Efficient Resource Allocation to Social Security Organization Hospitals in Iran by Using Centralized Data Envelopment Analysis

Document Type : Original Article

Authors

1 Department of Industrial Engineering, Najafabad Branch, Islamic Azad University, Najafabad, Iran

2 Department of Management, University of Isfahan, Isfahan, Iran

3 Department of Mathematics, Najafabad Branch, Islamic Azad University, Najafabad, Iran

Abstract

Introduction: Hospitals are regarded as the largest and most expensive operational units of the health system. Also, bed is one of the most valuable hospital resources. Due to the limited resources of the health system, paying attention to efficient resource allocation is necessary. This study aimed to allocate common beds to hospitals to optimize their overall efficiency.
Methods: This  is a cross-sectional and applied study. 70 Iranian hospitals affiliated to  social security organizations were examined. The required data were collected from the statistical yearbook of this organization (2016). A centralized data envelopment analysis model with an input-orientation approach was used to assess the performance and bed reallocation to hospitals. The input data consist of the number of active beds, and the output data consist of bed occupancy rate, average patient stay, and survival of patients in thousand. Hospitals were clustered by k‐means clustering method for analysis. The data were analyzed by GAMS and SPSS softwares.
Results: Hospitals were clustered into 4 groups of homogenous units. Based on this clustering, the number of hospitals in clusters 1 to 4 was 23, 2, 13, 32, and the overall efficiencies of them were 0.703, 1, 0.827, and 0.732, respectively. Before bed reallocation, 13(18.6%) hospitals were efficient. After bed reallocation by Centralized data envelopment analysis, 31(44.3%) hospitals became efficient.
Conclusion: It  seems that the active bed factor can be one of the inputs influencing  the overall efficiency of hospitals. However, in this regard, inclusive attention to other resources such as physicians and nurses will be necessary to achieve desirable hospital efficiency.
 

Keywords


1. Faezipour M, Ferreira S, editors. A System Dynamics Perspective of Patient Satisfaction in Healthcare. CSER; 2013.doi: 10.1016/j.procs.2013.01.016.
2. Duckett S, Willcox S. The Australian health care system. 2nd ed. Oxford: Oxford university press. South Melbourne; 2004.
3. Ketabi S, Ganji H, Shahin S, Mahnam M, Soltanolkottabi M, Moghadam SAHZ. Surgical services efficiency by data envelopment analysis. Benchmarking: An International Journal. 2015;22(6):978–93.
4. Cooper WW, Seiford L, Thanassoulis E, Zanakis SH. DEA and its uses in different countries. European Journal of Operational Research. 2004;154(2):337-44d doi: 10.1016/s0377-2217(03)00173-5 .
5. Kontodimopoulos N, Nanos P, Niakas D. Balancing efficiency of health services and equity of access in remote areas in Greece. Health Policy. 2006;76(1):49-57. doi: 10.1016/j.healthpol.2005.04.006.
6. Charnes A, Cooper WW, Rhodes E. Measuring the efficiency of decision making units. European journal of operational research. 1978;2(6):429-44. doi: 10.1016/0377-2217(78)90138-8 .
7. Mar-Molinero C, Prior D, Segovia M-M, Portillo F. On centralized resource utilization and its reallocation by using DEA. Annals of Operations Research. 2014;221(1):273-83. doi: 10.1007/s10479-012-1083-8 .
8. Masoumi G, Hoseini Kasnaviyeh M, Taherizade A, Panahi M, Najafi E. Hospital performance evaluation using Pabon Lasso analysis. International Journal of Hospital Research. 2014;3(1):267-72.
9. Goudarzi R, Pourreza A, Shokoohi M, Askari R, Mahdavi M, Moghri J. Technical efficiency of teaching hospitals in Iran: the use of Stochastic Frontier Analysis, 1999-2011. Int J Health Policy Manag. 2014;3(2):91-7. doi: 10.15171/ijhpm.2014.66.
10. Najarzadeh M, Torabipoor A, Ghasemzadeh R, Salehi R. Assessment of hospitals efficiency by Data Envelopment Analysis in Ahvaz in 2006- 2010. 2012. ;4(3): 77-87.
11. Nayar P, Ozcan YA. Data envelopment analysis comparison of hospital efficiency and quality. J Med Syst. 2008;32(3):193-9. doi: 10.1007/s10916-007-9122-8.
12. Saber-Mahani A, Gh G, Barouni M, Khakian M. Estimation of technical efficiency of general hospitals of Kerman University of Medical sciences by data envelopment analysis (DEA) method IN 2007. Journal of Kerman University of Medical Sciences. 2010;16(1): 59-67. Persian.
13. Jahangoshai Rezaee M, Karimdadi A, Izadbakhsh H. Road map for progress and attractiveness of Iranian hospitals by integrating self-organizing map and context-dependent DEA. Health Care Manag Sci. 2019;22(3):410-36. doi: 10.1007/s10729-019-09484-2.
14. Bahadori M, Izadi AR, Ghardashi F, Ravangard R, Hosseini SM. The Evaluation of Hospital Performance in Iran: A Systematic Review Article. Iran J Public Health. 2016;45(7):855-66.
15. Barouni M, Amiresmaieli MR, Shahravan A, Amini S. The Efficiency Assessment of Dental Units Using Data Envelopment Analysis Approach: The Case of Iran. Iran J Public Health. 2017;46(4):552-9.
16. Social Security Organization, Deputy of Economic and Programming. Social Security Organization statistical yearbook in 2016. Persian.
17. Lozano S, Villa G. Centralized resource allocation using data envelopment analysis. Journal of Productivity Analysis. 2004;22(1-2):143-61. doi: 10.1023/b:prod.0000034748.22820.33 .
18. Kiani MM, Mosavi Rigi SA, Karami H, Sepaseh F, Naghdi B, Shiravani M. Efficiency evaluation of university hospitals in Bushehr province before and after the implementation of the health system development plan. Evidence Based Health Policy, Management and Economics. 2018;2(1):1-11.
19. Pirani N, Zahiri M, Engali KA, Torabipour A. Hospital Efficiency Measurement Before and After Health Sector Evolution Plan in Southwest of Iran: a DEA-Panel Data Study. Acta Inform Med. 2018;26(2):106-10. doi: 10.5455/aim.2018.26.106-110.
20. Ali M, Debela M, Bamud T. Technical efficiency of selected hospitals in Eastern Ethiopia. Health Econ Rev. 2017;7(1):24. doi: 10.1186/s13561-017-0161-7.
21. Farzianpour F, Emami AH, Foroushani AR, Ghiasi A. Determining the technical efficiency of hospitals in tabriz city using data envelopment analysis for 2013-2014. Glob J Health Sci. 2016;9(5):42. doi: 10.5539/gjhs.v9n5p42 .
22. Jia T, Yuan H. The application of DEA (Data Envelopment Analysis) window analysis in the assessment of influence on operational efficiencies after the establishment of branched hospitals. BMC Health Serv Res. 2017;17(1):265. doi: 10.1186/s12913-017-2203-6.
23. Kalhor R, Amini S, Sokhanvar M, Lotfi F, Sharifi M, Kakemam E. Factors affecting the technical efficiency of general hospitals in
Iran: data envelopment analysis. J Egypt Public Health Assoc. 2016;91(1):20-5. doi: 10.1097/01. EPX.0000480717.13696.3c.
24. Wang X, Luo H, Qin X, Feng J, Gao H, Feng Q. Evaluation of performance and impacts of maternal and child health hospital services using Data Envelopment Analysis in Guangxi Zhuang Autonomous Region, China: a comparison study among poverty and non-poverty county level hospitals. Int J Equity Health. 2016;15(1):131. doi: 10.1186/s12939-016-0420-y.
25. Cheng Z, Tao H, Cai M, Lin H, Lin X, Shu Q, et al. Technical efficiency and productivity of Chinese county hospitals: an exploratory study in Henan province, China. BMJ Open. 2015;5(9):e007267. doi: 10.1136/bmjopen-2014-007267.
26. Harrison JP, Meyer S. Measuring efficiency among US federal hospitals. Health Care Manag (Frederick). 2014;33(2):117-27. doi: 10.1097/HCM.0000000000000005.
27. Yusefzadeh H, Ghaderi H, Bagherzade R, Barouni M. The efficiency and budgeting of public hospitals: case study of iran. Iran Red Crescent Med J. 2013;15(5):393-9. doi: 10.5812/ircmj.4742.
28. Hu H-H, Qi Q, Yang C-H. Analysis of hospital technical efficiency in China: Effect of health insurance reform. China Economic Review. 2012;23(4):865-77. doi: 10.1016/j.chieco.2012.04.008 .
29. Shahhoseini R, Tofighi S, Jaafaripooyan E, Safiaryan R. Efficiency measurement in developing countries: application of data envelopment analysis for Iranian hospitals. Health Serv Manage Res. 2011;24(2):75-80. doi: 10.1258/hsmr.2010.010017.
30. Kakeman E, Rahimi Forushani A, Dargahi H. Technical Efficiency of Hospitals in Tehran, Iran. Iran J Public Health. 2016;45(4):494-502.
31. Yusefzadeh H, Ghaderi H, Bagherzade R, Barouni M. The efficiency and budgeting of public hospitals: case study of iran. Iran Red Crescent Med J. 2013;15(5):393-9. doi: 10.5812/ircmj.4742.
32. Kazemi Z, Kiadaliri AA, Haghparast H. Estimating efficiency and optimal resource utilization in selected hospitals in east of Iran: applying the data envelopment analysis. Payesh (Health Monitor). 2013;12(5):449-58.
33. Sherman HD. Hospital efficiency measurement and evaluation. Empirical test of a new technique. Med Care. 1984;22(10):922-38. doi: 10.1097/00005650-198410000-00005.