Social Protection and Health Division, Inter-American Development Bank, Washington, DC, United States of America.
PLoS One. 2024 Sep 5;19(9):e0309772. doi: 10.1371/journal.pone.0309772. eCollection 2024.
We estimate the efficiency of health spending in 145 middle and high-income and the potential gains from improving efficiency for a range of health system outputs using Robust Data Envelopment Analysis for 2010-2014 and 2015-2019 and examine associations with health system characteristics. Focusing on Latin American and Caribbean countries, we find large variability in efficiency and overall substantial potential gains in the later period, despite improvements over time. Our results suggest that, for example, improving spending efficiency could increase life expectancy at birth by 3.5 years (4.6%), or slightly more than the 3.4-year improvement in average life expectancy in the region between 2000 and 2015. Similarly, improved efficiency could reduce neonatal mortality by 6.7 per 1,000 live births (62%), increase service coverage by 6 percentage points (8.7%), and reduce the rich-poor gap in birth attendance by 10 percentage points (12.6%). We find that governance quality is positively associated with efficiency. Overall, the findings indicate an urgent need to improve efficiency in the region and substantial scope for realizing the potential gains of such improvements.
我们使用稳健数据包络分析（Robust Data Envelopment Analysis）对 2010-2014 年和 2015-2019 年期间的 145 个中高收入国家和地区的卫生支出效率进行了评估，并对一系列卫生系统产出的效率提升潜力进行了评估，同时还考察了与卫生系统特征之间的关联。重点关注拉丁美洲和加勒比地区，我们发现，尽管随着时间的推移效率有所提高，但效率的差异很大，后期仍有大量的整体潜在收益。我们的研究结果表明，例如，提高支出效率可以使出生时的预期寿命延长 3.5 年（4.6%），比该地区 2000 年至 2015 年期间平均预期寿命的 3.4 年的增长幅度略高。同样，提高效率可以使每千例活产的新生儿死亡率降低 6.7（62%），服务覆盖率提高 6 个百分点（8.7%），并使贫富之间的分娩护理差距缩小 10 个百分点（12.6%）。我们发现，治理质量与效率呈正相关。总体而言，研究结果表明，该地区迫切需要提高效率，并且有很大的潜力实现这种改进的潜在收益。
