Background
Study context
Conceptual framework
Hospitals as production units
Efficiency concepts
Data envelopment analysis
Research questions and objectives
Methods
Study design
Study population
Data and variables
Input and output variables
Variables | Definition | Measurement | Data Source |
---|---|---|---|
Input variables | |||
BEDS | Beds | Total number of hospital beds during the financial year | Annual Health Sector Performance Report 2012/2013 |
STAFF | Medical Staff | Total number of doctors, nurses, Clinical officers, Laboratory technicians and anesthetic officers. | Annual Health Sector Performance Report 2012/2013 |
Output variables | |||
INPATDAYS | In Patient days | Total number of inpatient days for the Financial year | Annual Health Sector Performance Report 2012/2013 |
OPD | Outpatient visits | Total number of outpatient visits during the Financial year | Annual Health Sector Performance Report 2012/2013 |
Explanatory variables | |||
BOR | Bed Occupancy Rate | Proportion of beds which are occupied over a specified period of time | Annual Health Sector performance report 2012/2013 |
OPDIPD | Outpatient visits as a proportion of inpatient days; | Total Outpatient department visits divided by the total inpatient days | Annual Health Sector performance report 2012/2013 (calculated) |
ALOS | Average Length of Stay | Average number of days that patients spend in hospital. Measured by dividing the total number of days stayed by all inpatients during a year by the number of admissions | Annual Health Sector performance report 2012/2013 |
SIZE | Hospital Size | Number of beds in the hospital. 1 if >190 and 0 if <190 | Annual Health Sector performance report 2012/2013 |
OWN | Ownership | Governing authority of hospital. 1 if Government/private hospital owned; 0 if NGO/PNFP | Annual Health Sector performance report 2012/2013 |
TEACH | Teaching status | Whether a hospital is attached to a university or not for the purpose of training medical students (doctors & Pharmacists) | Individual hospital website |
DIST | Distance | Distance of the teaching hospital from the capital city. 1 if and 0 if | Individual hospital website |
POP | Population size | Total population of districts in the hospital’s catchment area.: 1 if and 0 if | Uganda National Population and Housing Census 2014 (calculated) |
Explanatory variables
Data management and analysis methods
First stage analysis-data envelopment analysis (DEA)
Model specification
Second stage- econometric analysis (Tobit Regression)
Ethical clearance
Results
Descriptive analysis of inputs and output variables
Mean | Standard deviation | Minimum | Maximum | |
---|---|---|---|---|
Inputs | ||||
Number of Clinical staff | 202 | 88 | 97 | 453 |
Number of beds | 287 | 117 | 100 | 482 |
Outputs | ||||
Number of outpatient department visits | 143,654 | 51,339 | 35,390 | 209,032 |
Patient days | 87,344 | 41,052 | 24,382 | 176,671 |
Descriptive analysis of explanatory variables
Mean | Standard deviation | Minimum | Maximum | |
Continuous variables | ||||
Bed Occupancy Rate (BOR) | 81.4 % | 19.9 % | 40.8 % | 100 % |
Outpatient department visits as a proportion of In-patient stays (OPDIPD) | 2 | 1.27 | 0.48 | 5.30 |
Average Length of Stay (ALOS)-days | 4.6 | 1.2 | 3 | 7 |
Description | Number | Percentage | ||
Categorical Variables | ||||
Catchment Population (POP)- 1 if catchment population less than 1.5 million and 0 if greater than 1.5 million | 0 | 8 | 47 % | |
1 | 9 | 53 % | ||
Distance from city (DIST) 1 if hospital located greater than 200Km Kilometres from capital city and 0 if located less than 200 km | 1 | 14 | 82 % | |
0 | 3 | 18 % | ||
Teaching Status (TEACH) 1 if Teaching Hospital and 0 if not | 0 | 15 | 88 % | |
1 | 2 | 12 % | ||
Hospital Ownership (OWN) -1 if government/MOH and 0 if NGO/PNFP | 0 | 3 | 18 % | |
1 | 14 | 82 % | ||
Hospital Size (SIZE)-1 if >190 hospital beds and 0 if <190 hospital beds | 0 | 4 | 24 % | |
1 | 13 | 76 % |
Technical efficiency
Hospital | Efficiency scores | Returns to scale | Reference set (lambda weights) | ||
---|---|---|---|---|---|
CRS_TE | VRS_TE | Scale | |||
Gulu | 1 | 1 | 1 | Constant returns to scale | |
Hoima | 1 | 1 | 1 | Constant returns to scale | |
Mbale | 0.940133 | 1 | 0.940133 | Diminishing returns to scale | |
Moroto | 1 | 1 | 1 | Constant returns to scale | |
Masaka | 0.8954 | 1 | 0.8954 | Diminishing returns to scale | |
Lira | 0.900694 | 1 | 0.900694 | Diminishing returns to scale | |
Nsambya | 0.431078 | 1 | 0.431078 | Diminishing returns to scale | |
St. Mary’s Lacor | 0.692294 | 1 | 0.692294 | Diminishing returns to scale | |
Mbarara | 0.861657 | 0.976592 | 0.88231 | Diminishing returns to scale | Masaka (0.406617), Mbale (0.309851), Gulu (0.097515), Hoima (0.162609) |
Soroti | 0.850387 | 0.941373 | 0.903348 | Diminishing returns to scale | Gulu (0.260962) Hoima (0.250726) Mbale (0.323689); Moroto (0.105996) |
Fort Portal | 0.76477 | 0.921675 | 0.829762 | Diminishing returns to scale | Hoima (0.037365) Masaka (0.884309) |
Jinja | 0.70878 | 0.86767 | 0.816877 | Diminishing returns to scale | Masaka (0.640645) St. Mary’s Lacor (0.114007); Mbale (0.113018) |
Arua | 0.75922 | 0.855481 | 0.887478 | Diminishing returns to scale | Gulu (0.055922) ;Mbale (0.008273), Masaka (0.791286) |
Mubende | 0.847976 | 0.850297 | 0.99727 | Increasing returns to scale | Gulu (0.064533), Hoima (0.318159); Mbale (0.005493); Moroto (0.462112) |
Kabale | 0.81319 | 0.843276 | 0.964323 | Increasing returns to scale | Masaka (0.125589) Hoima (0.702674); Lira (0.015013) |
Rubaga | 0.524107 | 0.762422 | 0.687424 | Increasing returns to scale | Gulu (0.126505) Nsambya (0.19374);Masaka (0.442177) |
Naguru | 0.509215 | 0.523887 | 0.971994 | Increasing returns to scale | Gulu (0.408324), Moroto (0.077042) |
Min | 0.431078 | 0.523887 | 0.431078 | ||
Max | 1 | 1 | 1 | ||
Mean | 0.794053 | 0.914275 | 0.870611 | ||
SD | 0.174409 | 0.125919 | 0.149222 |
Pearson correlation analysis
Econometric analysis of the determinants of inefficiency
Variable | Coefficient | t |
P > |t| |
---|---|---|---|
SIZE | -0.3173112 | -3.50 | 0.004** |
OWN | 0.919808 | 0.79 | 0.446 |
OPDID | -0.0950934 | -2.47 | 0.028* |
BOR | -1.097405 | 4.24 | 0.001** |
cons | 1.376723 | 4.67 | 0.000 |
Sigma | 0.1448706 | ||
**p < 0.01; | *p < 0.05 | ||
Observations Summary | |||
Number of observations | 17 | ||
LR χ2
| 15.42 | ||
Prob > χ2
| 0.0039 | ||
Log likelihood | 6.7537247 | ||
Pseudo R2 | 8.0570 |
Scope for output increases/input reductions to improve efficiency
Hospital | Score-VRS | Input/output | Actual quantity | Target quantity | Difference | Percentage |
---|---|---|---|---|---|---|
Arua | 0.855481 | Medical Staff | 198 | 164 | -34 | -17 % |
Beds | 316 | 270 | -46 | -15 % | ||
OPD Visits | 176689 | 176689 | 0 | 0 % | ||
Patient Days | 90231 | 90,231 | 0 | 0 % | ||
Fort Portal | 0.921675 | Medical Staff | 189 | 174 | -15 | -8 % |
Beds | 371 | 300 | -71 | -19 % | ||
OPD Visits | 190665 | 190665 | 0 | 0 % | ||
Patient Days | 88832 | 99260 | 10428 | 12 % | ||
Jinja | 0.86767 | Medical Staff | 219 | 190 | -29 | -13 % |
Beds | 443 | 316 | -127 | -29 % | ||
OPD Visits | 160387 | 160387 | 0 | 0 % | ||
Patient Days | 108007 | 108007 | 0 | 0 % | ||
Kabale | 0.843276 | Medical Staff | 130 | 110 | -20 | -15 % |
Beds | 252 | 203 | -49 | -19 % | ||
OPD Visits | 138321 | 138,321 | 0 | 0 % | ||
Patient Days | 70396 | 70,396 | 0 | 0 % | ||
Soroti | 0.941373 | Medical Staff | 178 | 168 | -10 | -6 % |
Beds | 254 | 239 | -15 | -6 % | ||
OPD Visits | 121629 | 121629 | 0 | 0 % | ||
Patient Days | 96558 | 96558 | 0 | 0 % | ||
Mubende | 0.850297 | Medical Staff | 112 | 95 | -17 | -15 % |
Beds | 175 | 149 | -26 | -15 % | ||
OPD Visits | 86715 | 86715 | 0 | 0 % | ||
Patient Days | 62456 | 62,456 | 0 | 0 % | ||
Naguru | 0.523887 | Medical Staff | 153 | 80 | -73 | -48 % |
Beds | 100 | 52 | -48 | -48 % | ||
OPD Visits | 35390 | 81,333 | 45943 | 130 % | ||
Patient Days | 24382 | 24382 | 0 | 0 % | ||
Rubaga | 0.762422 | Medical Staff | 256 | 195 | -61 | -24 % |
Beds | 271 | 207 | -64 | -24 % | ||
OPD Visits | 155544 | 155544 | 0 | 0 % | ||
Patient Days | 40380 | 61377 | 20997 | 52 % | ||
Mbarara | 0.976592 | Medical Staff | 197 | 192 | -5 | -3 % |
Beds | 323 | 315 | -8 | -2 % | ||
OPD Visits | 155185 | 155,185 | 0 | 0 % | ||
Patient Days | 116277 | 116277 | 0 | 0 % |