•  
  •  
 

Abstract

Health financing reforms, particularly the expansion of National Health Insurance (NHI) schemes, have changed hospital incentives and increased pressure to improve efficiency. Evidence on the determinants of hospital efficiency under NHI remains scattered across countries, payment systems, and analytical methods, and a focused synthesis remains limited. This study aimed to synthesize empirical evidence on determinants of hospital efficiency under NHI. This systematic review followed PRISMA guidelines. searched PubMed/MEDLINE, Scopus, the Cochrane Library, ProQuest, and relevant official sources for quantitative hospital-based studies published through November 2025. Two reviewers independently screened studies, extracted data, assessed methodological quality, and conducted a structured narrative synthesis. Fifteen studies were included. Hospital efficiency was influenced by organizational characteristics, case-mix complexity, demographic pressures, and payment design. Larger or more specialized hospitals, certain own-ership patterns, an appropriate staffing mix, and better clinical documentation were generally associated with higher efficiency. Longer length of stay, inefficient bed use, ageing populations, and poor information quality were associated with lower efficiency. Payment reforms based on diagnosis-related groups, capitation, or global budgets were often linked to efficiency gains, although the effects varied by implementation and local conditions. The interac-tion between provider payment, hospital structure, managerial ca-pacity, and service environment therefore shapes hospital efficiency under NHI. Policies to improve efficiency should combine payment reform with stronger governance, better information systems, accu-rate coding and documentation, and monitoring that considers local population and service characteristics.

Pages

110-122

DOI

10.65844/2356-4067.1460

Download

Share

COinS