Efficiency and Productivity of Public Hospitals in Serbia Using DEA-Malmquist Model and Tobit Regression Model, 2015–2019

TLDR

Improving productivity within health systems using limited resources is a matter of great concern. The objectives of the paper were to evaluate the productivity, efficiency, and impact of environmental factors on efficiency in Serbian hospitals from 2015‑2019. The study applied DEA, the Malmquist index, and Tobit regression to 2015‑2019 Serbian hospital data, revealing wide variation in capacity and performance. Between 2015 and 2019, only five to eight hospitals ran efficiently, productivity rose while technical efficiency fell; Tobit regression showed that a higher proportion of elderly patients and smaller size (below 200 beds) negatively affected technical efficiency, whereas larger size (400‑600 beds), higher outpatient‑to‑inpatient ratios, bed turnover, and bed occupancy positively correlated, indicating substantial room for technical efficiency improvement that requires public action.

Abstract

Improving productivity within health systems using limited resources is a matter of great concern. The objectives of the paper were to evaluate the productivity, efficiency, and impact of environmental factors on efficiency in Serbian hospitals from 2015-2019. Data envelopment analysis, Malmquist index and Tobit regression were applied to hospital data from this period, and public hospitals in Serbia exhibited a great variation regarding their capacity and performance. Between five and eight hospitals ran efficiently from 2015 to 2019, and the productivity of public hospitals increased whereas technical efficiency decreased in the same period. Tobit regression indicated that the proportion of elderly patients and small hospital size (below 200 beds) had a negative correlation with technical efficiency, while large hospital size (between 400 and 600 beds), the ratio of outpatient episodes to inpatient days, bed turnover rate and the bed occupation rate had a positive correlation with technical efficiency. Serbian public hospitals have considerable space for technical efficiency improvement and public action must be taken to improve resource utilization.