Journal of Medical Systems

, 39:85 | Cite as

Do Geographical Locations Affect in Hospitals Performance? A Multi-group Data Envelopment Analysis

Systems-Level Quality Improvement
Part of the following topical collections:
  1. Systems-Level Quality Improvement


Hospitals are the main and the last component of the health care systems. Therefore, evaluating the performance of hospitals is vital. Several studies are done in hospitals evaluation, but almost none of them consider the geographical features. This paper proposes a new approach for evaluating hospitals. In the proposed approach, hospitals are classified into various groups and each group is equivalent to a province. It causes hospitals in each category (province) must be evaluated in homogenous environment. For this purpose, the conventional data envelopment analysis (DEA) model has been developed to this structure. The main feature of the proposed model is that it takes into consideration the geographical location. In other words, we propose a multi-group DEA model. The data on 288 Iranian hospitals grouped under 31 provinces are used to demonstrate the model. The results show that the efficiency scores are greatly changed when hospitals are evaluated in own groups.


Multi-group data envelopment analysis Efficiency Geographical location Province Hospital 


  1. 1.
    Charnes, A., Cooper, W. W., and Rhodes, E., Measuring the efficiency of decision making units. Eur. J. Oper. Res. 2:429–444, 1978.CrossRefGoogle Scholar
  2. 2.
    Banker, R. D., Charnes, A., and Cooper, W. W., Some models for estimating technical and scale inefficiencies in data envelopment analysis. Manag. Sci. 30:1078–1092, 1984.CrossRefGoogle Scholar
  3. 3.
    Chirikos, T. N., and Sear, A. M., Measuring hospital efficiency: A comparison of two approaches. Health Serv. Res. 34:1389, 2000.PubMedCentralPubMedGoogle Scholar
  4. 4.
    Daidone, S., and D’Amico, F., Technical efficiency, specialization and ownership form: Evidences from a pooling of Italian hospitals. J. Prod. Anal. 32:203–216, 2009.CrossRefGoogle Scholar
  5. 5.
    Mutter, R. L., and Rosko, M. D., The impact of ownership on the cost-efficiency of US hospitals. Adv. Health Econ. Health Serv. Res. 18:113–138, 2007.CrossRefGoogle Scholar
  6. 6.
    Burgess, J. F., and Wilson, P. W., Hospital ownership and technical inefficiency. Manag. Sci. 42:110–123, 1996.CrossRefGoogle Scholar
  7. 7.
    Özcan, Y. A., Luke, R. D., and Haksever, C., Ownership and organizational performance: A comparison of technical efficiency across hospital types. Med. Care 30:781–794, 1992.CrossRefPubMedGoogle Scholar
  8. 8.
    Lee, K.-H., Yang, S.-B., and Choi, M., The association between hospital ownership and technical efficiency in a managed care environment. J. Med. Syst. 33:307–315, 2009.CrossRefPubMedGoogle Scholar
  9. 9.
    Tiemann, O., and Schreyögg, J., Effects of ownership on hospital efficiency in Germany. BUR-Bus. Res. 2(2):115–145, 2009.Google Scholar
  10. 10.
    Lindlbauer, I., and Schreyögg, J., The relationship between hospital specialization and hospital efficiency: Do different measures of specialization lead to different results?. Health Care Manag. Sci. 1–14, 2014.Google Scholar
  11. 11.
    Linna, M., and Häkkinen, U., Determinants of cost efficiency of Finnish hospitals. A comparison of DEA and SFA: Helsinki University of Technology. Syst. Anal. Lab., 1998.Google Scholar
  12. 12.
    Lee, K.-s., Chun, K.-h., and Lee, J.-s., Reforming the hospital service structure to improve efficiency: Urban hospital specialization. Health Policy 87:41–49, 2008.CrossRefPubMedGoogle Scholar
  13. 13.
    Herwartz, H., and Strumann, C., On the effect of prospective payment on local hospital competition in Germany. Health Care Manag. Sci. 15:48–62, 2012.CrossRefPubMedGoogle Scholar
  14. 14.
    Flokou, A., Kontodimopoulos, N., and Niakas, D., Employing post-DEA cross-evaluation and cluster analysis in a sample of Greek NHS hospitals. J. Med. Syst. 35:1001–1014, 2011.CrossRefPubMedGoogle Scholar
  15. 15.
    Dalmau-Atarrodona, E., and Puig-Junoy, J., Market structure and hospital efficiency: evaluating potential effects of deregulation in a National Health Service. Rev. Ind. Organ. 13:447–466, 1998.CrossRefGoogle Scholar
  16. 16.
    Sahin, I., and Özcan, Y. A., Public sector hospital efficiency for provincial markets in Turkey. J. Med. Syst. 24:307–320, 2000.CrossRefPubMedGoogle Scholar
  17. 17.
    Ersoy, K., Kavuncubasi, S., Özcan, Y. A., and Harris, J. M., Technical efficiencies of Turkish hospitals: DEA approach. J. Med. Syst. 21:67–74, 1997.CrossRefPubMedGoogle Scholar
  18. 18.
    Kontodimopoulos, N., Nanos, P., and Niakas, D., Balancing efficiency of health services and equity of access in remote areas in Greece. Health Policy 76:49–57, 2006.CrossRefPubMedGoogle Scholar
  19. 19.
    Au, N., Hollingsworth, B., and Spinks, J., Measuring the efficiency of health services in lower‐income countries: The case of Papua New Guinea. Dev. Policy Rev. 32:259–272, 2014.CrossRefGoogle Scholar
  20. 20.
    Linna, M., Häkkinen, U., and Magnussen, J., Comparing hospital cost efficiency between Norway and Finland. Health Policy 77:268–278, 2006.CrossRefPubMedGoogle Scholar
  21. 21.
    Özcan, Y. A., Efficiency of hospital service production in local markets: The balance sheet of US medical armament. Socio Econ. Plan. Sci. 29:139–150, 1995.CrossRefGoogle Scholar
  22. 22.
    Hajialiafzali, H., Moss, J. R., and Mahmood, M. A., Efficiency measurement for hospitals owned by the Iranian social security organisation. J. Med. Syst. 31:166–172, 2007.CrossRefPubMedGoogle Scholar
  23. 23.
    Shahhoseini, R., Tofighi, S., Jaafaripooyan, E., and Safiaryan, R., Efficiency measurement in developing countries: application of data envelopment analysis for Iranian hospitals. Health Serv. Manag. Res. 24:75–80, 2011.CrossRefGoogle Scholar
  24. 24.
    Girginer, N., Köse, T., and Uçkun, N., Efficiency analysis of surgical services by combined use of data envelopment analysis and gray relational analysis. J. Med. Syst. 39:56, 2015.Google Scholar
  25. 25.
    Deidda, M., Lupiáñez-Villanueva, F., Codagnone, C., and Maghiros, I., Using data envelopment analysis to analyse the efficiency of primary care units. J. Med. Syst. 38:122, 2014.CrossRefPubMedGoogle Scholar
  26. 26.
    Jahangoshai, R. M., Moini, A., and Asgari, F. H. A., Unified performance evaluation of health centers with integrated model of data envelopment analysis and bargaining game. J. Med. Syst. 36(6):3805–3815, 2012.CrossRefGoogle Scholar
  27. 27.
    Mitropoulos, P., Mitropoulos, I., and Giannikos, I., Combining DEA with location analysis for the effective consolidation of services in the health sector. Comput. Oper. Res. 40(9):2241–2250, 2013.CrossRefGoogle Scholar
  28. 28.
    Torres-Jiménez, M., García-Alonso, C. R., Salvador-Carulla, L., and Fernández-Rodríguez, V., Evaluation of system efficiency using the Monte Carlo DEA: The case of small health areas. Eur. J. Oper. Res. 242(2):525–535, 2015.CrossRefGoogle Scholar
  29. 29.
    Cook, W. D., and Zhu, J., Within-group common weights in DEA: An analysis of power plant efficiency. Eur. J. Oper. Res. 178:207–216, 2007.CrossRefGoogle Scholar
  30. 30.
    Özcan, Y.A. Health care benchmarking and performance evaluation. Springer, 2008.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Urmia University of TechnologyUrmiaIslamic Republic of Iran

Personalised recommendations