Determinants of hospital inefficiency. The case of Polish county hospitals

Local hospitals play a crucial role in the healthcare system. In this study, the efficiency of Polish county hospitals is assessed by considering characteristics of hospitals that may determine their performance, such as the form of ownership, size, and staff structure. The main goal was to analyze the effect of three possible determinants on efficiency: ownership, the presence of an Emergency Department, and the presence of an Intensive Care Unit. The study covered different subgroups of hospitals and different approaches of inputs and outputs. An input-oriented radial super-efficiency DEA model under variable returns to scale was used for the efficiency analysis, and then differences between distributions of efficient and inefficient units were evaluated using a Chi-square test. A Kruskal-Wallis test was also used to analyze differences in mean efficiency. Inefficiency scores were regressed with hospital characteristics to test for other determinants. These results did not confirm differences in efficiency concerning ownership. However, in some subgroups of hospitals, running an Emergency Department or an Intensive Care Unit had a significant effect. Tobit regression results provided additional insight into how an Emergency Department or Intensive Care Unit can affect efficiency. Both cases had an effect of increasing inefficiency, and the data suggested that the department/unit size plays an important role.