Health has a significant impact on the infrastructure of different parts of society based on sustainable social, economic, political, and cultural development [1]. The promotion of health is a moral obligation, including the social and economic categories. Thus, every health treatment service planning should be part of the pervasive attitude of healthcare policy to make part of the integrated plan of sustainable development [2]. Most of the world’s countries have faced rising health treatment section expenses during the recent decade [3]. This problem has occurred due to the combination of factors associated with demand, including demographic and epidemiological changes, the developed technology, and the lack of available information for health treatment services’ customers and consumers related to factors affecting supply. Moreover, the previous research shows that at least some parts of the rising expenses result from the inefficient use of sources [4]. Similar to major organizations, hospitals play a critical role in providing health treatment services, resulting in the recovery facilitation of the physical and mental health of the patient in society in a specific way. It also leads to training specialists in the health treatment section, performing medical research, and improving the health of society. Therefore, this organization has a particular sensitivity and importance regarding economic infrastructures and its severe vulnerability against currency rate fluctuations and commodity markets, particularly in developing countries [5]. This institution is the most extensive and most costly operating unit of the health treatment system in Iran [6]. The portion of hospital expenses is estimated at least 40% of total health expenses in 2015. This statistic is out of the total expenses of health treatment based on the national health accounts of Iran (4).
Considering that the health change plan was implemented in May 2014 with particular effects on hospitals, the portion of health expenses has increased out of gross domestic incomes, and that of the hospitals has risen through this statistic more than ever [7]. Despite many expenses spent on hospitals, many differences exist between the available and required resources in this section. The rise in demand, the rapid growth of health expenses to incomes in developing countries, economic crises, and the government budget lack are many problems for hospitals. Therefore, hospitals sustain heavy pressure to control and decrease expenses. These conditions double the necessity of creating additional probable resources and using the possible resources with resource allocation patterns and increasing efficiency in this section [8].
There is a pressing need concerning the optimal use of scarce sources and improvement of efficiency for providing health treatment cares. Accordingly, some measures are taken into account to prevent or decrease the waste of resources allocated to the health treatment system, helping in providing services as better as possible, developing availability, and improving hospital service quality [9]. Therefore, the use of scientific and applied methods is necessary for assessing the function and activities of the hospital and the optimal use of physical and human resources. Thus, one can enjoy economic tools and analyses, which provide a logical and specific framework for analyzing vital health care subjects. Although the mere assessment of health treatment services seems unnecessary, due to their human and humanitarian nature, it is highly beneficial to use assessment in the measurement, efficiency, and optimal use of resources [10].
In the economic literature, efficiency is the minimum use of inputs for a certain level of output. In other words, it is the increasing of outputs with a certain level of inputs. Inputs are the same as manufacturing factors such as energy, initial materials, capital, and labour force in the manufacturing process of commodities and services for generating outputs (i.e., commodities or services in the organization). Efficiency is an appropriate criterion for measuring the acquirement of the best output by limited inputs. Further, it is a new approach to peoples’ work and life [11]. The ratio analysis can be used in most efficiency studies. This method has limitations due to its use in the measurement of efficiency between one input and one output and the association of the studied subject for creating a relation between one input and some outputs or some inputs and some outputs. It is noteworthy that more advanced methods should be used since a hospital is an organization that encounters some inputs and outputs [12]. Extensive studies have focused on assessing the hospital, including Mahfoozpour et al. [13], Kiadaliri et al. [14], Rezaei et al. [15, 16], Mosadeghrad et al. [17], Hatam et al. [18], Goudarzi et al. [19] in Iran as well as Mujasi [20], Cheng, [21], and Ali. [22] in Uganda, China, and Ethiopia, respectively. Therefore, there is now a great interest in data envelopment analysis as a dynamic, capable, and progressive method for measuring efficiency and productivity. It is mainly applied in government units and the private sector, in which their valuable information is unavailable or unreliable.
Data envelopment analysis determines whether the considered decision-making units consider the efficiency line. It is non-parameter linear planning that estimates the frontier production function. The difference between this study and previous studies is Tobit regression, which can measure the effect of environmental factors on the efficiency level. The environment in this context is the factor that can affect firm efficiency although it is not part of the applied inputs. Furthermore, the assumption is that it is not under management control. Environment variables are ownership, the number of customers, and the firm position and size. Thus, if a dependent variable of a critical limit, Tobit regression or censored regression, will apply to review linear relationships [23]. Considering the above-mentioned explanations, the current research sought to evaluate the technical efficiency of the public hospitals of Hamedan County with data envelopment analysis and Tobit regression in 2018.