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.

中文翻译：

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公立医院技术效率的决定因素：沙特阿拉伯的案例。


目的 在本研究中，我们调查外部环境和制度因素对沙特阿拉伯王国（KSA）卫生部（MOH）所属公立医院效率和绩效的影响。我们估计了流域人口的人口和社会经济特征，这些特征解释了对卫生服务的需求。方法我们应用描述性分析来探索哪些外部因素（人口和社会经济因素）可以解释观察到的技术效率得分差异。我们使用Spearman等级相关、多元Tobit回归和两部分模型来衡量解释变量（即人口密度、国籍、性别、年龄组、经济状况、健康状况、医疗干预和地理位置）对效率得分的影响。结果分析表明，外部因素对效率得分有显着影响。我们发现，医院效率得分与辖区人口数量、儿童（0-5 岁）比例、传染病流行率以及医院科室开出的处方数量之间存在显着关联。此外，这些分数与在医疗期间面临经济困难的人口数量以及获得社会管理财政支持的人口数量显着相关。这说明在以往的特点下，服务患者较多的医院技术效率相对较高。结论 环境和制度因素对公立医院的效率和绩效具有至关重要的影响。 在这方面，我们建议改进医院效率和资源分配方面的卫生政策和规划，考虑流域人口的不同人口、社会经济和健康状况（例如人口密度、贫困、健康指标和服务利用）。卫生部要更加注重健全卫生资源配置机制，提高目标人群卫生服务利用率，确保卫生服务高效、公平。