An Evaluation of BLU Hospital Efficiency: A Quantitative Approach with Data Envelopment Analysis
Main Article Content
Abstract
Research Originality — This study is the first to assess the efficiency of Public Service Agency (BLU) hospitals in Indonesia using data envelopment analysis (DEA). It provides a comprehensive evaluation of hospital efficiency in multiple categories and identification of benchmark hospitals and areas for improvement. The study offers insights into hospital resource management efficiency to help policymakers in optimizing hospital performance.
Research Objectives — This study aims to evaluate the efficiency of 32 BLU hospitals in Indonesia by analyzing their inpatient and outpatient services, human resource allocation, and bed utilization efficiency. It also investigates historical performance trends from 2016 to 2020 to assess long-term efficiency patterns.
Research Methods — The study employed DEA, which is a non-parametric approach widely used for efficiency analysis. The evaluation was based on four input variables and seven output variables categorized into four main efficiency measures: inpatient services, outpatient services, human resources, and bed utilization. The efficiency scores were calculated using BCC-I and Super-Radial BCC-I models.
Empirical Results — The findings showed that 15 hospitals were efficient, while 17 hospitals exhibited inefficiencies. Nine hospitals consistently demonstrated efficiency across all categories from 2016 to 2020, whereas four hospitals consistently underperformed in at least one category. The study also indicates that hospitals with lower efficiency scores can benchmark against efficient hospitals to improve performance.
Implications — The findings of this study have policy implications for healthcare administrators and government agencies. The Directorate of BLU Financial Management Development can use the DEA results to guide hospital efficiency improvements. In addition, inefficient hospitals can use these findings to identify performance gaps and adopt best practices. Future studies could integrate other methods such as the Malmquist productivity index (MPI) or balanced scorecard (BSC) for a more comprehensive assessment.
Article Details

This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright notice can be accessed here
References
Abdurachman, E., Eni, Y., Furinto, A., Warganegara, D., & Gautama So, I. (2019). Hospital Efficiency in Indonesia with Frontier Analysis. KnE Social Sciences, August. https://doi.org/10.18502/kss.v3i22.5049
Ahmed, S., Hasan, M. Z., MacLennan, M., Dorin, F., Ahmed, M. W., Hasan, M. M., Hasan, S. M., Islam, M. T., & Khan, J. A. M. (2019). Measuring the efficiency of health systems in Asia: A data envelopment analysis. BMJ Open, 9(3), 1–12. https://doi.org/10.1136/bmjopen-2018-022155
Al Subhi, M. (2022). Technical efficiency, productivity, and determinants of technical inefficiency of local hospitals in Oman: Using data envelopment analysis. Innovation Journal of Social Sciences and Economic Review, 4(1), 10-17.
Ali, M., Debela, M., & Bamud, T. (2017). Technical efficiency of selected hospitals in Eastern Ethiopia. Health Economics Review, 7(1). https://doi.org/10.1186/s13561-017-0161-7
Azreena, E., Hanafiah Juni, M., & Rosliza, A. M. (2018). A Systematic Review Of Hospital Inputs And Outputs In Measuring Technical Efficiency Using Data Envelopment Analysis. International Journal of Public Health and Clinical Sciences, 5(1), 17–35.
Banker, R. D., Charnes, A., & Cooper, W. W. (1984). Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis. Management Science, 30(9), 1078–1092. https://doi.org/10.1287/mnsc.30.9.1078
Cetin, V. R., & Bahce, S. (2016). Measuring the efficiency of health systems of OECD countries by data envelopment analysis. Applied Economics, 48(37), 3497–3507. https://doi.org/10.1080/00036846.2016.1139682
Charnes, A., Cooper, W.., & E.Rhodes. (2017). Measuring the Efficiency of decision making units. Renewable and Sustainable Energy Reviews, 70, 1298–1322. https://doi.org/10.1016/j.rser.2016.12.030
Dubas-Jakóbczyk, K., Albreht, T., Behmane, D., Bryndova, L., Dimova, A., Džakula, A., ... & Quentin, W. (2020). Hospital reforms in 11 Central and Eastern European countries between 2008 and 2019: a comparative analysis. Health Policy, 124(4), 368-379.
Fazria, N. F., & Dhamanti, I. (2021). A Literature review on the Identification of Variables for Measuring Hospital Efficiency in the Data Envelopment Analysis (DEA). Unnes Journal of Public Health, 10(1), 1–15. https://doi.org/10.15294/ujph.v10i1.38253
Fernández-Montes, A., Velasco, F., & Ortega, J. A. (2012). Evaluating decision-making performance in a grid-computing environment using DEA. Expert Systems with Applications, 39(15), 12061–12070. https://doi.org/10.1016/j.eswa.2012.04.028
Andrews, A., & Emvalomatis, G. (2024). Efficiency measurement in healthcare: the foundations, variables, and models–a narrative literature review. Economics, 18(1), 20220062.
Gigantesco, A., & Giuliani, and M. (2011). Quality of life in mental health services with a focus on psychiatric rehabilitation practice. Ann Ist Super Sanità, 47(4), 363–372. https://doi.org/10.4415/ANN
Hofmarcher, M. M., Paterson, I., & Riedel, M. (2002). Measuring Hospital Efficiency in Austria – A DEA Approach ∗. 7–14.
Irwandy, I., & Sjaaf, A. C. (2018). The Impact of National Health Insurance Policy on Hospital Efficiency: A Case Study in South Sulawesi Province. Indonesian Public Health Media, 14(4), 360. https://doi.org/10.30597/mkmi.v14i4.5144
Jacobs, R. (2001). Alternative methods to examine hospital efficiency: Data envelopment analysis and stochastic frontier analysis. Health Care Management Science, 4(2), 103–115. https://doi.org/10.1023/A:1011453526849
Ministry of Health of the Republic of Indonesia. (2010). Regulation of the Minister of Health of the Republic of Indonesia Number 340 of 2010 concerning Hospital Classification. Jakarta: Ministry of Health of the Republic of Indonesia.
Narci, H., Ozcan, Y. A., Sahin, I., Tarcan, M., & Narci, M. (2014). An examination of competition and efficiency for hospital industry in Turkey. Health Care Management Science, 18, 407–418. https://doi.org/10.1007/s10729-014-9313-9
Pirani, N., Zahiri, M., Engali, K. A., & Torabipour, A. (2018). Hospital efficiency measurement before and after health sector evolution plan in southwest of Iran: A DEA-panel data study. Acta Informatica Medica, 26(2), 106–110. https://doi.org/10.5455/aim.2018.26.106-110
Priyotomo, I., Hidayat, M. S., & Handayani, L. (2022). Analysis of the Impact of Covid-19 on Hospital Efficiency, Effectiveness, and Productivity (Case study: RSU Mitra Paramedika DI Yogyakarta). JUMANTIK (Scientific Journal of Health Research), 7(3), 285-300.
Republic of Indonesia. (2004). Law Number 1 of 2004 concerning the State Treasury. Statute Book of the Republic of Indonesia Year 2004 Number 5. Accessed from https://jdih.kemenkeu.go.id
Republic of Indonesia. (2005). Decree of the Minister of Health of the Republic of Indonesia No. 836/Menkes/SK/VI/2005 concerning Guidelines for the Development of Performance Management of Nurses and Midwives.
Şahin, B., & İlgün, G. (2019). Assessment of the impact of public hospital associations (PHAs) on the efficiency of hospitals under the ministry of health in Turkey with data envelopment analysis. Health Care Management Science, 22(3), 437–446. https://doi.org/10.1007/s10729-018-9463-5
Sahin, I., & Ozcan, Y. A. (2000). Public Sector Hospital Efficiency for Provincial Markets in Turkey. 24(6).
Saputra, R. O. (2018). University Efficiency of Public Service Agency with Data Envelopment Analysis Method. Indonesian Treasury Review Journal of State Treasury and Public Policy, 3(1), 35–42. https://doi.org/10.33105/itrev.v3i1.21
Siagian, V. (2012). Efficiency of Units of Economic Activities of the Sugar Industry Using the Carbon Overcoming Process in Indonesia. SOCA: Journal of Agricultural Socioeconomics, 4(3), 1–16. https://www.neliti.com/id/publications/43911/efisiensi-unit-unit-kegiatan-ekonomi-industri-gula-yang-menggunakan-proses-karbo
Sickles, R. C., & Zelenyuk, V. (2019). Measurement of productivity and efficiency. Cambridge University Press.
Simamora, I., & Sinuhaji, F. (2021). Analysis of the Efficiency Level of Medan City Health Center with the DEA Model. Journal of Curere, 5(1), 26-38.
Soares, A. B., Pereira, A. A., & Milagre, S. T. (2017). A model for multidimensional efficiency analysis of public hospital management. Research on Biomedical Engineering, 33(4), 352–361 https://doi.org/10.1590/2446-4740.05117
Sultan, W. I. M., & Crispim, J. (2018). Measuring the efficiency of Palestinian public hospitals during 2010-2015: An application of a two-stage DEA method. BMC Health Services Research, 18(1), 1–17. https://doi.org/10.1186/s12913-018-3228-1
The Legatum Prosperity Index 2020: Legatum Institute. (2020). The Legatum Prosperity Index 2020. Legatum Institute.
United Nations. (2015). UN GAOR, 70th Sess., 1st Comm. 21st mtg. UN read. A/C.1/70/PV.21. 0506, 1–26.
United Nations Development Programme. (2020). Human development report 2020: The next frontier—Human development and the Anthropocene. UNDP.
Widyastuti, P., & Nurwahyuni, A. (2021). Systematic Review: Assessment of Hospital Efficiency with Data Envelopment Analysis (DEA) Method. Journal of Public Health Sciences, 10(04), 258-268.
Wiranusa, B. B. (2017). ANALYSIS OF THE EFFICIENCY OF PUBLIC SERVICE AGENCY HOSPITALS WITH DATA ENVELOPMENT ANALYSIS (DEA) AND PRINCIPAL COMPONENT ANALYSIS (PCA) METHODS (STUDY ON THE CENTRAL GOVERNMENT GENERAL HOSPITAL OF THE REPUBLIC OF INDONESIA WHICH HAS THE STATUS OF A PUBLIC SERVICE AGENCY IN 2017). 1–18.
Zhao, L., Wang, L., Li, S., & Zhang, Y. (2020). Evaluation and analysis of hospital efficiency in China based on macro- and micro-level analyses. Journal of Public Health (Germany), 28(2), 191–197. https://doi.org/10.1007/s10389-019-01048-6
Zheng, W., Sun, H., Zhang, P., Zhou, G., Jin, Q., & Lu, X. (2018). A four-stage DEA-based efficiency evaluation of public hospitals in China after the implementation of new medical reforms. PLoS ONE, 13(10), 1–17. https://doi.org/10.1371/journal.pone.0203780