The study aimed at analyzing the state of health care service provision in Ethiopia in the case of Addis Ababaâ€˜s Public hospitals. Though empirical evidence on the state of hospitals service provision is important, systematic research results encompassing the core health care service dimensions and views of patients is scant in Ethiopia.The absence of data and research prioritization on hospitals is a self-perpetuating problem and in the absence of substantive data or pressure from external donors, policymakers face few incentives to improve hospital services. Health care reform has frequently been more an act of faith than on the basis of evidence-based policy making; therefore this study provides evidence on the actual health care service provision state of public hospitals in Addis Ababa city. To this end the study considered three specific objectives i.e. Assessing the public hospitals health care service: (1) quality (2) accessibility and (3) operational efficiency. The study has defined these three categories of health care service dimensions and adopted OECDâ€˜s (2006) analytical framework.rnTo achieve the objectives the study has employed a pragmatic research paradigm with mixed methods research design. To answer the research questions of the study data was collected from both primary and secondary sources. Primary sources include health care service users, and health care service providers. Observation was also made to hospital facilities, service provision sessions and the situation of service users and providers. Secondary data was collected from policy documents, hospital reform implementation reports and related published and unpublished sources. The individual level units of the study were hospital health care service providers (staffs and leaders) and also hospital service users (patients and other service seekers). The institutional level of unit of analysis were the public hospitals selected, and health care reform and policy documents. To these end seven hospitals, 376 hospital health service users and 14 hospital health care service professionals, 2 AACHB officials and 2 FMoH officials were selected and interviewed. Qualitative, descriptive and inferential statistics were used in the data analysis. Thematic analysis was used to organize and interpret qualitative data. Cronbach's alpha, descriptive statistics, from Chi-square test, Mann-Whitney U test, and Kruskal-Wallis test were used for descriptive statistical analysis. A principal component and logistic regression analysis were used for inferential statistical analysis. The overall satisfaction of patients with the effectiveness of the hospitals service provision was (71.28%). The multivariate logistic regression analysis predicts that the availability of thorough treatment and examination of patients (p