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Description:
Background: A good health care system and, especially, the provision of efcient hospital care are the goals of national and regional health policies. However, the scope of general hospital care in the 16 federal states in Germany varies considerably from region to region. The objectives of this paper are to evaluate the technical efciencies of all general hospitals of the 16 federal states for the period from 2015 to 2020, to fnd out the relation between the exogenous factors and score of efciency, and also the infuence of the COVID-19 pandemic on the results of the technical efciency of hospital care in the German states. Methods: A two-step approach was used. First, an input-oriented Data Envelopment Analysis model with constant returns to scale and variable returns to scale was applied for the 6-year period from 2015 to 2020. The calculation of technical efciency according to the input-oriented DEA model contains the three components-total technical efciency (TTE), pure technical efciency (PTE) and scale efciency (SE). In the second stage, the infuence of exogenous variables on the previously determined technical efciency was evaluated by applying the tobit regression analysis. Results: Although the level of average technical efciency of about 90% is high, total technical efciency deteriorated steadily from 2015 to 2020. Its lowest point at around 78%, was in the year 2020. The deterioration of the average technical efciency is notably infuenced by the lower results in the years 2019 and 2020. The decomposition of technical efciency also revealed that the deterioration of overall average efciency was infuenced by both pure technical efciency (PTE) and scale efciency (SE). Based on the tobit regression analysis performed, it was possible to conclude that the change in the efciency score can be explained by the infuence of exogenous factors only from 6.4% for overall efciency and from 7.1% for scale efciency. Conclusions: The results of the analysis of the overall technical efciency reveal that the aggregated ...