Directional distance function for FDH technologies with an application to Tunisian public hospitals

Tunisian’s public hospitals have been often deemed inefficiency, yet unfortunately no empirical study has demonstrated the breadth and/or depth of this inefficiency. To address this issue, we develop a non parametric methodology to measure efficiency at patient level for five cardiology wards. This methodology is based on the estimation of the input directional distance function, using a recent developed linear form of free disposal hull model. Results show that, on average, each cardiology ward could save more than 50% of each input; whereas at the patient level, illness severity and patients’ profiles were associated with inefficiency. At the ward level, practice patterns and wards missions explain disparities on inefficiency. By defining sub-specializations or standard procedures for cardiology wards, we demonstrate where the public hospitals can save resources when treating these patients.