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" Efficiency Evaluation of Public Hospitals to Improve Decision Making in the Kingdom of Saudi Arabia "
Alatawi, Ahmed Dhaifallah
Khan, Jahangir
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Latin Dissertation
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| Language of Document
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English
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| Record Number
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1058775
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| Doc. No
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TL57892
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| Main Entry
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Alatawi, Ahmed Dhaifallah
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| Title & Author
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Efficiency Evaluation of Public Hospitals to Improve Decision Making in the Kingdom of Saudi Arabia\ Alatawi, Ahmed DhaifallahKhan, Jahangir
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| College
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The University of Liverpool (United Kingdom)
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| Date
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2020
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| Degree
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Ph.D.
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| student score
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2020
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| Note
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290 p.
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| Abstract
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The Kingdom of Saudi Arabia (KSA) has experienced increase in health expenditure and the demand for healthcare services. Health statistics indicate inefficiency in resource utilization within the healthcare system, particularly in the hospital sector. This thesis assessed the efficiency of health service provision in public hospitals and demonstrated the factors that affect hospital efficiency as well as provided useful recommendations to improve efficiency, based on stakeholders’ experiences, using a combination of quantitative and qualitative analysis. First, the systematic review of public hospitals efficiency studies revealed that such studies were limited in number and showed methodological deficiencies. The metaanalyses confirmed that methodology and assumption choices had a substantial impact on the efficiency measurements. Although there was no consensus regarding the most appropriate technique to measure efficiency, most existing studies relied on Data Envelopment Analysis (DEA), applying input-orientation assumption. Second, by applying DEA, the technical efficiency of the public hospitals was measured, and the characteristics of high-performing hospitals were explored. The analysis found that most hospitals were technically inefficient with the average score of 76% and the variations in efficiency scores across hospitals depended on the capacity (hospital size) and geographic location. Moreover, findings revealed that many hospitals were operating at suboptimal scale size, which indicated the need for possible changes in the production capacity to facilitate the optimal utilization of health resources to provide the current level of health services. Third, the tobit and two-part regression models estimated the impact of the external factors (demographic and socioeconomic characteristics of catchment populations) on the efficiency estimates. Population density share of children and people in poverty, incidence of infectious disease in the catchment area appeared to be significantly associated with the efficiency of the hospitals. Based on the findings, the decision of resource allocation should consider these external factors to improve utilization of health services among the target populations towards achieving better efficiency. Fourth, Key-Informant Interviews using a semi-structured guideline were conducted among the policy-makers, regional health authority and hospital mangers under the MOH to identify the components of performance in the public hospitals, the barriers to the efficiency as well as informing tool for feasible recommendations to improve the efficiency in such hospitals. The stakeholders explained the barriers that face hospital performance, including challenges in health regulations, centralization of decision-making, shortage of health workers, inefficient allocation of health resources, population demands and an indigent health-information system. The findings recommended developing strategic health plans, effective health administrations and hospital objectives in the light of aims of the health affairs in the KSA and the healthcare needs of the community. Also, there was a need for appropriate allocation mechanisms of health resources and medical personnel across the public hospitals. Moreover, it was recommended to secure the autonomy for hospital managements with adequate supervision on hospital performance. Enhancement of employment conditions, training programmes for the health workers and monitoring on the performance and quality of service delivery appeared to be essential for improving hospital efficiency. In sum, the knowledge gaps on the efficiency in public hospitals in the KSA, that have been identified in the systematic review has been further investigated by empirical analyses using multiple national datasets. Several hospitals have been operating at inefficient levels, which could be explained by both internal (inputs and outputs) and external (demographic and socioeconomic characteristics of catchment populations) factors. The findings of the quantitative analyses were broadly supported by the qualitative investigations. Finally, based on this research, we made recommendations to guide the policy-makers for amending policies towards for achieving efficiency in the public hospitals in the KSA.
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| Descriptor
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Efficiency
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Health services
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Hospitals
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Software
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Khan, Jahangir
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The University of Liverpool (United Kingdom)
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