The efficiency of the local health systems: investigating the roles of health administrations and health care providers

Abstract

The analysis of efficiency in healthcare has largely focused either on individual healthcare providers, or on sub-national health systems conceived as a unique decision making unit.However, in hierarchically organised national health services, two separate entities are responsible for turning financial resources into services at the local level: health administrations and healthcare providers. Their separate roles and the one of health administrations in particular have not been explicitly considered in efficiency analysis.We applied Stochastic Frontier Analysis to district-level panel data from Mozambique to assess districts efficiency in delivering outpatient care. We first assessed the efficiency of the whole district considered as an individual decision making unit, and then we assessed separately the efficiency of health administrations and healthcare providers within the same district. We found that on average only 73% of the outpatient consultations deliverable with the given inputs were realized, with large differences in performance across districts.Individual districts performed differently in administrative or healthcare delivery functions.On average, a reduction of administrative inefficiency by 10 percentage points, for a given budget would increase by 0.2% the volume of services delivered per thousand population per year. Identifying and targeting the specific drivers of administrative inefficiencies can contribute to increase service delivery at local level.

Understanding efficiency and the effect of pay-for-performance across health facilities in Tanzania

“…Variations in efficiency across districts suggest that there may be district level factors still unexplored affecting efficiency, beyond rurality and catchment population characteristics. 74 The implementation of the P4P programme in Tanzania neither enhanced nor reduced efficiency across health facilities. The average efficiency scores remained almost unchanged over time.…”

“…81 82 Assessing the role of local health administrations, which in similar settings often manage the distribution of resources across facilities, would also be important to understand where improvements can be made. 74 Moreover, we encourage more research to assess whether performance-based provider payments (eg, P4P) can improve efficiency across facilities, as countries continue to implement health financing reforms toward UHC. In LMICs where staff and drugs are in shortage, it is important to improve efficiency by increasing output while maintaining or increasing inputs.…”

Level and determinants of county health system technical efficiency in Kenya: two stage data envelopment analysis

“…Several studies have examined the technical efficiency of health systems at the national and sub-national level using data envelopment analysis (DEA) in Africa. For instance, Ngobeni et al used DEA to assess the technical efficiency of provincial health systems in South Africa [ 13 ], Achoki et al assessed the technical efficiency of districts in Zambia [ 14 ], while Anselmi et al assessed technical efficiency of district health systems in Mozambique [ 15 ]. Several other papers used DEA to assess the technical efficiency of health facilities in African countries.…”

A spatio‐temporal cluster analysis of technical efficiency in the production of outpatient maternal health services and its structural correlates in México

“…Conceptually, TE is inherent to the functions of all health care systems, which include ensuring resources, providing funds, supplying services, and exercising governance. Furthermore, it depends on the relevant institutional and structural conditions of social development . It must therefore be perceived as a lynchpin in the achievement of the ultimate goals of any health system: improved population health, equality, and financial protection for all …”

“…Furthermore, it depends on the relevant institutional and structural conditions of social development. [18][19][20] It must therefore be perceived as a lynchpin in the achievement of the ultimate goals of any health system: improved population health, equality, and financial protection for all. [21][22][23] The sustainability of the SMS depends on how the challenge of raising the TE levels of its services is addressed, an endeavor requiring the improvement of its service production processes through the optimization of available budgetary resources.…”