Journal of Education and Health Promotion

Abstract BACKGROUND: The investment decision can be affected by changing levels of uncertainty and risk.
The main objective of this research was to identify, characterize, and quantify the parameters which
are essential in evaluation hospital construction projects and provide useful modeling techniques to
give the best investment decisions for investors in Iran’s health‑care projects investment.
MATERIALS AND METHODS: The methodology of this study was employing discounted cash
flow (DCF) and real option valuation to investigate the feasibility investment in the public hospital
construction project. The Islamshahr, Mashhad, and Fardis hospitals were included in the analysis.
Economic indices of DCF methods were internal rate of return (IRR) and net present value.
RESULTS: The economic evaluation of the Black–Scholes model was almost as same as the binomial
tree model, but there was a significant difference between the real options model and traditional
methods. According to the traditional methods, the profitability with IRR for Islamshahr, Mashhad,
and Fardis hospital projects was 35%, 43%, and 26%, respectively. Black–Scholes model showed
profitability only for Islamshahr and Mashhad hospitals, and there was no adequate profitability for
investors of Fardis Hospital project during the study.
CONCLUSIONS: The methods derived from the real options valuation could provide a more flexible
and reliable indices for investors in dynamic and high revolution economic conditions. On the other
hand, dynamic economic evaluation models can be applied to correctly evaluate the projects because
of Iran’s health revolution and its health plans.

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.