Babalola Tesleem K, Moodley Indres
Department of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences University of KwaZulu-Natal, Durban, South Africa.
J Public Health Res. 2020 Jun 26;9(1):1741. doi: 10.4081/jphr.2020.1741. eCollection 2020 Jun 4.
District hospitals (DHs) constitute a significant proportion of public hospitals and consume a more substantial percentage of the government's total hospital budget. With the level of resources disbursed to DHs, it is essential to ensure efficient allocation and utilization. Hence, this study set out to assess the technical efficiency and productivity of public DHs in KwaZulu- Natal province, South Africa. Data envelopment analysis (DEA) and Malmquist total factor productivity (MTFP) were used to assess technical efficiency, identify adjustments required to make inefficient facilities more efficient, and determine overall productivity growth. Input data such as medical personnel and output information such as outpatient visits were retrieved from the databases of the district health information system (DHIS), and personnel salary systems (PERSAL) for three consecutive financial years (2014/15, 2015/16 and 2016/17). A total of 38 district hospitals were included in the study. The proportion of technically efficient facilities according to constant return to scale (CRS) were 12 (31.6%), 16 (42.1%) and 14 (36.8%) in 2014/15, 2015/16 and 2016/17 respectively while according to the variable return to scale (VRS) technically efficient facilities were 22 (57.9%), 19 (50.0) and 21 (55.2%) respectively for the three consecutive years. On average, the total productivity of DHs increased by 4.8 percent over the three years, which is attributed majorly to technical growth of 6.9 percent. This study showed that a significant proportion of the district hospitals were technically inefficiency. Also, steps that could enable more efficient use of healthcare resources to yield optimal health service delivery were recommended.
地区医院（DHs）在公立医院中占很大比例，消耗了政府医院总预算中相当大的百分比。鉴于分配给地区医院的资源水平，确保资源的有效分配和利用至关重要。因此，本研究旨在评估南非夸祖鲁 - 纳塔尔省公立地区医院的技术效率和生产率。数据包络分析（DEA）和马尔姆quist全要素生产率（MTFP）被用于评估技术效率、确定使低效设施更高效所需的调整，并确定总体生产率增长。从地区卫生信息系统（DHIS）的数据库以及连续三个财政年度（2014/15、2015/16和2016/17）的人员薪资系统（PERSAL）中获取诸如医务人员等投入数据以及诸如门诊就诊等产出信息。该研究共纳入了38家地区医院。在规模报酬不变（CRS）情况下，2014/15年、2015/16年和2016/17年技术效率设施的比例分别为12家（31.6%）、16家（42.1%）和14家（36.8%）；而在规模报酬可变（VRS）情况下，连续三年技术效率设施分别为22家（57.9%）、19家（50.0%）和21家（55.2%）。平均而言，地区医院的总生产率在三年间增长了4.8%，这主要归因于6.9%的技术增长。本研究表明，相当一部分地区医院在技术上效率低下。此外，还建议采取措施，以便更有效地利用医疗资源，实现最佳的医疗服务提供。
