Ahmed Sayem, Hasan Md Zahid, Laokri Samia, Jannat Zerin, Ahmed Mohammad Wahid, Dorin Farzana, Vargas Veronica, Khan Jahangir A M
1Health Systems and Population Studies Division, icddr,b, Dhaka, 1212 Bangladesh.
2Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, SE-171 77 Stockholm, Sweden.
Cost Eff Resour Alloc. 2019 Jul 24;17:15. doi: 10.1186/s12962-019-0183-6. eCollection 2019.
District hospitals (DHs) provide secondary level of healthcare to a wide range of population in Bangladesh. Efficient utilization of resources in these secondary hospitals is essential for delivering health services at a lower cost. Therefore, we aimed to estimate the technical efficiency of the DHs in Bangladesh.
We used input-oriented data envelopment analysis method to estimate the variable returns to scale (VRS) and constant returns to scale (CRS) technical efficiency of the DHs using data from Local Health Bulletin, 2015. In this model, we considered workforce as well as number of inpatient beds as input variables and number of inpatient, outpatient, and maternal services provided by the DHs as output variables. A Tobit regression model was applied for assessing the association of institutional and environmental characteristics with the technical efficiency scores.
The average scale, VRS, and CRS technical efficiency of the DHs were estimated to 85%, 92%, and 79% respectively. Population size, poverty headcount, bed occupancy ratio, administrative divisions were significantly associated with the technical efficiency of the DHs. The mean VRS and CRS technical efficiency demonstrated that the DHs, on an average, could reduce their input mix by 8% and 21% respectively while maintaining the same level of output.
Since the average technical efficiency of the DHs was 79%, there is little scope for overall improvements in these facilities by adjusting inputs. Therefore, we recommend to invest further in the DHs for improvement of services. The Ministry of Health and Family Welfare (MoHFW) should improve the efficiency in resource allocation by setting an input-mix formula for DHs considering health and socio-economic indicators (e.g., population density, poverty, bed occupancy ratio). The formula can be designed by learning from the input mix in the more efficient DHs. The MoHFW should conduct this kind of benchmarking study regularly to assess the efficiency level of health facilities which may contribute to reduce the wastage of resources and consequently to provide more affordable and accessible public hospital care.
在孟加拉国，地区医院（DHs）为广大民众提供二级医疗服务。有效利用这些二级医院的资源对于以较低成本提供医疗服务至关重要。因此，我们旨在评估孟加拉国地区医院的技术效率。
我们使用面向投入的数据 envelopment 分析方法，利用 2015 年《地方卫生公报》的数据，估计地区医院的可变规模报酬（VRS）和固定规模报酬（CRS）技术效率。在此模型中，我们将劳动力以及住院床位数视为输入变量，将地区医院提供的住院、门诊和孕产妇服务数量视为输出变量。应用 Tobit 回归模型评估机构和环境特征与技术效率得分之间的关联。
地区医院的平均规模、VRS 和 CRS 技术效率分别估计为 85%、92%和 79%。人口规模、贫困人口比例、床位占用率、行政区与地区医院的技术效率显著相关。平均 VRS 和 CRS 技术效率表明，地区医院平均可分别减少 8%和 21%的投入组合，同时保持相同的产出水平。
由于地区医院的平均技术效率为 79%，通过调整投入来全面改善这些设施的空间不大。因此，我们建议进一步投资于地区医院以改善服务。卫生和家庭福利部（MoHFW）应通过考虑健康和社会经济指标（如人口密度、贫困、床位占用率）为地区医院设定投入组合公式，提高资源配置效率。该公式可通过借鉴效率更高的地区医院的投入组合来设计。卫生和家庭福利部应定期进行此类标杆研究，以评估卫生设施的效率水平，这可能有助于减少资源浪费，从而提供更经济实惠且可及的公立医院护理。
