Background: In the health care systems, efficiency measurement is considered as a key step in performing individual performance audits of production units such as, health centres and hospitals. It entails a rational framework through which resources are distributed and shared among health care facilities. Thus, there are two common approaches to measure hospital efficiency namely: non-parametric (DEA) and parametric (SFA). The article is aimed to review the articles to analyze the characteristics of these approaches and to identify the similarities, differences, strengths, and limitations related to them. Materials and Methods: The literature, which related to measuring relative efficiency of hospitals were obtained from online database involving ScienceDirect, Pubmed. The keywords used for the search terms involving hospital efficiency, healthcare efficiency, parametric approach, non-parametric approach, DEA and SFA. The review only for articles published in English language. Result: The required information about methodological approaches were obtained and summarized into the construct form. The discussion was based on approach type in term of non-parametric and parametric. Conclusion: In a nutshell, both of DEA and SFA can be applicable in healthcare setting to measure hospitals efficiency. The selection of the convenient approach is subjected to the aim of the study.

Background: Access to healthcare can be defined as opportunity or ease for patients to come to the services, while accessibility can be defined as the potential or ease for certain health services or health facilities to be reach and utilized by the patients. Spatial accessibility is assessment of accessibility determinant which can be segregated according to geographical location. The aim of this manuscript is to identify spatial accessibility assessments methods used in the primary healthcare accessibility studies within rural population setting and integration with its determinants. Materials and Methods:Scoping systematic review was done using public domain search engine. Keywords used for article search are Spatial Accessibility; Geographical Accessibility; Primary Health Care; Primary Care; Rural; Non-Urban and Remote. All articles within 15 years of publication were included with the exclusion criteria of review article, research methodology protocol and non-English articles. After screening, 10 final articles were eligible for qualitative synthesis. Content analysis was carried out, then synthesized into location of study, purpose of the study, method of spatial accessibility assessment and accessibility determinants. Result:Most of the studies in this review used gravity method (floating catchment method), three studies using physician population ratio and one study used travel impedance. Travel impedance and physician population ratio were described descriptively, which later were correlated with utilization and mortality. Several aspatial factors were also been associated with spatial accessibility through correlation, integration through formula calculation, aggregation in index and overlaying through geographical information system.Conclusion: Development of geographical information system has made more studies to use floating catchment method as a tool to assess spatial accessibility. Alteration to existing floating catchment method to allow researcher to address limitation for its predecessor. Recent development also integrates spatial accessibility with aspatial factor and its determinants. This knowledge will facilitate policy maker to improve the accessibility by overcoming the barriers.

In Malaysia, smoking is the third risk factor with the most disease burden and it was hugely associated with diseases of the heart and lungs. In response to the tobacco epidemic, WHO had adopted the Framework Convention on Tobacco Control (FCTC) on 21 st May 2003 but despite ratifying to FCTC in 2005 and enforcing various types of policies in the country, consumption of cigarette remains widespread in Malaysia. Hence the objective of this study which is to determine the role of cigarette policies in reducing cigarette consumption and the occurrences of chronic obstructive pulmonary disease (COPD) and lung cancer in Malaysia. This is a time series study with cigarette consumption and COPD and lung cancer occurrences as the dependent variables while the independent variable was all policies related to cigarette smoking in Malaysia between the years 1995 until 2017. Data analyses were done using Microsoft Excel Version 16.12, and IBM SPSS Statistics Version 23. Descriptive statistics were conducted to describe the variables using mean and standard deviation or as median and interquartile range. Time series scatter plot was utilized to plot the data on a monthly basis. The mean for cigarette consumption was 1,268.34 million cigarettes (standard deviation (SD) 669.31 million). The median for minimum cigarette price was RM0.35 per cigarette (interquartile range (IQR) RM0.10 per cigarette). Import duty showed a median of RM0.20 (IQR RM0.06) while excise duty's median and IQR was RM0.12 and RM0.19 respectively. The median for COPD was 962 cases (IQR 381), while the mean for lung cancer cases was 231 cases (SD 55). Cigarette consumption showed a fluctuating pattern followed by a down going trend from year 2012 until 2017. This coincides with the introduction of more cigarette related policies and the introduction of minimum cigarette price policy with increasing excise tax rates. However, COPD and lung cancer cases showed an increasing trend despite the decreasing cigarette consumption, more policies implementation and increasing tax rates. In conclusion, cigarette policies have played a major role in reducing cigarette consumption but not the number of COPD and lung cancer occurrences in Malaysia from year 1995 until 2017.