Health Care Efficiency Across Countries: A Stochastic Frontier Analysis (original) (raw)
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Efficiency of Health Care Systems: Stochastic Frontier Analysis Including Innovation Component
2014
The efficiency of health care system can be evaluated at three levels: the one related to the healing process itself, the organizational one (associated with the functioning of entities providing health care, such as hospitals) and the systemic one (the overall efficiency of health care system). The goal of this paper is to focus on the latter efficiency concept investigating health care systems’ performance at the macroeconomic level. In order to analyze this question we apply a parametric stochastic frontier model (SFA) enriched by the innovation component. This specification allows us to construct the health system efficiency ranking among OECD countries, including Poland. Our results limit the impact of raising health expenses and claim the importance of better resource allocation. We also find the positive effect of pharmaceutical innovation on health condition while the innovation related to medical procedures needs to be less time consuming to be efficient.
International Health
Background The rising burden of non-communicable diseases presents an increasing public health challenge to many low- and middle-income countries. This problem may be compounded in health systems with lower levels of technical efficiency (TE). Methods This study used recent Service Provision Assessments data to estimate the level of TEs of health facilities in eight countries. Initially, the general and disease-specific service readiness indexes are estimated. Finally, the production function is estimated using the exposures and the outcomes of the model. Results Evidence shows that the general and disease-specific service readiness indexes are significantly associated with an increase in the number of outpatient visits. Outpatient visits may increase by 14% with an increase in health worker density. Similarly, outpatient visits may increase by 0.3% with a unit increase in the general and diabetes service readiness indexes. Furthermore, outpatient visits may increase by 0.4% and 0.8...
Technical efficiency of health production in Africa: A stochastic frontier analysis
International journal of healthcare, 2022
Background: Inefficiency is widespread in health systems all over the world. The World Health Organization (WHO) estimates that 20%-40% of the global health spending is wasted. In African countries, inefficiency of this magnitude will seriously hamper progress towards achieving universal health coverage and other health system goals. It is thus, significant to assess the efficiency of health systems over time in order to set the ground for identifying the contextual factors leading to inefficiency and design appropriate efficiency-enhancing measures. Methods: Using panel data for the years 2000, 2005, 2010, and 2015, the study employs a time-variant stochastic frontier production function to assess efficiency. The input measure used is current expenditure per capita in purchasing power parity (Int$) terms and the measure of output is health-adjusted life expectancy (HALE). Moreover, mean years of schooling, GDP per capita in Int$, and out-of-pocket payment as a share of current expenditure on health were used as technical inefficiency effect variables. Data were analyzed using Frontier Version 4.1.
Internal markets and health care efficiency: a multiple-output stochastic frontier analysis
Health Economics, 1999
This paper has two purposes. The first purpose is methodological and aims to extend previous work on efficiency analysis by implementing a multiple-output stochastic ray frontier production function model. This model generalizes the single-output stochastic frontier model to multiple-input, multiple-output technologies and allows simultaneous estimation of technical efficiency and analysis of influential variables on efficiency. The second, empirical, purpose is to test for existence and magnitude of the effect of purchaser/provider split combined with new reimbursement schemes on technical efficiency in the Swedish public hospital system. The analysis is carried out with a panel data set covering the total population of 26 Swedish County Councils from 1989 to 1995. Our empirical results support the frontier model specification and indicate that output-based reimbursement improves technical efficiency. The potential saving in costs due to a switch from budget-based allocation to output-based allocation is estimated to be almost 10%.
Comparing efficiency of health systems across industrialized countries: a panel analysis
BMC Health Services Research, 2015
Background: Rankings from the World Health Organization (WHO) place the US health care system as one of the least efficient among Organization for Economic Cooperation and Development (OECD) countries. Researchers have questioned this, noting simplistic or inappropriate methodologies, poor measurement choice, and poor control variables. Our objective is to re-visit this question by using newer modeling techniques and a large panel of OECD data. Methods: We primarily use the OECD Health Data for 25 OECD countries. We compare results from stochastic frontier analysis (SFA) and fixed effects models. We estimate total life expectancy as well as life expectancy at age 60. We explore a combination of control variables reflecting health care resources, health behaviors, and economic and environmental factors. Results: The US never ranks higher than fifth out of all 36 models, but is also never the very last ranked country though it was close in several models. The SFA estimation approach produces the most consistent lead country, but the remaining countries did not maintain a steady rank. Discussion: Our study sheds light on the fragility of health system rankings by using a large panel and applying the latest efficiency modeling techniques. The rankings are not robust to different statistical approaches, nor to variable inclusion decisions. Conclusions: Future international comparisons should employ a range of methodologies to generate a more nuanced portrait of health care system efficiency.
Review of Economics and Political Science
Purpose This paper aims to evaluate the technical efficiency of the health-care systems in 21 selected middle-income countries during the period (2000–2017) and determine the source of inefficiency whether it is transient (short run) or persistent (long run). Design/methodology/approach The study uses the stochastic frontier analysis technique through employing the generalized true random effects model which overcomes the drawbacks of the previously introduced stochastic frontier models and allows for the separation between unobserved heterogeneity, persistent inefficiency and transient inefficiency. Findings Persistent efficiency is lower than the transient efficiency; hence, there are more efficiency gains that can be made by the selected countries by adopting long-term policies that aim at reforming the structure of the health-care system in the less efficient countries such as South Africa and Russia. The most efficient countries are Vietnam, Mexico and China which adopted a soc...
Efficiency of Local Governments in Health Service Delivery: A Stochastic Frontier Analysis
The study analyzes the efficiency implications of fiscal decentralization using stochastic frontier analysis (SFA). It uses LGU health expenditure (in per capita real terms) as input. The output variables of interest include access to safe water and sanitation, health facility-based delivery, and access to hospital inpatient services. It also uses LGU income and its major components (i.e., own-source revenue and IRA, in per capita real terms) as covariates; as well as the health expenditure decentralization ratio to account for fiscal autonomy on the expenditure side and two measures of fiscal decentralization to account for financial/fiscal autonomy of the local government units (LGUs) on the income side (i.e., the ratio of LGU ownsource revenue to LGU expenditures and ratio of LGU own-source revenue to LGU income) as factors affecting efficiency. The findings of SFA lend empirical evidences to what the literature says about the health devolution experience in the country. Issues on mismatch between local government fiscal capacity and devolved functions, fragmentation of health system, existence of two-track delivery system, and unclear expenditure assignments, among others inevitably create inefficiency. These issues should be addressed to fully reap the potential benefits (e.g., efficiency gains) from fiscal decentralization, particularly health devolution.
Measuring CIS Health Systems Using the Stochastic Frontier Analysis (SFA)
Economy of Region, 2020
and Ukraine. Turkmenistan resigned its full membership status in 2005 and changed its CIS standing to observer member. Drawing on the methods of Least Squares and Maximum Likelihood Estimation of Stochastic Frontier Analysis, we made estimations to find efficiency scores in the health sector by using the data for the period from 2010 to 2015 of the countries that are members of the Commonwealth of Independent States. In the study, we used various factors as dependent and independent variables, including the number of doctors, medical personnel and hospital beds per ten thousand people, the life expectancy at birth, under-five mortality rate and the incidence of tuberculosis per one hundred thousand people. We have found that such factor as the number of doctors effectively influences reduction of the under-five mortality rates and the incidence of tuberculosis, while the factor "the number of hospital beds" is not very effective. Finally, for the CIS countries we made recommendations to popularize the health insurance, to change the old Soviet form of health management in public hospitals, and to implement liberal socioeconomic policies.
Studies on Health Systems Efficiency: Evidence from Sub-Saharan Africa
PhD Thesis, 2023
The World Health Assembly Resolution WHA58.33 in 2005 urged Member States to implement universal health coverage (UHC) to ensure that all people, including the poor and the marginalized, are able to afford essential healthcare services. The Sustainable Development Goal indicator 3.8 is dedicated to the UHC goal. However, evidence shows high levels of catastrophic and impoverishing healthcare expenditure among households in sub-Saharan Africa (SSA). This implies that achieving the UHC goal would require evidence-informed policies which would ensure more value for money and not just more money. This study investigated the factors that influence the efficiency of health systems in SSA. The investigation was carried out in three empirical papers. Paper one evaluated the cost efficiency and the factors that influence the cost efficiency of primary health care facilities (PHCFs) in Ghana using stochastic frontier analysis (SFA) model. The results show that the estimated cost efficiency of Health Centers (HCs) and Community-based Health Planning Services (CHPS) are 61.6% and 85.8%, respectively. Also, HCs (CHPS) with higher medical staff to patients’ ratios are likely to be more cost-efficient (inefficient) than those with lower ratios. Paper two estimated the UHC indices for 30 SSA countries and examined the efficiency with which health systems in SSA are utilizing healthcare resources towards achieving the UHC goal by 2030. The paper uses the bootstrap data envelopment analysis (DEA) model. The results show that the estimated UHC indices for countries in SSA range from a minimum of 52% to a maximum of 81% (SD=8.6%) with a median coverage of 66%. The average bias-corrected efficiency score for healthcare spending efficiency in pursuing the UHC goal is 0.81 (95% CI: 0.77-0.85). Paper three investigated the effect of health care financing policy reforms, particularly social health insurance and broader health financing typologies, on health system efficiency. The results reveal that prepayment health financing arrangements significantly improves health system efficiency.
2016
The study analysed the determinants of efficiency of government health expenditure in 3 selected Sub-Saharan African countries (Nigeria, Uganda and South Africa) with a view to identifying the health input most responsible for the inefficiency observed within their health sectors. It also examined the trend in efficiency change over the years in the countries and the effects of efficiency of government health expenditure on health outcomes within the study period. Secondary data were sourced from World Development Indicator (WDI) and from the officially released government budget documents of each country. The Stochastic Frontier Analysis (SFA) model with time-varying inefficiency effects technique was applied. The results showed that capital health expenditure efficiency in the 3 countries had improved significantly over the years while the recurrent health expenditure efficiency had not witnessed any significant improvement. It also showed that changes in infant survival rate were...