Developing a Hospital Bed Distribution Model in Iran

Background and objectives: The development and distribution of hospital beds, regardless of effective factors, may downgrade equity in access to health services through imposing costs of inefficiency. This study aimed to develop a hospital bed distribution model in Iran in order to facilitate the optimal and cost-effective development and distribution of hospital beds. Methods: This descriptive-analytical study with mixed-methods analysis was carried out during 2015-2016. The research population encompassed 345 managers and experts in the field of health, who were selected using multistage quota sampling method from five regions of Iran (north, south, center, west and east). A total pool of 23 experts were selected from each university, and a researcher-made questionnaire was used to collect data. Content Validity Ratio (CVR) was used to evaluate the questionnaire content and face validity. Cronbach's alpha coefficient and exploratory factor analysis with Varimax rotation were run as well to determine the questionnaire reliability and item consistency, respectively. For this purpose, AMOS version 20 and SPSS version 20 software were employed. To determine the fit of the model, the fit indices were also considered. Results: Out of 51 effective factors included in the questionnaire in accordance with content validity, 23 items were confirmed by the experts. Exploratory factor analysis detected five organizational (seven components), economic (four components), social (six components), political (three components) and geographic (three components) factors as the main dimensions of hospital bed distribution, which could explain 70.745% of variance for all variables. The organizational and geographical dimensions had the highest (1.00) and lowest (0.16) influence on the hospital bed distribution. After running confirmatory factor analysis, two components of social and economic attributes with factor load of 0.46 in social dimension and efficiency and effectiveness of existing centers with factor load of 0.31 in the economic dimension were excluded from the model. Conclusion: This study confirmed the hospital bed distribution model with five organizational, social, economic, political, and geographical dimensions, in which the organizational dimension with high explanatory power had the greatest impact on the hospital bed distribution. Therefore, this model seems efficient to be used as a comprehensive and appropriate method in making policies and decisions about the development and distribution of hospital beds.