IDEAS home Printed from
   My bibliography  Save this article

Determinants of Technical Efficiency in Public Hospitals: The Case of Saudi Arabia


  • Ahmed D. Alatawi

    (Liverpool School of Tropical Medicine, LSTM
    University of Al-Jouf)

  • Louis W. Niessen

    (Liverpool School of Tropical Medicine
    University of Warwick)

  • Jahangir A. M. Khan

    (Liverpool School of Tropical Medicine
    Karolinska Institute)


Objective In this study, we investigate the effect of the external environmental and institutional factors on the efficiency and the performance of the public hospitals affiliated to the Ministry of Health (MOH) in the Kingdom of Saudi Arabia (KSA). We estimate the demographic and socioeconomic characteristics of catchment populations that explain the demand for health services. Methods We apply descriptive analysis to explore what external factors (demographic and socioeconomic factors) can explain the observed differences in technical efficiency scores. We use Spearman’s rank correlation, multivariate Tobit regression and Two-part model to measure the impact of the explanatory variables (i.e. population density, nationality, gender, age groups, economic status, health status, medical interventions and geographic location) on the efficiency scores. Results The analysis shows that the external factors had a significant influence on efficiency scores. We find significant associations between hospitals efficiency scores and number of populations in the catchment area, percentage of children (0–5 years old), the prevalence of infectious diseases, and the number of prescriptions dispensed from hospital’s departments. Also, the scores significantly associate with the number of populations who faced financial hardships during medical treatments, and those received financial support from social administration. That indicates the hospitals that serve more patients in previous characteristics are relatively more technically efficient. Conclusions The environmental and institutional factors have a crucial effect on efficiency and performance in public hospitals. In these regards, we suggested improvement of health policies and planning in respect to hospital efficiency and resource allocation, which consider the different demographic, socioeconomic and health status of the catchment populations (e.g., population density, poverty, health indicators and services utilization). The MOH should pay more attention to ensure appropriate allocation mechanisms of health resources and improve utilization of health services among the target populations, for securing efficient and equitable health services.

Suggested Citation

  • Ahmed D. Alatawi & Louis W. Niessen & Jahangir A. M. Khan, 2020. "Determinants of Technical Efficiency in Public Hospitals: The Case of Saudi Arabia," Health Economics Review, Springer, vol. 10(1), pages 1-11, December.
  • Handle: RePEc:spr:hecrev:v:10:y:2020:i:1:d:10.1186_s13561-020-00282-z
    DOI: 10.1186/s13561-020-00282-z

    Download full text from publisher

    File URL:
    File Function: Abstract
    Download Restriction: no

    File URL:
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item

    References listed on IDEAS

    1. Owen O'Donnell & Eddy van Doorslaer & Adam Wagstaff & Magnus Lindelow, 2008. "Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation," World Bank Publications - Books, The World Bank Group, number 6896, November.
    2. Hanson, Kara & Atuyambe, Lynn & Kamwanga, Jolly & McPake, Barbara & Mungule, Oswald & Ssengooba, Freddie, 2002. "Towards improving hospital performance in Uganda and Zambia: reflections and opportunities for autonomy," Health Policy, Elsevier, vol. 61(1), pages 73-94, July.
    3. Firdaus Hafidz & Tim Ensor & Sandy Tubeuf, 2018. "Assessing health facility performance in Indonesia using the Pabón‐Lasso model and unit cost analysis of health services," International Journal of Health Planning and Management, Wiley Blackwell, vol. 33(2), pages 541-556, April.
    4. Bruce Hollingsworth, 2008. "The measurement of efficiency and productivity of health care delivery," Health Economics, John Wiley & Sons, Ltd., vol. 17(10), pages 1107-1128, October.
    5. Jacobs,Rowena & Smith,Peter C. & Street,Andrew, 2006. "Measuring Efficiency in Health Care," Cambridge Books, Cambridge University Press, number 9780521851442.
    6. Matthew Sutton & Peter Lock, 2000. "Regional differences in health care delivery: implications for a national resource allocation formula," Health Economics, John Wiley & Sons, Ltd., vol. 9(6), pages 547-559, September.
    7. Alvarez, Roberto & Crespi, Gustavo, 2003. "Determinants of Technical Efficiency in Small Firms," Small Business Economics, Springer, vol. 20(3), pages 233-244, May.
    Full references (including those not matched with items on IDEAS)


    Blog mentions

    As found by, the blog aggregator for Economics research:
    1. Angela Devine’s journal round-up for 28th September 2020
      by Angela Devine in The Academic Health Economists' Blog on 2020-09-28 11:00:07

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Ferreira, D.C. & Marques, R.C., 2019. "Do quality and access to hospital services impact on their technical efficiency?," Omega, Elsevier, vol. 86(C), pages 218-236.
    2. Laudicella, Mauro & Olsen, Kim Rose & Street, Andrew, 2010. "Examining cost variation across hospital departments-a two-stage multi-level approach using patient-level data," Social Science & Medicine, Elsevier, vol. 71(10), pages 1872-1881, November.
    3. Alonso, José M. & Clifton, Judith & Díaz-Fuentes, Daniel, 2015. "The impact of New Public Management on efficiency: An analysis of Madrid's hospitals," Health Policy, Elsevier, vol. 119(3), pages 333-340.
    4. Paolo Mancuso & Vivian Grace Valdmanis, 2016. "Care Appropriateness and Health Productivity Evolution: A Non-Parametric Analysis of the Italian Regional Health Systems," Applied Health Economics and Health Policy, Springer, vol. 14(5), pages 595-607, October.
    5. Bonasia, Mariangela & Kounetas, Konstantinos & Oreste, Napolitano, 2020. "Assessment of regional productive performance of European health systems under a metatechnology framework," Economic Modelling, Elsevier, vol. 84(C), pages 234-248.
    6. Oliver Tiemann & Jonas Schreyögg, 2012. "Changes in hospital efficiency after privatization," Health Care Management Science, Springer, vol. 15(4), pages 310-326, December.
    7. Margherita Neri & Patricia Cubi-Molla & Graham Cookson, 2022. "Approaches to Measure Efficiency in Primary Care: A Systematic Literature Review," Applied Health Economics and Health Policy, Springer, vol. 20(1), pages 19-33, January.
    8. Michael Rosko & Mona Al-Amin & Manouchehr Tavakoli, 2020. "Efficiency and profitability in US not-for-profit hospitals," International Journal of Health Economics and Management, Springer, vol. 20(4), pages 359-379, December.
    9. Fuhmei Wang & Jung-Der Wang, 2017. "Telehealth and Sustainable Improvements to Quality of Life," Applied Research in Quality of Life, Springer;International Society for Quality-of-Life Studies, vol. 12(1), pages 173-184, March.
    10. Nils Gutacker & Chris Bojke & Silvio Daidone & Nancy J. Devlin & David Parkin & Andrew Street, 2013. "Truly Inefficient Or Providing Better Quality Of Care? Analysing The Relationship Between Risk‐Adjusted Hospital Costs And Patients' Health Outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 22(8), pages 931-947, August.
    11. Davutyan, Nurhan & Bilsel, Murat & Tarcan, Menderes, 2015. "Migration, Risk-Adjusted Mortality, Varieties of Congestion and Patient Satisfaction in Turkish Provincial General Hospitals," Data Envelopment Analysis Journal, now publishers, vol. 1(2), pages 135-169, July.
    12. Varabyova, Yauheniya & Schreyögg, Jonas, 2013. "International comparisons of the technical efficiency of the hospital sector: Panel data analysis of OECD countries using parametric and non-parametric approaches," Health Policy, Elsevier, vol. 112(1), pages 70-79.
    13. Marianela Carrillo & Jesús M. Jorge, 2017. "DEA-Like Efficiency Ranking of Regional Health Systems in Spain," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 133(3), pages 1133-1149, September.
    14. Roberto Colombi & Gianmaria Martini & Giorgio Vittadini, 2017. "Determinants of transient and persistent hospital efficiency: The case of Italy," Health Economics, John Wiley & Sons, Ltd., vol. 26(S2), pages 5-22, September.
    15. Steenhuis, Sander & Groeneweg, Niels & Koolman, Xander & Portrait, France, 2017. "Good, better, best? A comprehensive comparison of healthcare providers’ performance: An application to physiotherapy practices in primary care," Health Policy, Elsevier, vol. 121(12), pages 1225-1232.
    16. Puertas, Rosa & Marti, Luisa & Guaita-Martinez, José M., 2020. "Innovation, lifestyle, policy and socioeconomic factors: An analysis of European quality of life," Technological Forecasting and Social Change, Elsevier, vol. 160(C).
    17. Anthun, Kjartan Sarheim & Kittelsen, Sverre Andreas Campbell & Magnussen, Jon, 2017. "Productivity growth, case mix and optimal size of hospitals. A 16-year study of the Norwegian hospital sector," Health Policy, Elsevier, vol. 121(4), pages 418-425.
    18. Berger, Michael & Sommersguter-Reichmann, Margit & Czypionka, Thomas, 2020. "Determinants of soft budget constraints: How public debt affects hospital performance in Austria," Social Science & Medicine, Elsevier, vol. 249(C).
    19. Daraio, Cinzia & Kerstens, Kristiaan & Nepomuceno, Thyago & Sickles, Robin C., 2019. "Empirical Surveys of Frontier Applications: A Meta-Review," Working Papers 19-005, Rice University, Department of Economics.
    20. Richard Heijink & Xander Koolman & Gert Westert, 2013. "Spending more money, saving more lives? The relationship between avoidable mortality and healthcare spending in 14 countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(3), pages 527-538, June.


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:hecrev:v:10:y:2020:i:1:d:10.1186_s13561-020-00282-z. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: . General contact details of provider: .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.