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This study aims to explore the nexus of equality and efficiency by considering public hospitals' development dynamics, capacity and technology indicators.

Data was collected from the Ministry of Health Public Hospital Almanacs from 2014 to 2017. The Gini index (GI) is used to estimate the inequality of distribution of hospital performance indicators. A bias-corrected efficiency analysis is calculated to obtain efficiency scores of public hospitals for the year 2017. A path analysis is then constructed to better identify patterns of causation among a set of development, equality and efficiency variables.

A redefined path model highlights that development dynamics, equality and efficiency are causally related and health technology (path coefficient = 0.57; t = 19.07; p < 0.01) and health services utilization (path coefficient = 0.24; t = 8; p < 0.01) effects public hospital efficiency. The final path model fit well (X²/df = 50.99/8 = 6; RMSEA = 0.089; NFI = 0.95; CFI = 0.96; GFI = 0.98; AGFI = 0.94). Study findings indicate high inequalities in distribution of health technologies (GI > 0.85), number of surgical operations (GI > 0.70) and number of inpatients (GI > 0.60) among public hospitals for the years 2014–2017.

Study results highlight that, hospital managers should prioritize equal distribution of health technology and health services utilization indicators to better orchestrate equity-efficiency trade-off in their operations.

The Philippine health care system is comprised of both private and public hospitals, clinics, and health care providers, and public health units serve a huge majority of the population because of their number and accessibility to more people in terms of price and location. It is therefore important to examine the performance of these public health units and see if they could become more efficient in the delivery of health services. This study will apply data envelopment analysis (DEA) to assess the efficiency of provinces in providing health care services in order to assist the Department of Health in identifying the performance level of each province, determining the targets for improvements in securing benefits and using resources, and identifying the peers of provinces in the delivery of health care. The data used in this study are taken from the Field Health Service Information System and Philippine Health Insurance System of the Department of the Health and the Statement of Income and Expenditure of the Department of Finance. The following programs were analyzed in this study: Maternal Health Care, Child Health Care, and Environmental Sanitation. These programs’ outcomes comprise the percentage of the prevalence of contraceptive use and fully immunized children, for maternal and child health care programs; and the percentage of people who have access to potable water and sanitary toilets, for environmental sanitation. As for inputs, expenditure efficiency is analyzed by the health unit budget per capita and technical efficiency includes the number of doctors and midwives per 100,000 population and the percentage of rural health units accredited by the Philippine Health Insurance Corporation. The DEA results for efficiency expenditure shows that only 9 out of 77 provinces are efficient in providing health programs given their budgets and the average input efficiency score is 54 percent and the average output efficiency score is 87 percent. As for the DEA results for technical efficiency, 24 out of 77 provinces are efficient in providing health care programs given the percentage number of doctors, midwives, and accredited health facilities by the Philippine Health Insurance Corporation. The average input efficiency score is 79 percent and the average output efficiency score is 80 percent. This study has shown the importance of DEA in analyzing the efficiency of delivery of public health services in provinces using expenditure, number of available health care providers, and the presence of accredited rural health units vis-à-vis environmental sanitation and maternal and child health care programs. DEA can rationalize the allocation of budgets among similar health units in order to further improve the efficiency in the delivery of health services in provinces. Moreover, benchmarking using DEA results can improve the accountability of provincial health units in the utilization of their budgets in order to further increase the reach of province-based health programs which could lead to a marked improvement in the health of Filipinos.

This work aims to analyse the relationship between public health efficiency and well-being considering a panel of 102 Italian provinces from 2000 to 2016 and evaluates if there are omitted variable biases and endogeneity biases and also evaluates if there are heterogeneous effects among provinces with different income levels.

We use a multi-input and output bootstrap data envelopment analysis to assess public health efficiency. Then, we measure well-being indices using the min-max linear scaling transformation technique. A two-stage least squares model is used to identify the causal effect of improving public health efficiency on well-being to account for time-invariant heterogeneity, omitted variable bias and endogeneity bias.

After controlling for important economic factors, the results show a significant effect of an accountable and efficient public health system on well-being. Those effects are concentrated in the North, the most economically, geographically and environmentally advantageous areas.

The use of the sample mean, probably the oldest and most used method for aggregating the indicators, could be affected by variable compensation, with consequent misleading results in the process of constructing the well-being index. Another limitation is the use of lagged values of the main predictor as an instrument in the instrumental variables setting because it could lead to information loss. Finally, the availability of data over a long period of time.

The findings could help policymakers adopt measures to strengthen the public health system, encourage private providers and inspire countries worldwide.

These results draw the attention of local authorities, who play an important role in designing and implementing policies to stimulate local public health efficiency, which puts individuals in the conditions of achieving overall well-being in their communities.

For the first time in Italy, a panel of well-being indices was constructed by developing new methodologies based on microeconomic theory. Furthermore, for the first time, the assessment of the relationship between public health efficiency and well-being is carried out using a panel of 102 Italian provinces.

Decree Law No. 663 introduced a decentralized organizational structure and administration pertaining to Turkish public hospitals in November 2011. This study aims to explore the effects of the public hospital unions (PHUs), which were a result of Decree Law No. 663, on the efficiency and productivity of public hospitals.

Data envelopment analysis (DEA) and DEA-based Malmquist total factor productivity (TFP) index were used from 2011 to 2016. Raw materials and supply expenses, salaries and fringe benefits, other service costs, general administrative expenses, total number of beds, number of specialists, number of residents, number of general practitioners, number of nurses and midwives and other medical officials were used as input variables. Working capital turnover, number of inpatients, number of outpatients and number of surgical operations for Groups A, B and C were used as output variables.

According to the DEA scores, the percentage of efficient hospitals showed a declining trend from 2011 to 2016. The TFP results also showed a decreasing trend from 2011 to 2016.

Providing administrative and financial autonomy to public hospital managers may cause efficiency and productivity losses, which is contrary to expectations.

This study is the first to reveal the impact of decentralization of public healthcare providers on their performance levels in Turkey.

The purpose of this paper is to assess whether the relative efficiency of South African municipalities in primary health care and hospital care is different and whether South African municipalities can learn from each other to improve on their efficiency.

The paper employs efficiency scores, estimated with data envelopment analysis using data from the District Health Barometer of the Health Systems Trust to rank South African municipalities across primary health care and hospital health care.

The finding is that the ranking of municipalities is not the same across both types of health care when efficiency scores and efficiency score growth are contemplated. These results imply that municipalities in South Africa are generally inefficient, but with the possibility of learning from each other’s practice in order to increase their technical efficiency.

The health system authority should monitor service-specific best practices among municipalities so that they can use them as practice guidelines for other municipalities.

Previous studies in South Africa have not dis-aggregated efficiency analysis across municipalities which are health system components of the broader national health system.

The purpose of this paper is to measure the efficiency of ISO 9001-certified public healthcare center in Jakarta, Indonesia and examine the impact of “re-certification“ on the efficiency.

The sample of the research is 30 ISO 9001-certified district public healthcare centers in Jakarta. The data envelopment analysis (DEA) and the Man–Whitney U test were applied.

The research result showed that there is a variation in efficiency values of ISO 9001-certified public healthcare centers that this research studied. There are only 23 percent of the public healthcare centers that can be categorized as the technically efficient public healthcare center. Furthermore, this research also found that there are no significant efficiency value differences among the groups of public healthcare center based on the number of “re-certification” the center experienced.

This research only involved ISO 9001-certified public healthcare center from Jakarta, Indonesia.

Registering ISO 9001 for the public healthcare center does not guarantee that the public healthcare center will have better efficiency. The government and the public healthcare center management should ensure that the ISO 9001 implementation method used by the public healthcare center is appropriate for improving the efficiency of the public healthcare center.

There is a lack of research that studied the efficiency of ISO 9001-certified public healthcare center. Furthermore, there is no research that investigates the effect of “re-certification“ on efficiency. This research fulfills the literature gaps.

This study aims to identify the efficiency scores of hospitals affiliated to the Ministry of Health in Turkey between the years of 2010–2015 at provincial level and to reveal the factors that affect the efficiency scores.

The two-stage data envelopment analysis (DEA) method was used to achieve the study purpose. In the first stage, DEA method based on input-oriented Charnes–Cooper–Rhodes (CCR) model was performed to calculate the efficiency scores of public hospitals at the provincial level between 2010 and 2015, and in the second stage, Tobit regression and linear regression analyses were used to identify whether the efficiency scores of provinces are affected by the input, output and control variables.

Upon the analysis, the average efficiency scores of 81 provinces by years were found to vary between 0.79 and 0.89. According to both regression analyses, all of the input and output variables were found to have significant effects on the efficiency scores of provinces while only the population of province among the control variables was identified as the factor with an effect on the efficiency scores of provinces (p < 0.05).

The results of this study are thought to guide health policymakers and managers in terms of both determining efficient and inefficient hospitals at the provincial level and revealing which variables should be taken into account in order to increase efficiency.

The study differs from previous studies on the efficiency of hospitals. First, although previous studies were generally descriptive studies to determine the efficiency level of hospitals, this study is an analytical study that tries also to show the factors affecting the efficiency of hospitals. In addition, while examining the effect of input and output variables on efficiency scores, control variables were also included in the study.

The purpose of this paper is to estimate the performance of Brazilian hospitals’ services and to examine contextual variables in the socioeconomic, demographic and institutional domains as predictors of the performance levels attained.

The paper applied a two-stage approach of the technique for order preference by similarity to the ideal solution (TOPSIS) in public hospitals in 92 Rio de Janeiro municipalities, covering the 2008–2013 period. First, TOPSIS is used to estimate the relative performance of hospitals in each municipality. Next, TOPSIS results are combined with neural networks in an effort to originate a performance model with predictive ability. Data refer to hospitals’ outpatient and inpatient services, based on frequent indicators adopted by the healthcare literature.

Despite a slight performance increase over the period, substantial room for improvement is observed. The most important performance predictors were related to the demographic and socioeconomic status (area in square feet and GDP per capita) and to the juridical nature and type of ownership of the healthcare facilities (number of federal and private hospitals).

The results provide managerial insights regarding the performance of public hospitals and opportunities for better resource allocation in the healthcare sector. The paper also considers the impact of external socioeconomic, demographic and institutional factors on hospitals’ performance, indicating the importance of integrative public health policies.

This study displays an innovative context for applying the two-stage TOPSIS technique, with similar efforts not having been identified in the healthcare literature.

The purpose of this paper is to measure the technical and scale efficiency of health centres; to evaluate changes in productivity; and to highlight possible policy implications of the results for policy makers.

Data envelopment analysis (DEA) is employed to assess the technical and scale efficiency, and productivity change over a four‐year period among 17 public health centres.

During the period of study, the results suggest that the public health centres in Seychelles have exhibited mean overall or technical efficiency of above 93 per cent. It was also found that the overall productivity increased by 2.4 per cent over 2001‐2004.

Further research can be undertaken to gather data on the prices of the various inputs to facilitate an estimation of the allocative efficiency of clinics. If such an exercise were to be undertaken, researchers may also consider collecting data on quantities and prices of paramedical, administrative and support staff to ensure that the analysis is more comprehensive than the study reported in this paper. Institutionalization of efficiency monitoring would help to enhance further the already good health sector stewardship and governance.

This paper provides new empirical evidence on a four‐year trend in the efficiency and productivity of health centres in Seychelles.

The fiscal outlay efficiency matters when the performance-based allocation of funds is made to state governments by the central government in a federal structure of an economy like India. Also the efficiency cannon of public expenditure is a key aspect in the field of public economics. Thus, a study to evaluate the efficiency in fiscal outlay of Indian states has been conducted.

The paper offers a three divisions–based paradigm under Network Data Envelopment Analysis framework to compare the performance of fiscal entities (say Indian state governments) in converting available fiscal resources into desired short-run and long-run growth and development objectives. The network efficiency score has been taken as a measure of the quality of fiscal outlay management that is trifurcated into divisional efficiencies representing budgeting process, fiscal outlay efficiency process and fiscal outlay effectiveness process.

It has been noticed that the states are under performing in achieving short-run growth targets and so the efficiency process division has been identified a major source of fiscal under performance. Suboptimum allocation of fiscal expenditure under various heads within the fiscal resources, as explained under budgeting process, is another major cause of fiscal under performance.

The study purposes a three divisions–based paradigm that takes into account efficiency of a state in (1) planning budget, (2) achieving short-run growth targets and (3) achieving long-run development targets. These three stages are named as budgeting process efficiency, fiscal outlay efficiency and fiscal outlay effectiveness, respectively. Therefore, a new paradigm called BEE paradigm is proposed to evaluate performance of fiscal entities in terms of fiscal outlay efficiency.

In existing literature on measuring efficiency of public expenditure, the public sector outputs have been made as function of fiscal expenditure as input treating the said outlay as an exogenous variable. In present context, the fiscal expenditure has been treated endogenous to the budgeting process. A high inefficiency on account of budgeting process supports this treatment too.