title: [Analysis of the technical efficiency of hospitals in the Spanish National Health Service].
abstract: OBJECTIVE
  To analyse the technical efficiency and productivity of general hospitals in the Spanish National Health Service (NHS) (2010-2012) and identify explanatory hospital and regional variables.
  
  
  METHODS
  230 NHS hospitals were analysed by data envelopment analysis for overall, technical and scale efficiency, and Malmquist index. The robustness of the analysis is contrasted with alternative input-output models. A fixed effects multilevel cross-sectional linear model was used to analyse the explanatory efficiency variables.
  
  
  RESULTS
  The average rate of overall technical efficiency (OTE) was 0.736 in 2012; there was considerable variability by region. Malmquist index (2010-2012) is 1.013. A 23% variability in OTE is attributable to the region in question. Statistically significant exogenous variables (residents per 100 physicians, aging index, average annual income per household, essential public service expenditure and public health expenditure per capita) explain 42% of the OTE variability between hospitals and 64% between regions. The number of residents showed a statistically significant relationship. As regards regions, there is a statistically significant direct linear association between OTE and annual income per capita and essential public service expenditure, and an indirect association with the aging index and annual public health expenditure per capita.
  
  
  CONCLUSIONS
  The significant room for improvement in the efficiency of hospitals is conditioned by region-specific characteristics, specifically aging, wealth and the public expenditure policies of each one.
authors.affiliation: Escuela Andaluza de Salud Pública, Granada, España.
authors.forename: Carmen
authors.initials: C
authors.lastname: Pérez-Romero
authors.affiliation: Departamento de Economía, Universidad de Jaén, Jaén, España. Electronic address: iortega@ujaen.es.
authors.forename: M Isabel
authors.initials: MI
authors.lastname: Ortega-Díaz
authors.affiliation: Escuela Andaluza de Salud Pública, Granada, España; Instituto de Investigación Biosanitaria de Granada, Granada, España.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ocaña-Riola
authors.affiliation: Instituto de Investigación Biosanitaria de Granada, Granada, España; Departamento de Economía Aplicada, Universidad de Granada, Granada, España.
authors.forename: José Jesús
authors.initials: JJ
authors.lastname: Martín-Martín
mesh_terms: D017598:Efficiency, Organizational; D006801:Humans; D009313:National Health Programs / Q000592:standards*; D013030:Spain
keywords: Análisis envolvente de datos; Análisis multinivel; Data envelopment analysis; Efficiency; Eficiencia; Hospitales; Hospitals; Malmquist index; Multilevel analysis; National Health Service; Sistema Nacional de Salud; Índice de Malmquist