Academic journal article Iranian Journal of Public Health

Performance Ratio Analysis: A National Study on Iranian Hospitals Affiliated to Ministry of Health and Medical Education

Academic journal article Iranian Journal of Public Health

Performance Ratio Analysis: A National Study on Iranian Hospitals Affiliated to Ministry of Health and Medical Education

Article excerpt

Abstract

Background: This study was designed to present and compare Iranian hospitals' performance applying ratio analysis technique.

Methods: This cross-sectional survey was conducted to present an instant image of 139 Iranian hospitals' performance status applying ratio analysis as one of the non parametric technical efficiency assessment methods in 2008. Data was collected using nine dimensional questionnaires supported by world wide web to achieve main hospital ratios. Final analysis was performed applying classic statistics and relevant statistical tests on significant level of 0.05.

Results: Four hospital performance indicators were estimated in the studied hospitals as follows: Bed turnover rate (BTR) was fluctuated from 64.5 to 114.8 times for hospitals located in rich and poor areas respectively. Moreover Bed Interval Rate (BIT) was calculated 1.36 versus 2.4 in the poor and rich areas. Average length of stay (ALS) was computed 1.82 for the poor regions but 3.27 for the rich ones furthermore, a positive statistical significant correlation was seen between ALS and the hospital size (P=0.001,r=0.28). Average bed occupancy rate (BOR) was 57.8% and its variation was from 31.4% to 64.5% depending on the hospital size so that there was a positive statistical significant relationship between the hospital size and BOR (P=0.006, r=0.32).

Conclusion: Regarding that BOR, ALS, BTR and BIT along with mortality rates are mentioned as the most considerable performance indicators, applying analytic frameworks more than considering single and raw indicators are severely recommended.

Keywords: Ratio analysis, Efficiency, Hospital, Iran

Introduction

Hospitals are considered as the most significant section of the health care systems all over the world providing complex and vital services (1), at the same time, they are mentioned as the largest consumer of the rare sources allocated to the health sector (2) in another word, hospitals specially in developing countries are accountable for almost 50 to 80 percent of the all healthcare system costs (3).

According to the hospitals' significance and regarding the constant increase in the health expenditures and its relevant financial problems that mostly belong to this biggest consumer (4), extra attention to hospital performance is required. Performance indicators can be applied for two main internal and external purposes. The Internal ones are related to the hospitals' managerial functions as health services delivery organizations and in this way, these internal indicators are used as an informational tool for managers to monitor, evaluate or improve the long term or short term functions. In contrast, the external purposes are related to accountability questions asked by other stakeholders such as the financier, consumers or the public (5).

Although there is no doubt using performance indicators to demonstrate a real and complete image of the hospital performance, different indexes are considered appropriate as a performance criterion mainly categorized in three branches of efficiency, effectiveness and quality(6). Among them, efficiency is used vastly though its definition is almost ambiguous (7).

Efficiency is simply explained as the ratio of outputs to inputs, however the efficiency of each hospital production unit consists of two essential elements: technical efficiency and allocative one (8). The former can be measured as the hospital performance indicator using different methods; one is applying hospital performance ratios.

Ratio analysis as one of the non parametric technical efficiency assessment methods, includes the separate examination of various key measures such as average cost per inpatient day, bed occupancy rate, average length of stay, bed turnover ratio and so on (9).

This is a simple applied method for presenting general status of the hospitals only in the condition of single inputs and single outputs. …

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