Open Access Open Badges Research article

Frontier-based techniques in measuring hospital efficiency in Iran: a systematic review and meta-regression analysis

Aliasghar A Kiadaliri123*, Mehdi Jafari4 and Ulf-G Gerdtham135

Author Affiliations

1 Division of Health Economics, Department of Clinical Sciences-Malmö, Lund University, Malmö University Hospital, CRC, Entrance 72, House 28, Plan 10, Room 027, 20502 Malmö, Sweden

2 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

3 Health Economics & Management, Institute of Economic Research, Lund University, Lund, Sweden

4 Department of Health Management and Economics, School of Health Informatics and Management, Iran University of Medical Sciences, Tehran, Iran

5 Department of Economics, Lund University, Lund, Sweden

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BMC Health Services Research 2013, 13:312  doi:10.1186/1472-6963-13-312

Published: 15 August 2013



In recent years, there has been growing interest in measuring the efficiency of hospitals in Iran and several studies have been conducted on the topic. The main objective of this paper was to review studies in the field of hospital efficiency and examine the estimated technical efficiency (TE) of Iranian hospitals.


Persian and English databases were searched for studies related to measuring hospital efficiency in Iran. Ordinary least squares (OLS) regression models were applied for statistical analysis. The PRISMA guidelines were followed in the search process.


A total of 43 efficiency scores from 29 studies were retrieved and used to approach the research question. Data envelopment analysis was the principal frontier efficiency method in the estimation of efficiency scores. The pooled estimate of mean TE was 0.846 (±0.134). There was a considerable variation in the efficiency scores between the different studies performed in Iran. There were no differences in efficiency scores between data envelopment analysis (DEA) and stochastic frontier analysis (SFA) techniques. The reviewed studies are generally similar and suffer from similar methodological deficiencies, such as no adjustment for case mix and quality of care differences. The results of OLS regression revealed that studies that included more variables and more heterogeneous hospitals generally reported higher TE. Larger sample size was associated with reporting lower TE.


The features of frontier-based techniques had a profound impact on the efficiency scores among Iranian hospital studies. These studies suffer from major methodological deficiencies and were of sub-optimal quality, limiting their validity and reliability. It is suggested that improving data collection and processing in Iranian hospital databases may have a substantial impact on promoting the quality of research in this field.

Technical efficiency; Meta-regression; Data envelopment analysis; Stochastic frontier analysis; Iran