Journal of Education and Health Promotion

Abstract BACKGROUND: The COVID‑19 pandemic has spread rapidly across the world and has currently
impacted most countries and territories globally. This study aimed to identify health‑care determinants
of mortality and recovery rates of COVID‑19 and compare the efficiency of health systems in response
to this pandemic.
MATERIALS AND METHODS: A cross‑sectional study was conducted using data obtained from the
World Bank database, that provides free and open access to a comprehensive set of health‑ and
socioeconomic‑related data, by September 12, 2020. An adjusted linear regression model was
applied to determine predictors of mortality (per 1 million population [MP]) and recovery rates (per 1
MP) in the included countries. One‑way analysis of variance was applied to assess health systems’
efficiency in response to COVID‑19 pandemic using mortality and recovery rate (output variables)
and current health expenditure (CHE) per capita (input variable).
RESULTS: Globally, San Marino and Qatar had the highest mortality rate (1237/1 MP) and confirmed
case rate (43,280/1 MP) until September 12, 2020, respectively. Iran had a higher mortality rate (273/1
MP vs. 214.5/1 MP) and lower recovery rate (4091.5/1 MP vs. 6477.2/1 MP) compared to countries
with high CHE per capita. CHE per capita (standardized coefficient [SC] = 0.605, P < 0.001) and
population aged 65 years and over as a percentage of total population (SC = −0.79, P < 0.001)
significantly predicted recovered cases from COVID‑19 in the included countries.
CONCLUSION: This study revealed that countries with higher CHE per capita and higher proportion of
older adults were more likely to have a higher recovery rate than those with lower ones. Furthermore,
our study indicated that health systems with higher CHE per capita statistically had a greater efficiency
in response to COVID‑19 compared to those with lower CHE per capita. More attention to preventive
strategies, early detection, and early intervention is suggested to improve the health system efficiency
in controlling COVID‑19 and its related mortalities worldwide.

Abstract CONTEXT: Selecting variables is a fundamental step in evaluating comparative efficiency because
the results of measuring efficiency depend on the used variables.
AIMS: The aim of this study is to provide a comprehensive set of input and output variables for
measuring efficiency with an emphasis on application in general hospitals in Iran.
MATERIALS AND METHODS: This study comprised a literature review followed by a Delphi survey
process. After extracting the variables from the literature review in order to reach consensus on them
and identify the native variables, the researchers used the Delphi technique in three rounds. Thirty
Iranian hospital managers, in Alborz, Saveh, Qazvin, Qom, and Hamadan universities, participated
in this study. For analysis, the interquartile range (IQR) and median were used. IQR was used to
assess the agreement of Delphi panel members.
RESULTS: After literature review, nine indicators were identified as input variables and 11 indicators
were identified as output variables. After the proposed changes by Delphi members, 24 input variables
and 24 output variables were identified to measure hospital efficacy. Finally, ten variables were
selected as inputs and ten variables were selected as outputs to measure the performance of public
hospitals in Iran by using the consensus of the members in the Delphi panel.
CONCLUSIONS: This study proposes a framework for selecting the most appropriate variables for
measuring the hospital efficiency with an emphasis on nonparametric methods. Choosing variables
to measure hospital efficiency requires infrastructure such as an intelligent information system.