Masiye Felix
Harvard University Initiative for Global Health, Cambridge, MA 02138, USA.
BMC Health Serv Res. 2007 Apr 25;7:58. doi: 10.1186/1472-6963-7-58.
Zambia has recently articulated an ambitious national health program designed to meeting health-related MDGs. Public expectations are high and Zambia continues to receive significant resources from global and bilateral donors to support its health agenda. Although the lack of adequate resources presents the most important constraint, the efficiency with which available resources are being utilised is another challenge that cannot be overlooked. Inefficiency in producing health care undermines the service coverage potential of the health system. This paper estimates the technical efficiency of a sample of hospitals in Zambia.
Efficiency is measured using a DEA model. Vectors of hospital inputs and outputs, representing hospital expended resources and output profiles respectively, were specified and measured. The data were gathered from a sample of 30 hospitals throughout Zambia. The model estimates an efficiency score for each hospital. A decomposition of technical efficiency into scale and congestion is also provided.
Results show that overall Zambian hospitals are operating at 67% level of efficiency, implying that significant resources are being wasted. Only 40% of hospitals were efficient in relative terms. The study further reveals that the size of hospitals is a major source of inefficiency. Input congestion is also found to be a source of hospital inefficiency.
This study has demonstrated that inefficiency of resource use in hospitals is significant. Policy attention is drawn to unsuitable hospital scale of operation and low productivity of some inputs as factors that reinforce each other to make Zambian hospitals technically inefficient at producing and delivering services. It is argued that such evidence of substantial inefficiency would undermine Zambia's prospects of achieving its health goals.
赞比亚最近明确提出了一项雄心勃勃的国家卫生计划，旨在实现与卫生相关的千年发展目标。公众期望很高，赞比亚继续从全球和双边捐助者那里获得大量资源，以支持其卫生议程。尽管缺乏足够资源是最重要的制约因素，但现有资源的利用效率是另一个不可忽视的挑战。卫生保健生产效率低下会削弱卫生系统的服务覆盖潜力。本文估计了赞比亚一些医院的技术效率。
使用数据包络分析（DEA）模型来衡量效率。分别确定并衡量了代表医院消耗资源和产出概况的医院投入和产出向量。数据收集自赞比亚各地的30家医院样本。该模型为每家医院估计一个效率得分。还提供了将技术效率分解为规模效率和拥挤效率的结果。
结果表明，赞比亚医院总体运营效率为67%，这意味着大量资源被浪费。相对而言，只有40%的医院是高效的。该研究进一步表明，医院规模是效率低下的主要原因。投入拥挤也是医院效率低下的一个原因。
本研究表明，医院资源利用效率低下问题严重。政策应关注医院运营规模不合适以及一些投入的生产率低下等因素，这些因素相互强化，导致赞比亚医院在生产和提供服务方面技术效率低下。有人认为，这种严重效率低下的证据将损害赞比亚实现其卫生目标的前景。
