Measuring Efficiency of Public Hospitals in Iran: A Comparative Study Using Extended Data Envelopment Analysis, 2012-2016

Measuring Efficiency of Public Hospitals in Iran: A Comparative Study Using Extended Data Envelopment Analysis, 2012-2016 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Measuring Efficiency of Public Hospitals in Iran: A Comparative Study Using Extended Data Envelopment Analysis, 2012-2016 Efat Mohamadi, Amirhossein Takian, Alireza Olyaee Manesh, Reza Majdzadeh, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-36996/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Aiming to enhance quality of care and increase efficiency, public hospitals have undergone several reforms in the course of last two decades in Iran. This paper reports the result of a national research that aimed to measure the technical efficiency and productivity change of public hospitals during 2012-2016 in Iran. Methods: We used Extended Data Envelopment Analysis (Extended-DEA) (an innovative modification to conventional DEA) to measure technical efficiency and productivity of 568 public hospitals. Nationally representative data were extracted from the official annual health reports. Data were analysed using GAMS software 24.3. Results: The average efficiency score of all hospitals was 0.733. 10.1% of all hospitals were efficient while 2.68% of them were under 0.2. The Malmquist Productivity Index (MPI) progressed in 49.3% of hospitals, remained constant in 2.3%, while 48.2% of hospitals regressed during 2015-2016. The average of MPI was 1.07 over the period of analysis. Conclusions: Extra efforts seem to be essential to enhance the efficient use of resources and develop appropriate policy solutions and tools. In particular, to increase the return to scale, we advocate the merger of small-size district hospitals towards establishing bigger efficient hospitals in various geographical regions across the country. Health Economics & Outcomes Research Health Policy Data envelopment analysis (DEA) Hospital Efficiency Productivity Malmquist Productivity Index (MPI) Technical Efficiency Hospital Performance Figures Figure 1 Full Text Supplementary Files Appendixes.docx SupplementaryMaterial.rar Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-36996","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":711243,"identity":"49d984f3-c8a6-47d5-a1bf-497255a9e245","order_by":0,"name":"Efat Mohamadi","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Efat","middleName":"","lastName":"Mohamadi","suffix":""},{"id":711244,"identity":"95683f2d-341f-4ea2-afbc-e3842ed3ca03","order_by":1,"name":"Amirhossein 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22:44:42","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-36996/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-36996/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":1409414,"identity":"1c15c606-fbbe-4794-8286-5b48fc052e3b","added_by":"auto","created_at":"2020-06-24 16:28:14","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":95751,"visible":true,"origin":"","legend":"Average efficiency score by hospital type, 2012-16.","description":"","filename":"Fig1.JPG","url":"https://assets-eu.researchsquare.com/files/rs-36996/v1/Fig1.JPG"},{"id":1409418,"identity":"b5e4812c-bc36-49e2-ae62-3f9c9e7b89d9","added_by":"auto","created_at":"2020-06-24 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Index (MPI), Technical Efficiency, Hospital Performance","lastPublishedDoi":"10.21203/rs.3.rs-36996/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-36996/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Aiming to enhance quality of care and increase efficiency, public hospitals have undergone several reforms in the course of last two decades in Iran. This paper reports the result of a national research that aimed to measure the technical efficiency and productivity change of public hospitals during 2012-2016 in Iran. \u003c/p\u003e\u003cp\u003eMethods: We used Extended Data Envelopment Analysis (Extended-DEA) (an innovative modification to conventional DEA) to measure technical efficiency and productivity of 568 public hospitals. Nationally representative data were extracted from the official annual health reports. Data were analysed using GAMS software 24.3. \u003c/p\u003e\u003cp\u003eResults: The average efficiency score of all hospitals was 0.733. 10.1% of all hospitals were efficient while 2.68% of them were under 0.2. The Malmquist Productivity Index (MPI) progressed in 49.3% of hospitals, remained constant in 2.3%, while 48.2% of hospitals regressed during 2015-2016. The average of MPI was 1.07 over the period of analysis. \u003c/p\u003e\u003cp\u003eConclusions: Extra efforts seem to be essential to enhance the efficient use of resources and develop appropriate policy solutions and tools. In particular, to increase the return to scale, we advocate the merger of small-size district hospitals towards establishing bigger efficient hospitals in various geographical regions across the country.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Measuring Efficiency of Public Hospitals in Iran: A Comparative Study Using Extended Data Envelopment Analysis, 2012-2016","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-06-24 16:28:13","doi":"10.21203/rs.3.rs-36996/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1354e852-32e3-4af8-ae80-2d37d4cb4f18","owner":[],"postedDate":"June 24th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":130118,"name":"Health Economics \u0026 Outcomes Research"},{"id":130119,"name":"Health Policy"}],"tags":[],"updatedAt":"2021-10-10T20:18:52+00:00","versionOfRecord":[],"versionCreatedAt":"2020-06-24 16:28:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-36996","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-36996","identity":"rs-36996","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}