Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Phnom Penh, Cambodia.
Department of General Business Administration and Health Care Management, University of Greifswald, Greifswald, Germany.
BMC Health Serv Res. 2023 Aug 28;23(1):912. doi: 10.1186/s12913-023-09570-w.
Cambodia is undergoing a series of reforms with the objective of reaching universal health coverage. Information on the causes of inefficiencies in health facilities could pave the way for a better utilization of limited resources available to ensure the best possible health care for the population.
The purpose of this study is to evaluate the technical efficiency of health centers and the determinants for inefficiencies.
This cross-sectional study used secondary data from a costing study on 43 health centers in six Cambodian provinces (2016-2017). Firstly, the Data Envelopment Analysis method with output-orientation was applied to calculate efficiency scores by selecting multiple input and output variables. Secondly, a tobit regression was performed to analyze potential explanatory variables that could influence the inefficiency of health centers.
Study findings showed that 18 (43%) health centers were operating inefficiently with reference to the variable returns to scale efficiency frontier and had a mean pure technical efficiency score of 0.87. Overall, 22 (51%) revealed deficits in producing outputs at an optimal scale size. Distance to the next referral hospital, size and quality performance of the health centers were significantly correlated with health center inefficiencies.
Differences in efficiency exist among health centers in Cambodia. Inefficient health centers can improve their technical efficiency by increasing the utilization and quality of health services, even if it involves higher costs. Technical efficiency should be continuously monitored to observe changes in health center performance over time.
柬埔寨正在进行一系列改革，目标是实现全民健康覆盖。了解卫生设施效率低下的原因，可以为更好地利用现有有限资源铺平道路，以确保为民众提供尽可能好的医疗保健。
本研究旨在评估卫生中心的技术效率及其效率低下的决定因素。
本横断面研究使用了来自柬埔寨六个省的 43 家卫生中心成本效益研究的二手数据（2016-2017 年）。首先，采用输出导向的数据包络分析（DEA）方法，通过选择多个投入和产出变量来计算效率得分。其次，采用 tobit 回归分析潜在的解释变量，这些变量可能会影响卫生中心的效率低下。
研究结果表明，18 家（43%）卫生中心的运营效率低于变量规模报酬效率前沿，其纯技术效率平均得分为 0.87。总体而言，22 家（51%）卫生中心在以最佳规模生产产出方面存在不足。距下一家转诊医院的距离、卫生中心的规模和质量绩效与卫生中心的效率低下显著相关。
柬埔寨的卫生中心之间存在效率差异。效率低下的卫生中心可以通过提高卫生服务的利用率和质量来提高其技术效率，即使这涉及更高的成本。应持续监测技术效率，以观察卫生中心绩效随时间的变化。
