;63:111–22.CrossRef Chowdhury H, Zelenyuk V. Performance of hospital services in Ontario: DEA with truncated regression approach. Omega Elsevier. 2016;63:111–22.CrossRef
50.
go back to reference Bowling A. Research methods in health. McGraw-Hill Education (UK); 2014. Bowling A. Research methods in health. McGraw-Hill Education (UK); 2014.
51.
go back to reference Färe R, Grosskopf S, Norris M, Zhang Z. Productivity growth, technical progress, and efficiency change in industrialized countries. Am Econ Rev JSTOR. 1994:66–83. Färe R, Grosskopf S, Norris M, Zhang Z. Productivity growth, technical progress, and efficiency change in industrialized countries. Am Econ Rev JSTOR. 1994:66–83.
52.
go back to reference Sarkis J, Talluri S. Efficiency measurement of hospitals: issues and extensions. Int J Oper Prod Manag MCB UP Ltd. 2002;22:306–13.CrossRef Sarkis J, Talluri S. Efficiency measurement of hospitals: issues and extensions. Int J Oper Prod Manag MCB UP Ltd. 2002;22:306–13.CrossRef
53.
go back to reference Cooper WW, Seiford LM, Tone K. Data envelopment analysis: a comprehensive text with models, applications, references and DEA-solver software: Springer Science & Business Media; 2007. Cooper WW, Seiford LM, Tone K. Data envelopment analysis: a comprehensive text with models, applications, references and DEA-solver software: Springer Science & Business Media; 2007.
54.
go back to reference Aghamolaei T, Eftekhaari TE, Rafati S, Kahnouji K, Ahangari S, Shahrzad ME, et al. Service quality assessment of a referral hospital in southern Iran with SERVQUAL technique: patients’ perspective. BMC Health Serv Res. 2014;14:322.CrossRef Aghamolaei T, Eftekhaari TE, Rafati S, Kahnouji K, Ahangari S, Shahrzad ME, et al. Service quality assessment of a referral hospital in southern Iran with SERVQUAL technique: patients’ perspective. BMC Health Serv Res. 2014;14:322.CrossRef
55.
go back to reference Al-Shammari M. A multi-criteria data envelopment analysis model for measuring the productive efficiency of hospitals. Int J Oper Prod Manag MCB UP Ltd. 1999;19:879–91.CrossRef Al-Shammari M. A multi-criteria data envelopment analysis model for measuring the productive efficiency of hospitals. Int J Oper Prod Manag MCB UP Ltd. 1999;19:879–91.CrossRef
56.
go back to reference Mujasi PN, Kirigia JM. Productivity and efficiency changes in referral hospitals in Uganda: an application of Malmquist Total productivity index: iMedPub; 2016. Heal. Syst. Policy Res Mujasi PN, Kirigia JM. Productivity and efficiency changes in referral hospitals in Uganda: an application of Malmquist Total productivity index: iMedPub; 2016. Heal. Syst. Policy Res
Metadata
Title
Are public hospitals reforming efficiently in West Bank?
Authors
Wasim I. M. Sultan
José Crispim
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Conflict and Health / Issue 1/2018
Electronic ISSN: 1752-1505
DOI
https://doi.org/10.1186/s13031-018-0180-y

Other articles of this Issue 1/2018

Conflict and Health 1/2018 Go to the issue