World Health Organization Country Office, Port Louis, Mauritius.
Int J Equity Health. 2020 Sep 4;19(1):152. doi: 10.1186/s12939-020-01262-9.
General Government Health Expenditure (GGHE) in Mauritius accounted for only 10% of General Government Expenditure for the fiscal year 2018. This is less than the pledge taken under the Abuja 2001 Declaration to allocate at least 15% of national budget to the health sector. The latest National Health Accounts also urged for an expansion in the fiscal space for health. As public hospitals in Mauritius absorb 70% of GGHE, maximising returns of hospitals is essential to achieve Universal Health Coverage. More so, as Mauritius is bracing for its worst recession in 40 years in the aftermath of the COVID-19 pandemic public health financing will be heavily impacted. A thorough assessment of hospital efficiency and its implications on effective public health financing and fiscal space creation is, therefore, vital to inform ongoing health reform agenda.
This paper aims to examine the trend in hospital technical efficiency over the period 2001-2017, to measure the elasticity of hospital output to changes in inputs variables and to assess the impact of improved hospital technical efficiency in terms of fiscal space creation.
Annual health statistics released by the Ministry of Health and Wellness and national budget of the Ministry of Finance, Economic Planning and Development were the principal sources of data. Applying Stochastic Frontier Analysis, technical efficiency of public regional hospitals was estimated under Cobb-Douglas, Translog and Multi-output distance functions, using STATA 11. Hospital beds, doctors, nurses and non-medical staff were used as input variables. Output variable combined inpatients and outpatients seen at Accident Emergency, Sorted and Unsorted departments. Efficiency scores were used to determine potential efficiency savings and fiscal space creation.
Mean technical efficiency scores, using the Cobb Douglas, Translog and Multi-output functions, were estimated at 0.83, 0.84 and 0.89, respectively. Nurses and beds are the most important factors in hospital production, as a 1% increase in the number of beds and nurses, result in an increase in hospital outputs by 0.73 and 0.51%, respectively. If hospitals are to increase their inputs by 1%, their outputs will increase by 1.16%. Hospital output process has an increasing return to scale. With technical efficiencies improving to scores of 0.95 and 1.0 in 2021-2022, potential savings and fiscal space creation at hospital level, would amount to MUR 633 million (US$ 16.2 million) and MUR 1161 million (US$ 29.6 million), respectively.
Fiscal space creation through full technical efficiency, is estimated to represent 8.9 and 9.2% of GGHE in fiscal year 2021-2022 and 2022-2023, respectively. This will allow without any restrictions the funding of the national response for HIV, vaccine preventable diseases as well as building a resilient health system to mitigate impact of emerging infectious diseases as experienced with COVID-19.
2018 财年，毛里求斯的政府卫生支出（GGHE）仅占政府总支出的 10%。这低于阿布贾 2001 年宣言中承诺将至少 15%的国家预算用于卫生部门。最新的国家卫生账户也敦促扩大卫生财政空间。由于毛里求斯的公立医院吸收了 GGHE 的 70%，因此最大限度地提高医院的回报对于实现全民健康覆盖至关重要。更重要的是，毛里求斯正面临着自 40 年前 COVID-19 大流行以来最严重的经济衰退，公共卫生融资将受到严重影响。因此，对医院效率进行全面评估及其对有效公共卫生融资和财政空间创造的影响，对于告知正在进行的卫生改革议程至关重要。
本文旨在研究 2001-2017 年期间医院技术效率的趋势，衡量医院产出对投入变量变化的弹性，并评估提高医院技术效率对财政空间创造的影响。
卫生部发布的年度卫生统计数据和财政部的国家预算是数据的主要来源。本文应用随机前沿分析，在柯布-道格拉斯、传递对数和多产出距离函数下，使用 STATA 11 估计了公立地区医院的技术效率，使用病床、医生、护士和非医务人员作为投入变量。产出变量结合了急症、分类和未分类部门的住院和门诊病人。效率得分用于确定潜在的效率节省和财政空间创造。
使用柯布-道格拉斯、传递对数和多产出函数，分别估计出平均技术效率得分分别为 0.83、0.84 和 0.89。护士和病床是医院生产中最重要的因素，因为床位和护士数量每增加 1%，医院产出分别增加 0.73%和 0.51%。如果医院将投入增加 1%，其产出将增加 1.16%。医院产出过程具有递增的规模报酬。如果医院的技术效率提高到 2021-2022 年的 0.95 和 1.0 分，那么医院层面的潜在节省和财政空间创造将分别达到 6.33 亿毛里求斯卢比（1620 万美元）和 11.61 亿毛里求斯卢比（2960 万美元）。
通过完全技术效率创造的财政空间，估计分别占 2021-2022 年和 2022-2023 年财政年度 GGHE 的 8.9%和 9.2%。这将允许在没有任何限制的情况下为国家应对艾滋病毒、疫苗可预防疾病以及建立有弹性的卫生系统提供资金，以减轻 COVID-19 等新兴传染病的影响。
