Also, in terms of 4 variables, input and output variables have been used to measure the efficiency. Four variables have been used as input and output variables for measuring efficiency. In this figure, the efficiency estimation for DEA-based studies is closer to one, indicating a higher efficiency of these hospitals than hospitals which use the SFA method. In the present study, 24 articles were reviewed using systematic, meta-analysis, and meta-regression methods.
Of these, 16 articles using DEA method and 8 articles using the SFA method have measured the efficiency of governmental hospitals, and 3 articles have measured the efficiency of nongovernmental hospitals evaluated using DEA method Thirteen studies using DEA method and 2 studies using SFA have measured the efficiency of noneducational hospitals; 9 studies using DEA method and 5 studies using SFA method have measured the efficiency of specialized hospitals; 14 studies using DEA method and 7 studies using SFA method have measured the efficiency of general hospitals; 14 studies using input-driven approach and 2 studies using output-driven approach and 5 studies using the DEA method and 3 studies using SFA method with constant returns to scale approach have measured the efficiency.
In this study, four input variables including number of active beds, number of physicians, number of nurses, and other hospital staff, and four output variables including the number of admissions of outpatients and number of hospitalized patients, bed occupancy rate The occupancy rate is calculated as the number of beds effectively occupied [bed-days] for curative care [HC. Meta-analysis and meta-regression and the study of the number of variables have not been addressed in previous studies.
For example, Mosadeghrad et al. Kiadaliri et al. A number of systematic reviews were carried out on measuring efficiency of healthcare centers around the world, and inputs and outputs have been proposed. Input and outputs which are usually used by researchers for the analysis of the technical efficiency of a hospital using DEA include the number of physicians, the number of nurses and the number of beds, the number of other nonmedical staff and the total number of employees, the total cost, the total cost of nonstaff, the value of fixed capital, and the cost of drug storage and outputs include the total number of admissions, mean daily admission, number of outpatients, number of surgeries, number of deliveries, ALOS, bed occupancy rate, and total income.
Although the present study identified input and outputs, the researchers believe that the selection of data and outputs should be defined according to the goals of each hospital. Hussey et al. In the present study, the days of discharge, visits of doctors, results of health measures, and therapeutic procedures were investigated as outputs. In these articles, the inputs were analyzed using meta-analysis and the relationship between input and outputs was investigated by measuring more accurately the efficiency, better decision-making, their effectiveness on the efficiency, and selecting an appropriate model to measure efficiency and proved that the accuracy of both methods depends on many factors, including statistical methods, definition of inputs and outputs, and access to data.
On the other hand, there are some shortcomings such as inappropriate selection of input and output indices and unmodified errors on efficiency score in the studies conducted on the efficiency of hospitals based on DEA. Therefore, it is necessary to investigate and select an appropriate index for using the DEA method. They found that the difference in efficiency determined by DEA and SFA methods is due to various factors such as statistical errors, input and outputs definitions, and available data.
However, the views of the different models have different advantages and disadvantages, and selecting the most appropriate method depends on the type of organization under study and available data. The SFA method is often used for analysis of no efficient hospitals although this method has clear and important advantages; but, the disadvantages of this method for hospital efficiency measurement are also evident such as the need for production functions estimation and the use of an output.
In contrast, the DEA method can investigate several input and output simultaneously and is used as an effective and flexible tool to measure the efficiency of the hospital. However, in general, due to lack of optimal efficiency level in the hospital, it is suggested that policymakers determine the hospital efficiency indices to evaluate their efficiency from different dimensions. The lack of access to a number of articles due to access restrictions on the university site is considered as one of the constraints in this study that the websites of other universities were used to solve this problem.
Furthermore, it is suggested that an appropriate method for efficiency measurement using systematic review and meta-analysis to be identified in future studies aimed to the optimal allocation of resources in Iranian hospitals. The article has not been registered elsewhere before and will not be published. The authors of this study would like to acknowledge the research staff of the School of Health and the jury members, who helped us to conduct and improve the quality of this study.
National Center for Biotechnology Information , U. J Educ Health Promot. Published online Jun Author information Article notes Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: moc. Received Nov 17; Accepted Dec This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.
Keywords: Data envelopment analysis, efficiency improvement, stochastic frontier analysis, systematic review. Materials and Methods The present study was carried out using systematic and meta-analysis methods and includes all studies that measure the hospitals' efficiency in Iran using DEA and SFA methods. Data collection method Search strategy In the present study, the electronic search of the subject has been done in published articles in domestic and foreign journals, theses, conferences available in Persian databases of SID, Iranmedex, Magiran, Medlib, Civilica, Irandoc and English databases of Web of Science, Pubmed, Scopus, Science Direct, Google Scholar, and the WHO site between March 21, and December 21, , and the search strategy has been mainly performed based on Persian and English keywords using the Mesh system, with the possible combination of important, original, and sensitive words.
Selection of studies Of articles, studies were repetitive and removed. Open in a separate window. Figure 1. Statistical analysis Random effect model and fixed-effect model were used to perform meta-analysis and the study heterogeneity was investigated using Q-Cochran test and I 2 index. Results According to Table 1 and based on most studies conducted in , the DEA method is more investigated compared to SFA method to measure the efficiency of Iranian hospitals more than other cities.
Table 1 Specifications of studies in meta-analysis and metaragiosis. Figure 2. Discussion In the present study, 24 articles were reviewed using systematic, meta-analysis, and meta-regression methods. Research constraints The lack of access to a number of articles due to access restrictions on the university site is considered as one of the constraints in this study that the websites of other universities were used to solve this problem. Conflicts of interest The article has not been registered elsewhere before and will not be published.
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