Technical efficiency of health-care systems in selected middle-income countries: an empirical investigation (original) (raw)
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Health Care Efficiency Across Countries: A Stochastic Frontier Analysis
Applied Econometrics and International Development, 2011
This study addresses the increasingly important issue of efficiency of national health care systems. It uses the stochastic frontier technique to estimate a health production function where the inefficiency term is modeled as a linear function of relevant explanatory variables. The results show that inefficiency of national health care systems is inversely related with per capita income and directly related with income inequality. An important policy related finding is that health care systems are more efficient when greater shares of total health care expenditure come from public sources and out of pocket, rather than from private insurance coverage.
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.
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...
مطالعات اقتصاد بينالملل, 2014
The importance of community's health followed by the consideration of endogenous growth models has led to an increase in health expenditure of countries to speed up economic growth and development. This has made the efficiency of health production function to an essential issue especially in developing countries. Based upon this, the present study with employing the stochastic frontier analysis method looks for identifying the main determinants such as economic(children immunization and age dependency ratio), environmental (the rule of law) and social(globalization) conditions on technical inefficiency of health production function between member countries of Organization of the Islamic Conference (OIC) in the period of 1998-2007. The empirical results show increasing the efficiency of health production through improvement in economic and environmental condition. But the increase in socialization globalization such as social factor has led to a decrease in technical efficiency that may be due to the lack of appropriate culture of using new technologies and modern social relations affected by the process of globalization in such countries.
2014
Background Improving efficiency of health sector is of particular importance in all countries. To reach this end, it is paramount to measure the efficiency. On the other hand, there are many factors that affect the efficiency of health systems. This study aimed to measure the Technical Efficiency (TE) of health systems in Economic Cooperation Organization (ECO) countries during 2004–10 and to determine the factors affecting their TE. Methods This was a descriptive-analytical and panel study. The required data were gathered using library and field studies, available statistics and international websites through completing data collection forms. In this study, the TE of health systems in 10 ECO countries was measured using their available data and Data Envelopment Analysis (DEA) through two approaches. The first approach used GDP per capita, education and smoking as its inputs and life expectancy and infant mortality rates as the outputs. The second approach, also, used the health expenditures per capita, the number of physicians per thousand people, and the number of hospital beds per thousand people as its inputs and life expectancy and under-5 mortality rates as the outputs. Then, the factors affecting the TE of health systems were determined using the panel data logit model. Excel 2010, Win4Deap 1.1.2 and Stata 11.0 were used to analyze the collected data. Results According to the first approach, the mean TE of health systems was 0.497 and based on the second one it was 0.563. Turkey and Turkmenistan had, respectively, the highest and lowest mean of efficiency. Also, the results of panel data logit model showed that only GDP per capita and health expenditures per capita had significant relationships with the TE of health systems. Conclusion In order to maximize the TE of health systems, health policy-makers should pay special attention to the proper use of healthcare resources according to the people’s needs, the appropriate management of the health system resources, allocating adequate budgets to the health sector, establishing an appropriate referral system to provide better public access to health services according to their income and needs, among many others.
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.
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.
Technical efficiency in the use of health care resources: a comparison of OECD countries
Health Policy, 2004
Our paper analyzes technical efficiency in the production of aggregate health outcomes of reduced infant mortality and increased life expectancy, using Organization for Economic Cooperation and Development (OECD) health data. Application of data envelopment analysis (DEA) reveals that some countries achieve relative efficiency advantages, including those with good health outcomes (Japan, Sweden, Norway, and Canada) and those with modest health outcomes (Mexico and Turkey). We conclude the USA may learn from countries more economical in their allocation of healthcare resources that more is not necessarily better. Specifically, we find that the USA can substantially reduce inputs while maintaining the current level of life expectancy.
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.
The efficient performance of hospitals is critical to cost containment and the delivery of effective health services. This paper examines the efficiency of hospitals in LIC context using a sample of 200 hospitals generated from a survey of hospitals in southeast Nigeria. The paper uses the translog production function version of the stochastic frontier model (SFA) to estimate the efficiency levels of individual hospitals and the determinants of inefficiency. The results indicate large variations in the efficiency scores of sample healthcare facilities with average efficiency of 71%. Private hospitals show greater level of efficiency than public ones. The average scale elasticity was also found to reflect constant returns to scale. The results suggest that large social welfare gains could be made by improving the efficiency of hospitals in LICs. Suggestions are made on how to achieve greater efficiency in these institutions.