Management and efficiency have a fundamental impact on the performance of public hospitals, as well as on their philanthropic mission. Various studies have shown that the financial weaknesses of these entities affect the planning, setting of goals and objectives, monitoring, evaluation and feedback necessary to improve health systems and guarantee accessibility as an inalienable right. This study aims to analyze the management and efficiency of third-level and/or high-complexity hospitals in Colombia, through a statistical model that uses financial analysis and key performance indicators (KPIs) such as ROA, ROE and EBITDA. A non-experimental cross-sectional design is used, with an analytical-synthetic, documentary, exploratory and descriptive approach. The results show financial deficiencies in the hospitals evaluated; hence it is recommended to make adjustments in the operating cycle to increase efficiency rates. In addition, the use of the KPIs ROA and ROE under adjusted models is suggested for a more precise analysis of the financial ratios, since these adequately explain the variability of each indicator and are appropriate to evaluate hospital management and efficiency, but not in EBITDA ratio, hence the latter is not recommended to evaluate hospital efficiency reliably. This study provides relevant information for public health policy makers, hospital managers and researchers, in order to promote the efficiency and improvement of health services.

1. Amaral, M. (2024). Profitability of Commercial Banks in Portugal and Spain: A Panel Data Analysis Model. Revista de Métodos Cuantitativos Para La Economía y La Empresa, 1–18. https://doi.org/10.46661/rev.metodoscuant.econ.empresa.8172
2. Arroyavez, I. D. (2009). Preliminary formulation of a rational financial model for public hospitals (Spanish). Revista Facultad Nacional de Salud Pública, 19(2). https://doi.org/10.17533/udea.rfnsp.897
3. Banditori, C., Cappanera, P., & Visintin, F. (2013). A combined optimization-simulation approach to the master surgical scheduling problem. IMA Journal of Management Mathematics, 24(2), 155–187. https://doi.org/10.1093/imaman/dps033
4. Batrancea, L. (2021). The Influence of Liquidity and Solvency on Performance within the Healthcare Industry: Evidence from Publicly Listed Companies. Mathematics, 9(18), 2231. https://doi.org/10.3390/math9182231
5. Berger, M., & Tutz, G. (2018). Tree-Structured Clustering in Fixed Effects Models. Journal of Computational and Graphical Statistics, 27(2), 380–392. https://doi.org/10.1080/10618600.2017.1371030
6. Bernhard, E., & Reto, S. (2020). Strategies as a basis for the development of hospital assets. Public Money & Management, 40(1), 21–30. https://doi.org/10.1080/09540962.2019.1612204
7. Bonhomme, S., & Davezies, L. (2019). Panel Data, Old and New. Annals of Economics and Statistics, 134, 1. https://doi.org/10.15609/annaeconstat2009.134.0001
8. Bosa, I. M. (2010). Ethical budgets: a critical success factor in implementing new public management accountability in health care. Health Services Management Research, 23(2), 76–83. https://doi.org/10.1258/hsmr.2009.009024
9. Cárdenas G., M., & Velasco B., et al. (2014). Incidence of accounts receivable delinquency on profitability and liquidity: a case study of a Empresa Social del Estado health services provider (Spanish). Revista Facultad Nacional de Salud Pública, 32(1), 16–25. https://doi.org/10.17533/udea.rfnsp.15182
10. Creixans, J., & Arimany-Serrat, N. (2018). Influential variables in the profitability of hospital companies. Intangible Capital, 14(1), 171. https://doi.org/10.3926/ic.1109
11. Cronin, C. E., Singh, S. R., Turner, J. S., & Evashwick, C. J. (2022). Hospitals’ contributions to their communities: Should they be regulated?. Frontiers In Public Health, 10, 1-4. https://doi.org/10.3389/fpubh.2022.1064210
12. Das, S. L., Patnaik, B. C. M., Satpathy, I., et al. (2022). Working capital management and financial health of private hospitals of India after COVID-19 pandemic. International Journal of Health Sciences, 1911–1922. https://doi.org/10.53730/ijhs.v6ns5.9043
13. Ekiz Bozdemir, M. K., Avcı, S., & Aladağ, Z. (2023). Assessment of the Turkish Health Transformation Program with Data Envelopment Analysis. IEEE Transactions on Engineering Management, 70(8), 2800–2808. https://doi.org/10.1109/tem.2021.3106581
14. Eldenburg, L., & Krishnan, R. (2006). Management accounting and control in healthcare: an economic perspective. Handbooks of management accounting research, 2, 859-883. https://doi.org/10.1016/S1751- 3243(06)02016-5
15. Esposito, R., Cerrato, M., & Locatelli, M. (2024). Partitioned least squares. Machine Learning, 113(9), 6839–6869. https://doi.org/10.1007/s10994-024-06582-3
16. Fiondella, C., Macchioni, R., Maffei, M., et al. (2016). Successful changes in management accounting systems: A healthcare case study. Accounting Forum, 40(3), 186–204. https://doi.org/10.1016/j.accfor.2016.05.004
17. Ghandour, Z., Siciliani, L., & Straume, O. R. (2022). Investment and quality competition in healthcare markets. Journal of Health Economics, 82, 102588. https://doi.org/10.1016/j.jhealeco.2022.102588
18. Giménez, V., Prieto, W., Prior, D., et al. (2019). Evaluation of efficiency in Colombian hospitals: An analysis for the post-reform period. Socio-Economic Planning Sciences, 65, 20–35. https://doi.org/10.1016/j.seps.2018.02.002
19. Guerra, M., Morgan, B.F., & Alves, M.C. (2022). Financial Performance and Profile of Brazilian Hospitals. Journal of Health Management, 24(2), 175-186. https://doi.org/10.1177/09720634221088056
20. Guimaraes, A. L. de S., & Nossa, V. (2010). Working capital, profitability, liquidity and solvency of healthcare insurance companies. Brazilian Business Review, 7(2), 37–59. https://doi.org/10.15728/bbr.2010.7.2.3
21. Hammad, S. A., Jusoh, R., & Yen Nee Oon, E. (2010). Management accounting system for hospitals: a research framework. Industrial Management & Data Systems, 110(5), 762–784. https://doi.org/10.1108/02635571011044777
22. Hill, T. D., Davis, A. P., Roos, J. M., et al. (2019). Limitations of Fixed-Effects Models for Panel Data. Sociological Perspectives, 63(3), 357–369. https://doi.org/10.1177/0731121419863785
23. Jacob, J., & Varadharajan, R. (2024). Robust Variance Inflation Factor: A Promising Approach for Collinearity Diagnostics in the Presence of Outliers. Sankhya B, 86(2), 845–871. https://doi.org/10.1007/s13571-024-00342-y
24. Kalnins, A., & Praitis Hill, K. (2024). Additional caution regarding rules of thumb for variance inflation factors: extending O’Brien to the context of specification error. Quality & Quantity. https://doi.org/10.1007/s11135-024-01980-0
25. Kraus, K., Kennergren, C., & von Unge, A. (2017). The interplay between ideological control and formal management control systems – A case study of a non-governmental organisation. Accounting, Organizations and Society, 63, 42–59. https://doi.org/10.1016/j.aos.2016.02.001
26. Lee, D., Yu, S., & Yoon, S. N. (2019). Analysis of Hospital Management based on the Characteristics of Hospitals: Focusing on Financial Indicators. Global Business Finance Review, 24(3), 1–13. https://doi.org/10.17549/gbfr.2019.24.3.1
27. Lim, H., & Rokhim, R. (2020). Factors affecting profitability of pharmaceutical company: an Indonesian evidence. Journal of Economic Studies, ahead-of-print(ahead-of-print). https://doi.org/10.1108/jes-01-2020-0021
28. Llewellyn, S., Eden, R., & Lay, C. (2005). Costs, incentives and changing resource allocations in health care organisations: comparing the UK and Canada. Journal of Accounting & Organizational Change, 1(1), 79–95. https://doi.org/10.1108/18325910510635308
29. Macinati, M. S., & Rizzo, M. G. (2016). Exploring the link between clinical managers involvement in budgeting and performance. Health Care Management Review, 41(3), 213–223. https://doi.org/10.1097/hmr.0000000000000071
30. McKenzie, J. E., & Veroniki, A. A. (2024). A brief note on the random-effects meta-analysis model and its relationship to other models. Journal of Clinical Epidemiology, 174, 111492. https://doi.org/10.1016/j.jclinepi.2024.111492
31. McPake, B. (2003). Is the Colombian health system reform improving the performance of public hospitals in Bogota? Health Policy and Planning, 18(2), 182–194. https://doi.org/10.1093/heapol/czg023
32. Meredith, J. O., Grove, A. L., Walley, P., et al. (2011). Are we operating effectively? A lean analysis of operating theatre changeovers. Operations Management Research, 4(3–4), 89–98. https://doi.org/10.1007/s12063-011-0054-6
33. Moons, K., Waeyenbergh, G., & Pintelon, L. (2019). Measuring the logistics performance of internal hospital supply chains – A literature study. Omega, 82, 205–217. https://doi.org/10.1016/j.omega.2018.01.007
34. Nyland, K., Morland, C., & Burns, J. (2017). The interplay of managerial and non-managerial controls, institutional work, and the coordination of laterally dependent hospital activities. Qualitative Research in Accounting & Management, 4(4), 467-495. https://doi.org/10.1108/QRAM-08- 2017-0076
35. Popesko, B., Novák, P., & Papadaki, S. (2015). Measuring diagnostics and patient profitability in healthcare: Economics vs. Ethics. Economics and Sociology, 8(1), 234-245. https://doi.org/10.14254/2071-789X.2015/8-1/18
36. Purbey, S., Mukherjee, K., & Bhar, C. (2007). Performance measurement system for healthcare processes. International Journal of Productivity and Performance Management, 56(3), 241–251. https://doi.org/10.1108/17410400710731446
37. Ramanathan, R. (2005). Operations assessment of hospitals in the Sultanate of Oman. International Journal of Operations & Production Management, 25(1), 39–54. https://doi.org/10.1108/01443570510572231
38. Salmerón-Gómez, R., García-García, C. B., & García-Pérez, J. (2024). A Redefined Variance Inflation Factor: Overcoming the Limitations of the Variance Inflation Factor. Computational Economics, 65(1), 337–363. https://doi.org/10.1007/s10614-024-10575-8
39. Siedlecki, R., Bem, A., Ucieklak-Jeż, P., et al. (2016). Rural Versus Urban Hospitals in Poland. Hospital’s Financial Health Assessment. Procedia - Social and Behavioral Sciences, 220, 444–451. https://doi.org/10.1016/j.sbspro.2016.05.519
40. Turner, J., Broom, K., Elliot, M., & Lee, J. (2015). Decomposition of Hospital Profitability: An Application of DuPont Analysis to the US Market. Health services research and managerial epidemiology, 1-10. https://doi.org/10.1177/2333392815590397
41. Van Erp, W., Roozen, F., & Vosselman, E. (2019). The performativity of a management accounting and control system: Exploring the dynamic relational consequences of a design. Scandinavian Journal of Management, 35(4), 101077. https://doi.org/10.1016/j.scaman.2019.101077
42. Younis, I., Longsheng, C., Zulfiqar, M. I., et al. (2020). Regional disparities in Preventive measures of COVID-19 pandemic in China. A study from international students’ prior knowledge, perception and vulnerabilities. Environmental Science and Pollution Research, 28(30), 40355–40370. https://doi.org/10.1007/s11356-020-10932-8