AUTHOR=Mohamadi Efat , Kiani Mohammad Mehdi , Olyaeemanesh Alireza , Takian Amirhossein , Majdzadeh Reza , Hosseinzadeh Lotfi Farhad , Sharafi Hamid , Sajadi Haniye Sadat , Goodarzi Zahra , Noori Hekmat Somayeh 

TITLE=Two-Step Estimation of the Impact of Contextual Variables on Technical Efficiency of Hospitals: The Case Study of Public Hospitals in Iran

JOURNAL=Frontiers in Public Health

VOLUME=Volume 9 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2021.785489

DOI=10.3389/fpubh.2021.785489

ISSN=2296-2565

ABSTRACT=Background: Assessing the efficiency and productivity of hospitals is a key tool to cost control and management that is very importance for any healthcare system for having an efficient system 
Objective: The purpose of this study is to examine the effects of contextual factors on hospital efficiency in Iranian public hospitals.
Methods: This was a quantitative and descriptive- analytical study conducted in two stages. First, we measured the efficiency score for teaching and non-teaching hospitals. Second, the relationship between efficiency score and contextual factors were analyzed. In the first stage of study, DEA method was used to determine the hospitals efficiency according to the input and output variables. In the second stage of study, we used median statistics (first and third quarters) to describe the concentration and distribution of each variables in teaching and non-teaching hospitals, and then Wilcoxon test was used to compare them. The Spearman test was used to evaluate the correlation between the efficiency of hospitals and contextual variables (province area, province population, population density and number of beds per hospital in 31 provinces).
Results: The median score of efficiency in non- teaching hospitals in 31 provinces was 0.67 and for teaching hospitals was 0.54. Results showed that the efficiency of non- teaching hospitals is significantly higher than of teaching hospitals. There is no significant relationship between the efficiency score and the number of hospitals in the provinces (p=0.1,0.15 respectively). The relationship between the number of hospitals and the province's population was significant and positive; also, there were positive relationship between the number of beds and the area of the province in both types of teaching and non- teaching hospitals and between the number of beds and the province's population. Although this relationship is not significant in Non- teaching hospitals (p = 0.12), it is significant in teaching hospitals.
Conclusion: Multilateral factors influence the efficiency of hospitals and to address hospital inefficiency multi-intervention packages focusing on the hospital and its environment should be developed. It is necessary to pay attention to the contextual factors and organizational architecture before any cost reduction and efficiency improvement.