Keywords: hospital efficiency, technical efficiency, hospital productivity, Malmquist index, technological change, data envelopment analysis, DEA, healthcare services, Tunisia, public hospitals, environmental factors, truncated model, bootstrap method, bed occupancy rate, hospital capacity utilisation, length of stay, number of beds
Productivity and its components in Tunisian public hospitals
This paper analyses the productivity and efficiency of the Tunisian public hospitals over the period from 2000 to 2007. We obtain estimates of productivity using the bootstrapped Malmquist index, and a truncated regression model is used to examine how external factors impact the level of productivity and its components (i.e. (a) the bed occupancy ratio which represents the hospital capacity utilisation; (b) the average length of stay; (c) the total number of beds). The hospitals are represented by means of a simple model whereby they use inputs (labour and capital) to produce outputs (healthcare services). The efficiency model, which is output–oriented, assumes variable returns to scale. The results show that the evolution of the productivity of the hospital is overwhelmingly due to the technological change, but the magnitude of the change in technical efficiency remains low. The results suggest also that the average length of stay has a negative impact on productivity and its components whereas other variables like, the bed occupancy ratio and the total number of beds, are non–significant.