Analysis of factors infuencing technical efciency of public district hospitals in KwaZulu-Natal province, South Africa

Abstract

Background: District hospitals are crucial in supporting primary health care and serve as a gateway to more specialist care through a referral system. Majority of South Africans access health care services through the public sector district health system. Given the enormous task assigned to the public district hospital within the country, this study examined factors infuencing their technical efciency. Method: Data were collected for 38 public district hospitals in KwaZulu-Natal province from 2014/15 to 2016/17. Data envelopment analysis (DEA) was used to determine the technical efciency of the hospitals, adopting both the constant return to scale (CRS) and variable return to scale (VRS) models. Tobit regression model was used to determine factors related to the technical efciency of the district hospitals. Results: This study showed that a signifcant proportion of the district hospitals were technically inefcient. The Tobit regression model identifed catchment population, the proportion of inpatients treated per medical personnel, the proportion of inpatients treated per nursing personnel and expenditure per patient day equivalent as factors infuencing technical efciency of the district hospitals. Conclusion: Findings from this study suggest that the technical efciency of the district hospitals can be enhanced through an efective referral system and improved peoples’ health-seeking behaviour. In addition, a standard mix of clinical staf toward efcient service delivery and periodic cost analysis of health services with the view to saving cost and maintaining the quality of health care should be considered.