Anselmi Laura, Lagarde Mylène, Hanson Kara
1Manchester Centre For Health Economics,The University of Manchester,Manchester,UK.
2Department of Social Policy,London School of Economics,London,UK.
Health Econ Policy Law. 2018 Jan;13(1):10-32. doi: 10.1017/S1744133117000068. Epub 2017 May 2.
The analysis of efficiency in health care has largely focussed either on individual health care providers, or on sub-national health systems conceived as a unique decision-making unit. However, in hierarchically organized national health services, two separate entities are responsible for turning financial resources into services at the local level: health administrations and health care 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 (2008-2011) to assess district 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 health care providers within the same district. We found that on average only 73% of the outpatient consultations deliverable using available inputs were realized, with large differences in performance across districts. Individual districts performed differently in administrative or health care delivery functions. On average, a reduction of administrative inefficiency by 10 percentage points, for a given expenditure 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.
医疗保健效率分析主要集中在个体医疗保健提供者或被视为单一决策单位的次国家级卫生系统上。然而，在层级式组织的国家卫生服务体系中，有两个独立的实体负责在地方层面将财政资源转化为服务：卫生行政部门和医疗保健提供者。在效率分析中，它们各自的角色，尤其是卫生行政部门的角色，尚未得到明确考量。我们将随机前沿分析应用于莫桑比克（2008 - 2011年）地区层面的面板数据，以评估地区提供门诊护理的效率。我们首先将整个地区视为一个个体决策单位来评估其效率，然后分别评估同一地区内卫生行政部门和医疗保健提供者的效率。我们发现，平均而言，利用现有投入可提供的门诊咨询中只有73%得以实现，各地区的表现存在很大差异。个别地区在行政或医疗服务提供功能方面表现各异。平均而言，在给定支出情况下，将行政低效率降低10个百分点，每年每千人口提供的服务量将增加0.2%。识别并针对行政低效率的具体驱动因素有助于增加服务。
