Influence of cost systems on efficiency. An analysis of Spanish hospitals using public national databases

García-Cornejo, Beatriz; Méndez, José Antonio Pérez

doi:10.6018/rcsar.365031

Cited by 8 publications

(5 citation statements)

References 51 publications

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“…Health care system efficiency has been extensively researched, but previous studies have a number of defects: firstly, they were mostly based on cross-sectional data for efficiency accounting, and this makes it impossible to analyze the trend of dynamic efficiency change in government health care expenditure [ 10 , 24 , 27 , 37 , 49 , 50 ]; secondly, a number of contributions to the literature take health outcomes, such as life expectancy and child mortality, as output variables when calculating the efficiency of health care system; however, various health care resources are the most direct output of government health care expenditure [ 51 ]. The complexity of the health decision process means that using health outcomes as an output of government health care expenditure will inevitably introduce more bias, and this will affect the accuracy of the accounting results.…”

Section: Discussionmentioning

confidence: 99%

“…Haniye Sadat Sajadi measures efficiency and productivity changes in the Iranian health care system and also assesses its progress towards UHC by making a comparison with 36 upper-middle-income countries [ 23 ]. Garcia-Cornejo uses public data taken from 159 hospitals in the Spanish National Health System (NHS) in the period 2010–13, and analyzes if the development of hospital cost systems (CS) implemented by the Spanish Regional Health Services (RHS) has affected hospital efficiency [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

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The efficiency of provincial government health care expenditure after China’s new health care reform

Guo

Zhang

et al. 2021

PLoS ONE

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Objective We aim to estimate the total factor productivity and analyze factors related to the Chinese government’s health care expenditure in each of its provinces after its implementation of new health care reform in the period after 2009. Materials and methods We use the Malmquist DEA model to measure efficiency and apply the Tobit regression to explore factors that influence the efficiency of government health care expenditure. Data are taken from the China statistics yearbook (2004–2020). Results We find that the average TFP of China’s 31 provincial health care expenditure was lower than 1 in the period 2009–2019. We note that the average TFP was much higher after new health care reform was implemented, and note this in the eastern, central and western regions. But per capita GDP, population density and new health care reform implementation are found to have a statistically significant impact on the technical efficiency of the provincial government’s health care expenditure (P<0.05); meanwhile, region, education, urbanization and per capita provincial government health care expenditure are not found to have a statistically significant impact. Conclusion Although the implementation of the new medical reform has improved the efficiency of the government’s health expenditure, it is remains low in 31 provinces in China. In addition, the government should consider per capita GDP, population density and other factors when coordinating the allocation of health care input. Significance This study systematically analyzes the efficiency and influencing factors of the Chinese government’s health expenditure after it introduced new health care reforms. The results show that China’s new medical reform will help to improve the government’s health expenditure. The Chinese government can continue to adhere to the new medical reform policy, and should pay attention to demographic and economic factors when implementing the policy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The efficiency of provincial government health care expenditure after China’s new health care reform

Guo

Zhang

et al. 2021

PLoS ONE

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“…On the supply side, it would be appropriate to optimize the workforce and the infrastructure, increase the quality of service and develop financial strategies; while on the demand side, financial barriers should be minimized, accessibility to health services should be increased and citizens’ health habits should be changed. In addition, a system of hospital costs that allows an exhaustive control would mean taking more efficient decisions, thus improving the performance in health management [ 18 ]. However, in order to analyze health management in terms of efficiency, it is necessary to include exogenous factors that can strongly condition the provision of the service [ 11 ].…”

Section: Theoretical Frameworkmentioning

confidence: 99%

Efficiency in the governance of the Covid-19 pandemic: political and territorial factors

2021

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Background The pandemic generated by Covid-19 has changed the way of life of citizens around the world in a short time, affecting all areas of society directly or indirectly, which is facing a global health crisis with different national responses implemented by governments. Several months into the pandemic, the first after-effects of Covid-19 are beginning to be felt by citizens, who are questioning the management carried out so far. In order to improve the performance of governmental decisions to reduce the impact of the pandemic during the coming months, we calculated the levels of efficiency in the management of health resources. In addition, we identify some country characteristics that may condition efficient management. Results We obtained significant differences according to the geographical location of the country, with European and American countries being less efficient than Asian and African countries. Likewise, we can affirm that greater freedom of expression, a higher median age and an unstable economy and labor market reduce efficiency. However, female leadership of the government and greater compliance with the rule of law offer more efficient management, as do countries that derive more revenues from tourism. Conclusions These results provide an opportunity for political leaders to reflect on their management during these months of the pandemic in order to identify mistakes and improve the implementation of effective measures. It has been shown that using more resources does not mean managing better; therefore, policymakers need to pay special attention to the use of resources, taking into account the budgetary constraints of the public sector.

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“…In terms of costing methodology, according to Gapenski and Reiter (2016) ‘the holy grail of cost estimation is costing at the service or individual patient level’. 9 10 More advanced systems, for example, those in the UK and Australia use bottom-up style costing methods to derive patient-level DRG costs; 11 but there are simplified methods available that calculate the average cost of procedure through step-down allocation methods. 1 Whichever approach is taken, it is important that the costing is nationally acceptable and can capture structural differences in cost that might be present (types of provider, demography, geography, etc), as well as variability between the cost of the conditions treated.…”

Section: Introductionmentioning

confidence: 99%

Role of healthcare cost accounting in pricing and reimbursement in low-income and middle-income countries: a scoping review

Guinness¹,

Ghosh²,

Mehndiratta³

et al. 2022

BMJ Open

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ObjectivesProgress towards universal health coverage (UHC) requires evidence-based policy including good quality cost data systems. Establishing these systems can be complex, resource-intensive and take time. This study synthesises evidence on the experiences of low-income and middle-income countries (LMICs) in the institutionalisation of cost data systems to derive lessons for the technical process of price-setting in the context of UHC.DesignA scoping review and narrative synthesis of publicly available information.Data sourcesPubMed, MEDLINE, EconLit, the Web of Science and grey literature searched from January 2000 to April 2021.Eligibility criteriaEnglish-language papers published since 2000 that identified and/or described development of and/or methods used to estimate or inform national tariffs for hospital reimbursement in LMICs. Papers were screened by two independent reviewers.Data extraction and synthesisExtraction was performed by one reviewer and checked by the second reviewer on: the method and outputs of cost data collection; commentary on the use of cost data; description of the technical process of tariff setting; and strengths and challenges of the approach. Evidence was summarised using narrative review.ResultsThirty of 484 papers identified were eligible. Fourteen papers reported on primary cost data collection; 18 papers explained how cost evidence informs tariff-setting. Experience was focused in Asia (n=22) with countries at different stages of developing cost systems. Experiences on cost accounting tend to showcase country costing experiences, methods and implementation. There is little documentation how data have been incorporated into decision making and price setting. Where cost information or cost systems have been used, there is improved transparency in decision making alongside increased efficiency.ConclusionsThere are widely used and accepted methods for generating cost information. Countries need to build sustainable cost systems appropriate to their settings and budgets and adopt transparent processes and methodologies for translating costs into prices.

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Influence of cost systems on efficiency. An analysis of Spanish hospitals using public national databases

Cited by 8 publications

References 51 publications

The efficiency of provincial government health care expenditure after China’s new health care reform

The efficiency of provincial government health care expenditure after China’s new health care reform

Efficiency in the governance of the Covid-19 pandemic: political and territorial factors

Role of healthcare cost accounting in pricing and reimbursement in low-income and middle-income countries: a scoping review

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