International Journal of Econometrics and Financial Management
ISSN (Print): 2374-2011 ISSN (Online): 2374-2038 Website: Editor-in-chief: Tarek Sadraoui
Open Access
Journal Browser
International Journal of Econometrics and Financial Management. 2020, 8(2), 37-45
DOI: 10.12691/ijefm-8-2-1
Open AccessArticle

Measuring the Efficiency of Hospital’s Cardiology Wards Using the Free Disposal Hull Approach

Chokri Arfa1, , Hervé Leleu2, Habiba Ben Romdhane3, Cornelis van Mosseveld4 and Tarek Sadraoui5

1National Institute of Labour and Social Studies, University of Carthage, Tunis Tunisia

2LEM UMR 9221; Catholic University of Lille - IESEG School of Management, France

3Preventive Medicine, Faculty of Medicine, Tunis, Tunisia

4Health Economist PhD (Free-lance)

5Faculty of economics and management, University of Monastir, Tunis Tunisia

Pub. Date: April 09, 2020

Cite this paper:
Chokri Arfa, Hervé Leleu, Habiba Ben Romdhane, Cornelis van Mosseveld and Tarek Sadraoui. Measuring the Efficiency of Hospital’s Cardiology Wards Using the Free Disposal Hull Approach. International Journal of Econometrics and Financial Management. 2020; 8(2):37-45. doi: 10.12691/ijefm-8-2-1


The assessment of efficiency of public hospitals in Tunisia is almost missing. Actually, the efficient utilization of existing resources becomes crucial for strengthening the healthcare delivery. The objective of this study was to measure technical efficiency of five cardiology wards, using an innovative nonparametric approach through an aggregated efficiency at patient level. It can assist practitioners to understand the underlying causes of clinical practice inefficiency. Linearized Free Disposal Hull using the non-radial input directional distance function provide a efficiency scores at the patient level and aggregate scores at ward’s level. The cardiology wards operate at high inefficiency. Through the 217-treated diagnosis' disease, 50 are the greatest sources of inefficiency. Each ward could save more than 50% of inputs used. The decision makers can ensure the optimum utilization of the available resources through a new design of the management and clinical practices of these wards. High inefficiency is due to the lack evaluation, accountability and effective management of public hospitals.

efficiency directional distance function free disposal hull cardiology wards Tunisian’s teaching hospitals

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Moshiri, H., S. M. Aljunid, R. Mohd Amin, M. Dahlui and W. Norlida Ibrahim (2011). "Measuring Efficiency of Teaching Hospitals in Malaysia." International Journal of Business and Management 6(4): 207-213.
[2]  Achouri, H. (2001). "La réforme du système de santé." Tunisie Médicale 79(5): 268-335.
[3]  Chilingerian, J. A., Sherman, D. (2004). Health Care Applications - From Hospitals to Physicians; From Productive Efficiency to Quality Frontiers. Cooper W.W, Seiford L.M, Zhu J, (Ed) : Handbook on Data Envelopment Analysis. Boston, USA, Boston Kluwer Academic Publishers.
[4]  Thanassoulis, E., A. Boussofiane and R. G. Dyson (1996). "A comparison of Data Envelopment Analysis and ratio analysis as tools for performance assessment." Omega 24(3): 229-244.
[5]  Charnes, A., W. W. Copper, J. t. s. Rhodes and E. Lao. (1978). "Measuring the efficiency of decision making units." European Journal of Operational Research 2(6): 429-444.
[6]  Sherman, H. D. (1984). "Hospital Efficiency Measurement and Evaluation: Empirical Test of a New Technique." Medical Care 22(10): 922-938.
[7]  Kohl, S., J. Schoenfelder, A. Fügener and J. O. Brunner (2018). "The use of Data Envelopment Analysis (DEA) in healthcare with a focus on hospitals." Health Care Management Science: 1-42.
[8]  Koopmans, T. C. (1951), ‘An analysis of production as an efficient combination of activities’, in Koopmans, T. C. (Ed.): Activity Analysis of Production and Allocation, Proceeding of a Conference, pp.33-97, John Wiley and Sons Inc., London.
[9]  Hollingsworth, B. (2003). "Non-Parametric and Parametric Applications Measuring Efficiency in Health Care." Health Care Management Science 6(4): 203-218.
[10]  Morey, R. C., D. J. Fine and S. W. Loree (1990). "Comparing the allocative efficiencies of hospitals." Omega 18(1): 71-83.
[11]  Chang, H.-H. (1998). "Determinants of hospital efficiency: The case of central government-owned hospitals in Taiwan." Omega 26(2): 307-317.
[12]  Giokas, D. I. (2001). "Greek hospitals: How well their resources are used." Omega 29(1): 73-83.
[13]  Kleine, A. (2004). "A general model framework for DEA." Omega 32(1): 17-23.
[14]  Shimshak, D. G., M. L. Lenard and R. K. Klimberg (2009). "Incorporating quality into data envelopment analysis of nursing home performance: A case study." Omega 37(3): 672-685.
[15]  Tulkens, H. (2006). On FDH Efficiency Analysis: Some Methodological Issues and Applications to Retail Banking, Courts and Urban Transit. Public goods, environmental externalities and fiscal competition. Boston, MA, Springer US: 311-342.
[16]  Deprins, D., L. Simar and H. Tulkens (1984). Measuring labor-efficiency in post offices. Marchand M., Pestieau P. and Tulkens H. (Ed) : The Performance of Public Enterprises : Concepts and Measurement. Amsterdam Elsevier: pp 243-267.
[17]  Leleu, H. (2006). "Linear programming framework for free disposal hull technologies and cost functions: primal and dual models." European Journal of Operational Research 168(2): 340-344.
[18]  Chambers, R. G., Y. Chung and R. Färe (1998). "Profit, directional distance functions, and nerlovian efficiency." Journal of Optimization Theory and Applications 98(2): 351-364.
[19]  Luenberger, D. G. (1992). "Benefit functions and duality." Journal of Mathematical Economics 21(5): 461-486.
[20]  Färe, R. and S. Grosskopf (2004). New directions in efficiency and productivity. Boston, Klüwer Academic Publishers.
[21]  Färe, R. and C. A. K. Lovell (1978). "Measuring the technical efficiency of production." Journal of Economic Theory 19(1): 150-162.
[22]  Agrell, P. J. and J. Tind (2001). "A dual approach to non convex frontier models." Journal of Productivity Analysis 16(2): 129-147.
[23]  Shephard, R. W. (1953). Cost and production functions. Princeton New Jersey., Princeton University Press.
[24]  Shephard, R. W. (1970). Theory of cost and production functions. Princeton New Jersey., Princeton University Press.
[25]  Färe, R., S. Grosskopf and C. A. K. Lovell (1994). Production frontiers, Cambridge University Press, Cambridge.
[26]  Briec, W., K. Kerstens and P. V. Eeckaut (2004). "Non-convex Technologies and Cost Functions: Definitions, Duality and Nonparametric Tests of Convexity." Journal of Economics 81(2): 155-192.
[27]  National Institute of Health (2004). National survey of hospitals morbidity and mortality. Ministry of Health, Tunisia.
[28]  Ministère de la Santé (1995). Tarifs et Nomenclature des Actes Professionnels. Tunisie, Imprimerie Officielle de la République Tunisienne.
[29]  Souza, G., E. Gomes and E. Alves (2017). "Conditional FDH Efficiency to assess performance factors for brazilian agriculture." Pesquisa Operacional 37: 93-106.
[30]  Li, L. X. (1997). "Relationships between determinants of hospital quality management and service quality performance-a path analytic model." Omega 25(5): 535-545.