Montpellier Recherche en Economie, Université de Montpellier and Fellow, Ferdi, Fondation pour les Etudes et Recherches sur le Développement International, Avenue Raymond Dugrand, Montpellier 34960 Cedex 2, France.
Centre d'Etudes et de Recherches sur le Développement International (CERDI) and Fondation pour les Etudes et Recherches sur le Développement International (FERDI), Université Clermont Auvergne, 63 Boulevard François-Mitterrand, Clermont-Ferrand 63009, France.
Health Policy Plan. 2022 Aug 3;37(7):822-835. doi: 10.1093/heapol/czac042.
Mongolia is facing serious challenges in the health sector and the macro-economic sphere that have important implications for health financing and the completion of universal health coverage. In this context, improving the efficiency of primary health care facilities is a critical issue. We study the efficiency of Soum Health Centres (SHCs) that provide primary care in rural Mongolia. Based on activity and resources data collected for all SHCs of Mongolia in 2017 and 2018 we estimate bias-adjusted efficiency scores. A double bootstrap truncated regression procedure is then used to study the factors associated with SHCs' efficiency. On average, SHCs could potentially engage in the same activity while reducing overall resource use by ∼23%. A comparatively higher population density and dependency ratio in the districts where they are located tend to favour SHCs' efficiency. Conversely, the higher the poverty rate in the soum, the lower the efficiency. We find a positive association between SHCs' efficiency and the proportion of doctors in the health workforce. The human resources allocation process and the capitation formula currently used to pay SHCs should be adjusted based on the size and socioeconomic/demographic characteristics of the population living in the catchment area of SHCs.
蒙古在卫生部门和宏观经济领域面临严峻挑战，这对卫生筹资和实现全民健康覆盖有重要影响。在这种情况下，提高初级保健设施的效率是一个关键问题。我们研究了在蒙古农村提供初级保健的苏木卫生中心（SHC）的效率。基于 2017 年和 2018 年为蒙古所有 SHC 收集的活动和资源数据，我们估计了经过偏差调整的效率得分。然后，使用双 bootstrap 截断回归程序研究与 SHC 效率相关的因素。平均而言，SHC 可以在减少整体资源使用量的同时，潜在地开展相同的活动，减少约 23%。在它们所在的地区，人口密度和抚养比较高，往往有利于 SHC 的效率。相反，苏木的贫困率越高，效率越低。我们发现 SHC 的效率与卫生劳动力中医生的比例之间存在正相关关系。应该根据 SHC 服务区域内的人口规模和社会经济/人口特征，调整 SHC 的人力资源配置过程和人头费公式。
