Levels, Trends and Determinants of Technical Efficiency of General Hospitals in Uganda: Data Envelopment Analysis and Tobit Regression Analysis

Abstract

Background General hospitals provide a wide range of primary and secondary healthcare services. They accounted for 38% of government funding to hospitals, 8.8% of OPD visits and 28% of admissions in Uganda in FY 2016/17. We assessed the levels, trends and determinants of technical efficiency of general hospitals in Uganda from FY 2012/13 to FY 2016/17.Methods We undertook input-oriented Data Envelopment Analysis to estimate technical efficiency of 78 general hospitals using data abstracted from the Annual Health Sector Performance Reports for FY 2012/13, 2014/15 and 2016/17. Trends in technical efficiency was analysed using Excel while determinants of technical efficiency were analysed using Tobit Regression Model in STATA 15.1.Results Average Constant Returns to Scale, Variable Returns to Scale and Scale Efficiency of general hospitals for FY 2016/17 were 49% (95% CI, 44% − 54%), 69% (95% CI, 65% − 74%) and 70% (95% CI, 65% − 75%) respectively. There was no statistically significant difference in the efficiency scores of public and private hospitals. Technical efficiency generally increased from FY2012/13 to 2014/15, and dropped by FY 2016/17. Some hospitals were persistently efficient while others were inefficient over this period. Hospital size, geographical location, training status and average length of stay were statistically significant determinants of efficiency at 5% level of significance.Conclusion The 69% average variable returns to scale technical efficiency indicates that the hospitals could generate the same volume of outputs using 31% (3,439) less staff and 31% (3,539) less beds. Benchmarking performance of the efficient hospitals would help to guide performance improvement in the inefficient ones. There is need to incorporate hospital size, geographical location, training status and average length of stay in the resource allocation formula and adopt annual hospital efficiency assessments.

Approach in Inputs & Outputs Selection of Data Envelopment Analysis (DEA) Efficiency Measurement in Hospital: A Systematic Review

“…In other words, either output expansion or input decrease is the primary evaluation goal. More than half of the studies (55.06%, 49 of 89) [46][47][48][50][51][52][53][54]58,60,[64][65][66][67][68][69][71][72][73][75][76][77]80,[91][92][93][94]96,98,99,[103][104][105][106][107][109][110][111][113][114][115][116]118,121,124,127,128,130,135] applied input-orientated DEA models. The researchers indicated that the choice of input orientation was made to be in line with th...…”