Department of Economics, Central University of Kashmir, India 191201.
School of Social Sciences and languages, Vellore Institute of Technology, Vellore 632014, India.
Eval Program Plann. 2024 Oct;106:102472. doi: 10.1016/j.evalprogplan.2024.102472. Epub 2024 Aug 9.
Nearly 400 million Indians (30 % of the total population) lack any financial protection for health which leads to very high out of pocket expenditure. In India more than 90 million people spend 10-25 % of household expenses on healthcare. This is a serious threat to Sustainable Development Goal 3, which aims at providing universal health coverage along with protection from catastrophic spending on health.
The aim of this paper is to estimate the efficiency and determinants of public health in India at subnational level.
To estimate the efficiency of public healthcare, input oriented bias corrected DEA model has been used. In this model life expectancy at birth and infant survival rate have been treated as outputs. Public health spending and per capita income are treated as inputs. In the second stage Tobit regression is used to analyse the determinants of efficiency.
The mean bias corrected efficiency score across Indian states is 0.60, implying that on average there is a 40 % inefficiency in public healthcare in India. Maharashtra and Mizoram are the most and least efficient states with efficiency score of 0.921 and 0.218, respectively. Fourteen states have efficiency scores less than 0.60, two states have efficiency score of 0.60 and 15 states have the efficiency score greater than 0.60. Socio economic factors outweigh the medical factors in determining the public healthcare efficiency in India.
There are 40 % inefficiencies in public health in India implying significant wastages in public health. By improving public health efficiency, there would be savings of 48 % in terms of government expenditure on health per capita. It will also improve infant survival rate by 27.19 % and life expectancy by 20.65 %.
近 4 亿印度人（占总人口的 30%）没有任何健康金融保障，导致医疗支出过高。在印度，超过 9000 万人将家庭支出的 10-25%用于医疗保健。这对实现可持续发展目标 3 构成了严重威胁，该目标旨在提供全民健康覆盖，并防止因医疗支出而陷入灾难性贫困。
本文旨在评估印度各邦的公共卫生效率及其决定因素。
采用投入导向的有偏 DEA 模型来评估公共卫生的效率。在这个模型中，出生时的预期寿命和婴儿存活率被视为产出，公共卫生支出和人均收入被视为投入。在第二阶段，采用 Tobit 回归来分析效率的决定因素。
印度各邦的平均有偏校正效率得分是 0.60，这意味着印度公共卫生系统的平均效率损失了 40%。马哈拉施特拉邦和米佐拉姆邦是效率最高和最低的邦，效率得分分别为 0.921 和 0.218。有 14 个邦的效率得分低于 0.60，有 2 个邦的效率得分是 0.60，有 15 个邦的效率得分高于 0.60。社会经济因素在决定印度公共卫生效率方面比医疗因素更为重要。
印度公共卫生存在 40%的效率损失，这意味着公共卫生领域存在大量浪费。通过提高公共卫生效率，印度政府在人均卫生支出方面将节省 48%。这还将使婴儿存活率提高 27.19%，预期寿命延长 20.65%。
