Measuring efficiency of governmental hospitals in Palestine using stochastic frontier analysis

BACKGROUND: The Palestinian government has been under increasing pressure to improve provision of health services while seeking to effectively employ its scare resources. Governmental hospitals remain the leading costly units as they consume about 60 % of governmental health budget. A clearer understanding of the technical efficiency of hospitals is crucial to shape future health policy reforms. In this paper, we used stochastic frontier analysis to measure technical efficiency of governmental hospitals, the first of its kind nationally. METHODS: We estimated maximum likelihood random-effects and time-invariant efficiency model developed by Battese and Coelli, 1988. Number of beds, number of doctors, number of nurses, and number of non-medical staff, were used as the input variables, and sum of number of treated inpatients and outpatients was used as output variable. Our dataset includes balanced panel data of 22 governmental hospitals over a period of 6 years. Cobb–Douglas function, translog function, and multi-output distance function were estimated using STATA 12. RESULTS: The average technical efficiency of hospitals was approximately 55 %, and ranged from 28 to 91 %. Doctors and nurses appear to be the most important factors in hospital production, as 1 % increase in number of doctors, results in an increase in the production of the hospital of 0.33 and 0.51 %, respectively. If hospitals increase all inputs by 1 %, their production would increase by 0.74 %. Hospitals production process has a decrease return to scale. CONCLUSION: Despite continued investment in governmental hospitals, they remained relatively inefficient. Using the existing amount of resources, the amount of delivered outputs can be improved 45 % which provides insight into mismanagement of available resources. To address hospital inefficiency, it is important to increase the numbers of doctors and nurses. The number of non-medical staff should be reduced. Offering the option of early retirement, limit hiring, and transfer to primary health care centers are possible options. It is crucial to maintain a rich clinical skill-mix when implementing such measures. Adopting interventions to improve the quality of management in hospitals will improve efficiency. International benchmarking provides more insights on sources of hospital inefficiency.