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Gaceta Sanitaria

Print version ISSN 0213-9111


PEREZ-ROMERO, Carmen; ORTEGA-DIAZ, M. Isabel; OCANA-RIOLA, Ricardo  and  MARTIN-MARTIN, José Jesús. Multilevel analysis of the technical efficiency of hospitals in the Spanish National Health System by property and type of management. Gac Sanit [online]. 2019, vol.33, n.4, pp.325-332.  Epub Dec 02, 2019. ISSN 0213-9111.


To analyze technical efficiency by type of property and management of general hospitals in the Spanish National Health System (2010-2012) and identify hospital and regional explanatory variables.


230 hospitals were analyzed combining data envelopment analysis and fixed effects multilevel linear models. Data envelopment analysis measured overall, technical and scale efficiency, and the analysis of explanatory factors was performed using multilevel models.


The average rate of overall technical efficiency of hospitals without legal personality is lower than hospitals with legal personality (0.691 and 0.876 in 2012). There is a significant variability in efficiency under variable returns (TE) by direct, indirect and mixed forms of management. The 29% of the variability in TE es attributable to the Region. Legal personality increased the TE of the hospitals by 11.14 points. On the other hand, most of the forms of management (different to those of the traditional hospitals) increased TE in varying percentages. At regional level, according to the model considered, insularity and average annual income per household are explanatory variables of TE.


Having legal personality favours technical efficiency. The regulatory and management framework of hospitals, more than public or private ownership, seem to explain technical efficiency. Regional characteristics explain the variability in TE.

Keywords : Efficiency; Data envelopment analysis; Multilevel analysis; National health service; Hospitals; Public-private partnership; Public hospital enterprises.

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