Hospitals in Poland's border regions face persistent staffing pressures and rising costs, and the COVID-19 pandemic further disrupted activity. We assessed year-by-year changes in operational and financial efficiency in three regional hospitals (BIA, LOM, SUW) in Podlaskie Voivodeship, on NATO's eastern flank, over 2015–2024. Input-oriented Data Envelopment Analysis with CCR (CRS) and BCC (VRS) models was applied in two domains (operational and financial), and 95% bootstrap confidence intervals were calculated for efficiency scores. Operational efficiency declined during the pandemic and partially recovered thereafter. Before COVID-19, mean TECCR ranged from 0. 607 (95% CI: 0. 571–0. 643) in LOM to 0. 909 (0. 833–0. 989) in SUW. In 2020–2021, TECCR fell to 0. 746 (0. 704–0. 783) in BIA and 0. 399 (0. 371–0. 410) in LOM, with SUW decreasing to 0. 810 (0. 731–0. 870). Post-pandemic values showed partial rebound: 0. 858 (0. 781–0. 946) in BIA, 0. 602 (0. 565–0. 634) in LOM, and 0. 830 (0. 758–0. 913) in SUW. For LOM, operational TECCR dropped as low as 0. 399 while financial TECCR remained at or above 0. 94, illustrating a marked divergence between service delivery and financial performance. Across periods, PTEBCC remained high, indicating scale efficiency as an important source of inefficiency. Financial efficiency showed a similar trough and recovery. Pandemic-period TECCR declined to 0. 785 (0. 766–0. 798) in BIA and 0. 951 (0. 925–0. 967) in SUW, while LOM remained relatively stable at 0. 960 (0. 947–0. 970). Post-pandemic values increased to 0. 928 (0. 863–0. 959) in BIA and 0. 949 (0. 901–0. 979) in SUW, with LOM at 0. 940 (0. 919–0. 958). Several confidence intervals did not include 1. 00, indicating persistent inefficiency components. Overall, the decade shows a distinct pandemic-related dip followed by partial normalisation, with between-hospital heterogeneity and recurrent scale-related shortfalls in both domains. These results support routine, domain-specific efficiency monitoring as a tool for transparent performance tracking in strategically sensitive border regions. However, findings are constrained by the very small three-hospital sample, low discriminatory power of annual frontiers and the use of aggregated administrative data. Key methodological constraints are summarised in the Limitations section and should be considered when interpreting the findings.
Małyszko et al. (Thu,) studied this question.