Improving Health System Efficiency: Perspectives of Decision-Makers

Allin, Sara; Guilcher, Sara; Riley, Dana L.; Zhang, Yu Janice

doi:10.12927/hcq.2017.25143

Cited by 6 publications

(8 citation statements)

References 25 publications

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Section: Resultsmentioning

confidence: 99%

“…Quantitative approaches were used to measure the level and determinants of efficiency. Qualitative approaches were used to examine study participants' perceptions about the objectives of the health system [41,45] and existence and nature of health system inefficiency and its determinants [41,[45][46][47][48]. Beyond identification, qualitative approaches provided explanations of the relationship between identified determinants and health system efficiency [36,48,49].…”

Section: Methods Used To Analyse Efficiencymentioning

confidence: 99%

“…Of the papers that used panel data, 36 (67%) used the Malmquist productivity index (MPI) approach to measure efficiency changes over time, while 18 (33%) included time as a covariate in a regression analysis. Five publications (4%) employed qualitative approaches [36,46,[53][54][55], while two studies (2%) used a mixed methods approach by combining both qualitative and quantitative methods [47,49]. Efficiency measurement in the retrieved literature was done using non-parametric (data envelopment analysis-DEA and Free disposal hull technique) and parametric methods (stochastic frontier analysis-SFA).…”

Section: Methods Used To Analyse Efficiencymentioning

confidence: 99%

“…The Democratic Republic of Congo and Zambia realised improvement in health system efficiency by aligning and coordinating donor support with health sector priorities, and coordinating health sector planning, budgeting and resource allocation to reduce waste and duplication [36,53]. Beyond health sector coordination, multisectoral coordination and partnerships to tackle social determinants of health were thought to improve efficiency [46]. Some studies reported that decentralisation of health functions was associated with higher technical efficiency of national and subnational health systems [59].…”

Section: Health System Characteristicsmentioning

confidence: 99%

“…An assessment of the technical efficiency of healthcare systems of selected middle-income countries found that technical efficiency was enhanced by decentralisation, which enhanced the delivery of care in rural areas, and improved the responsiveness of health systems to community needs through improved community participation in healthcare decision making [104]. Effective performance monitoring and accountability was found to improve health system efficiency in Canada [46]. Leadership and management practices and capacity were also thought to be a determinant of health system efficiency [45,46,53].…”

Section: Health System Characteristicsmentioning

confidence: 99%

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Analysing the Efficiency of Health Systems: A Systematic Review of the Literature

Mbau

Musiega

Nyawira

et al. 2022

Appl Health Econ Health Policy

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Background Efficiency refers the use of resources in ways that optimise desired outcomes. Health system efficiency is a priority concern for policy makers globally as countries aim to achieve universal health coverage, and face the additional challenge of an aging population. Efficiency analysis in the health sector has typically focused on the efficiency of healthcare facilities (hospitals, primary healthcare facilities), with few studies focusing on system level (national or sub-national) efficiency. We carried out a thematic review of literature that assessed the efficiency of health systems at the national and sub-national level. Methods We conducted a systematic search of PubMed and Google scholar between 2000 and 2021 and a manual search of relevant papers selected from their reference lists. A total of 131 papers were included. We analysed and synthesised evidence from the selected papers using a thematic approach (selecting, sorting, coding and charting collected data according to identified key issues and themes). Findings There were more publications from high-and upper middle-income countries (53%) than from low-income and lower middle-income countries. There were also more publications focusing on national level (60%) compared to sub-national health systems' efficiency. Only 6% of studies used either qualitative methods or mixed methods while 94% used quantitative approaches. Data envelopment analysis, a non-parametric method, was the most common methodological approach used, followed by stochastic frontier analysis, a parametric method. A range of regression methods were used to identify the determinants of health system efficiency. While studies used a range of inputs, these generally considered the building blocks of health systems, health risk factors, and social determinants of health. Outputs used in efficiency analysis could be classified as either intermediate health service outputs (e.g., number of health facility visits), single health outcomes (e.g., infant mortality rate) or composite indices of either intermediate outputs of health outcomes (e.g., Health Adjusted Life Expectancy). Factors that were found to affect health system efficiency include demographic and socio-economic characteristics of the population, macro-economic characteristics of the national and sub-national regions, population health and wellbeing, the governance and political characteristics of these regions, and health system characteristics. Conclusion This review highlights the limited evidence on health system efficiency, especially in low-and middle-income countries. It also reveals the dearth of efficiency studies that use mixed methods approaches by incorporating qualitative inquiry. The review offers insights on the drivers of the efficiency of national and sub-national health systems, and highlights potential targets for reforms to improve health system efficiency.

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Section: Resultsmentioning

confidence: 99%

Section: Methods Used To Analyse Efficiencymentioning

confidence: 99%

Section: Methods Used To Analyse Efficiencymentioning

confidence: 99%

Section: Health System Characteristicsmentioning

confidence: 99%

Section: Health System Characteristicsmentioning

confidence: 99%

See 3 more Smart Citations

Analysing the Efficiency of Health Systems: A Systematic Review of the Literature

Mbau

Musiega

Nyawira

et al. 2022

Appl Health Econ Health Policy

View full text Add to dashboard Cite

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Engaging the collective voice of physicians: Optimizing participation in research and policy development in the context of COVID-19 and physician burnout

McKay,

Brown,

Mallam

et al. 2023

Healthc Manage Forum

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Physicians and governments work collaboratively to determine optimal healthcare policy options. Physicians are also engaged by health researchers to participate in studies. Physician engagement can be impeded by limits on physician time and remuneration for engagement, and the impact of physician burnout (exacerbated by COVID-19). Doctors Nova Scotia engaged physicians on various research and policy items throughout the pandemic. Strategies included integrating physicians into research teams, remunerating engagement activities, and leveraging existing tools and networks. Health researchers and policy-makers can improve physician engagement through physician champions, reduction of research duplication, valuing of physician contributions, and integrating networks.

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Exploring physician engagement in health care organizations: a scoping review

Prenestini,

Palumbo,

Grilli

et al. 2023

BMC Health Serv Res

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Rationale Enhancing health system effectiveness, efficiency, and appropriateness is a management priority in most world countries. Scholars and practitioners have focused on physician engagement to facilitate such outcomes. Objectives Our research was intended to: 1) unravel the definition of physician engagement; 2) understand the factors that promote or impede it; 3) shed light on the implications of physician engagement on organizational performance, quality, and safety; and 4) discuss the tools to measure physician engagement. Method A scoping review was undertaken. Items were collected through electronic databases search and snowball technique. The PRISMA extension for Scoping Reviews (PRISMA-ScR) statement and checklist was followed to enhance the study replicability. Results The search yielded 16,062 records. After an initial screening, 300 were selected for potential inclusion in this literature review. After removing duplicates and records not meeting the inclusion criteria, full-text analysis of 261 records was performed, yielding a total of 174 records. Discussion Agreement on the conceptualization of physician engagement is thin; furthermore, scholars disagree on the techniques and approaches used to assess its implementation and implications. Proposals have been made to overcome the barriers to its adoption, but empirical evidence about implementing physician engagement is still scarce. Conclusions Our scoping review highlights the limitations of the extant literature about physician engagement. Physician engagement is a relatively ill-defined concept: developing an evidence base for its actual implementation is necessitated to provide reliable guidance on how the governance of health care organizations could be improved. Although we did not assess the quality or the robustness of current empirical research, our findings call for further research to: 1) identify potential drivers of physician engagement, 2) develop dependable assessment tools providing health care organizations with guidance on how to foster physician engagement, and 3) evaluate engagement’s actual impact on health care organizations’ performance.

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Improving Health System Efficiency: Perspectives of Decision-Makers

Cited by 6 publications

References 25 publications

Analysing the Efficiency of Health Systems: A Systematic Review of the Literature

Analysing the Efficiency of Health Systems: A Systematic Review of the Literature

Engaging the collective voice of physicians: Optimizing participation in research and policy development in the context of COVID-19 and physician burnout

Exploring physician engagement in health care organizations: a scoping review

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