In this context, the productivity of the hospitals between the first (2009) and last (2013) years of the study was also assessed by means of the Malmquist productivity index so that the changes in technology (reflected by shifts in the technology frontier) can be captured as well. Thus, the overall productivity change was subsequently decomposed into technological and efficiency changes whilst the latter was further analyzed into scale and pure technical efficiency changes. The relevant findings were in line with the ones from window analysis as all efficiency related indices were found to be greater than unity meaning that both scale and pure technical efficiency were improved in 2013. As far as the technological change is concerned, the findings revealed progress for the groups of larger hospitals (B and C) and regress for the smaller (groups A and B). The group D with the largest hospitals (>400 beds) experienced the highest technological progress (+20.2%) whilst the group B with the medium to small hospitals (85–190 beds) exhibited the highest regress (-11.1%). On the other hand, the comparisons of efficiency changes showed a twofold improvement for the medium-to-small sized hospitals (groups A+B) compared to the medium-to-large ones (groups C+D). It is therefore deducted that productivity change in larger hospitals is mainly related to changes in technology, as opposed to the smaller ones for which changes in efficiency appears to have higher contribution. It could be argued that the finding is compatible with the fact that larger hospitals are usually equipped with the latest medical technological innovations and personnel and therefore their productivity growth is heavily dependent on them. A similar finding is also reported by Gannon  who examined the productivity growth and efficiency in the production of hospital care in Ireland from 1995 to 1998.