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Objective (s): Performance and efficiency evaluation always is a process that analyzes the healthcare organizations. Hospitals in order to provide medical services and to fulfill their mission also require this type of evaluation. This paper aimed to review the efficiency studies of the hospitals in Iran. Methods: We attempt to evaluate the efficiency of hospitals using keywords such as hospital efficiency, performance evaluation, data envelopment analysis, stochastic frontier analysis. In all 1150 articles were identified. Of these 52 articles assessed the performance of hospitals and 18 articles investigated the efficiency. These papers evaluated 262 hospitals affiliated to medical universities nationwide. Results: This systematic review showed that the highest efficiency was related to the hospitals in Tabriz University of Medical Sciences during 2005-2008 and the lowest performance was determined for the West Azerbaijan province in 2009. Also, the highest efficiency of the management of the hospitals was related to the Kerman University of Medical Sciences in 1386 and the highest scale efficiency was related to Hamadan of Medical Sciences in 2010. Conclusion: Since there were a number of inefficient hospitals, it is necessary for policy makers to adopt solutions for efficiency promotion and appropriate distribution of resources. Additionally, it is recommended that the officials design an specific databases to evaluate efficiency regularly.