Assessing the Efficiency of Sub-National Units in Making Progress Towards Universal Health Coverage: Evidence from Pakistan

Abstract

The World Health Report 2010 encourages countries to reduce wastage and increase efficiency to achieve Universal Health Coverage (UHC). This research examines the efficiency of divisions (subprovincial geographic units) in Pakistan in moving towards UHC using Data Envelop Analysis. We have used data from the Pakistan National Accounts 2011-12 and the Pakistan Social Living and Measurement Survey 2012-13 to measure per capita pooled public health spending in the divisions as inputs, and a set of UHC indicators (health service coverage and financial protection) as outputs. Sensitivity analysis for factors outside the health sector influencing health outcomes was conducted to refine the main model specification. Spider radar graphs were generated to illustrate differences between divisions with similar public spending but different performances for UHC. Pearson product-moment correlation was used to explore the strength and direction of the associations between proxy health systems organization variables and efficiency scores.The results showed a large variation in performance of divisions for selected UHC outputs. The results of the sensitivity analysis were also similar. Overall, divisions in Sindh province were better performing and divisions in Balochistan province were the least performing. Access to health care, the responsiveness of health systems, and patients' satisfaction were found to be correlated with efficiency scores.This research suggests that progress towards UHC is possible even at relatively low levels of public spending. Given the devolution of health system responsibilities to the provinces, this analysis will be a timely reference for provinces to gauge the performance of their divisions and plan the ongoing reforms to achieve UHC. ARTICLE HISTORY

Improving public hospital efficiency and fiscal space implications: the case of Mauritius

“…A wide array of common sources for inefficiency have been identified. These include inadequate controls on supply-chain agents, prescribers and dispensers; inadequate pharmaceutical regulatory structures/mechanisms; inappropriate hospital admissions and length of stay; asymmetric level of managerial resources for coordination and control with too many hospitals and inpatient beds in some areas and not enough in others; unclear resource allocation guidance; lack of transparency; poor accountability and governance mechanism; and inefficient mix for health interventions with resources skewed to curative services at the expenses of health promotion and prevention interventions [2,3].…”

Assessing the efficiency of Iran health system in making progress towards universal health coverage: a comparative panel data analysis

“…The last output variable in terms of financial protection was General Government Health Expenditure as a percentage of Total Health Expenditure (GGHE/THE), which is the indirect measure of financial protection. Our rationale for selecting variables was along the lines used by scholars to assess health system efficiency in making progress towards UHC [8,29,38]. We convened a panel of six recognized national experts to discuss the relevancy of selected variables to our analysis and managed to reach consensus on a guideline for each variable to ensure consistency in data definition and gathering.…”

Assessing the Efficiency of Iran Health System in Making Progress Towards Universal Health Coverage: A Comparative Panel Data Analysis

“…The last output variable in terms of nancial protection was General Government Health Expenditure as a percentage of Total Health Expenditure (GGHE/THE), which is the indirect measure of nancial protection. Our rationale for selecting variables was along the lines used by scholars to assess health system e ciency in making progress towards UHC 8,29,38 . We convened a panel of six recognized national experts to discuss the relevancy of selected variables to our analysis and managed to reach consensus on a guideline for each variable to ensure consistency in data de nition and gathering.…”