Alatawi Ahmed D, Niessen Louis W, Khan Jahangir A M
Health Economics Group, Department of Clinical Sciences, Liverpool School of Tropical Medicine, LSTM, Room 1966-215, Pembroke Place, Liverpool, L3 5QA, UK.
Department of Clinical Pharmacy, Pharmacy College, University of Al-Jouf, Sakaka, Saudi Arabia.
Health Econ Rev. 2020 Aug 1;10(1):25. doi: 10.1186/s13561-020-00282-z.
In this study, we investigate the effect of the external environmental and institutional factors on the efficiency and the performance of the public hospitals affiliated to the Ministry of Health (MOH) in the Kingdom of Saudi Arabia (KSA). We estimate the demographic and socioeconomic characteristics of catchment populations that explain the demand for health services.
We apply descriptive analysis to explore what external factors (demographic and socioeconomic factors) can explain the observed differences in technical efficiency scores. We use Spearman's rank correlation, multivariate Tobit regression and Two-part model to measure the impact of the explanatory variables (i.e. population density, nationality, gender, age groups, economic status, health status, medical interventions and geographic location) on the efficiency scores.
The analysis shows that the external factors had a significant influence on efficiency scores. We find significant associations between hospitals efficiency scores and number of populations in the catchment area, percentage of children (0-5 years old), the prevalence of infectious diseases, and the number of prescriptions dispensed from hospital's departments. Also, the scores significantly associate with the number of populations who faced financial hardships during medical treatments, and those received financial support from social administration. That indicates the hospitals that serve more patients in previous characteristics are relatively more technically efficient.
The environmental and institutional factors have a crucial effect on efficiency and performance in public hospitals. In these regards, we suggested improvement of health policies and planning in respect to hospital efficiency and resource allocation, which consider the different demographic, socioeconomic and health status of the catchment populations (e.g., population density, poverty, health indicators and services utilization). The MOH should pay more attention to ensure appropriate allocation mechanisms of health resources and improve utilization of health services among the target populations, for securing efficient and equitable health services.
在本研究中，我们调查外部环境和机构因素对沙特阿拉伯王国（KSA）卫生部所属公立医院的效率和绩效的影响。我们估计了解释卫生服务需求的集水区人口的人口统计学和社会经济特征。
我们应用描述性分析来探索哪些外部因素（人口统计学和社会经济因素）可以解释观察到的技术效率得分差异。我们使用斯皮尔曼等级相关性、多元托比特回归和两部分模型来衡量解释变量（即人口密度、国籍、性别、年龄组、经济状况、健康状况、医疗干预措施和地理位置）对效率得分的影响。
分析表明，外部因素对效率得分有显著影响。我们发现医院效率得分与集水区人口数量、儿童（0 - 5岁）百分比、传染病患病率以及医院各科室发放的处方数量之间存在显著关联。此外，得分还与在医疗过程中面临经济困难以及获得社会管理部门经济支持的人口数量显著相关。这表明在上述特征方面服务更多患者的医院在技术上相对更有效率。
环境和机构因素对公立医院的效率和绩效具有关键影响。在这些方面，我们建议改进关于医院效率和资源分配的卫生政策和规划，要考虑集水区人口的不同人口统计学、社会经济和健康状况（例如人口密度、贫困、健康指标和服务利用情况）。卫生部应更加注重确保卫生资源的适当分配机制，并提高目标人群中卫生服务的利用率，以确保高效和公平的卫生服务。
