Liu Yaqing, Gong Liwen, Niu Haoran, Jiang Feng, Du Sixian, Jiang Yiyun
School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Major Disciplinary Platform under Double First-Class Initiative for Liberal Art, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Cost Eff Resour Alloc. 2024 Nov 26;22(1):86. doi: 10.1186/s12962-024-00588-3.
Equity and efficiency are two fundamental principles for the sound development of health systems, as advocated by the World Health Organization (WHO). Despite the notable progress made by the Association of Southeast Asian Nations (ASEAN) in advancing their health systems, gaps persist in achieving global health goals. This paper examines the efficiency of health system stages and the fairness of health resource distribution in ASEAN countries, analyzes the underlying causes of the existing gaps, and suggests potential solutions to bridge them.
Data spanning 2011 to 2019, sourced from the WHO Global Health Observatory and the World Bank Database, form the foundation of this study. This study employs an enhanced two-stage data envelopment analysis (DEA) to assess the efficiency of health system stages in ASEAN countries. Equity in health resource distribution is evaluated using health resource agglomeration degree and concentration curves across demographic, geographic, and economic aspects. Furthermore, the Entropy-Weighted TOPSIS method is utilized to integrate equity across these dimensions, measuring the overall fairness in health resource allocation across different countries. Finally, rankings of health system fairness and efficiency are compared to assess the overall development level of health systems.
The overall efficiency of the ASEAN health systems from 2011 to 2019 averaged 0.231, with an upward trend in the first stage efficiency at 0.559 and a downward trend in the second stage at 0.502. The health resource agglomeration degree indicated that Singapore, Brunei, and Malaysia had HRAD and HRPD values significantly greater than 1, and Cambodia, Myanmar, and Laos predominantly had indices significantly less than 1. The concentration curve for hospital beds was the closest to the line of absolute equity. During the study period, the health resource concentration curve increasingly approached absolute equity, shifting from above to below the concentration curve. Singapore, Brunei, and Malaysia consistently remained in the first quadrant of the quadrant plot, and Myanmar and Cambodia were consistently in the third quadrant.
ASEAN countries face two key challenges in their healthcare systems: first, while many nations such as Indonesia, Thailand, and Vietnam have improved resource allocation efficiency, this hasn't yet translated into better health services. To address this, establishing national health sector steering committees, focusing on workforce training and retention, and implementing centralized monitoring systems are crucial. Second, there is a growing disparity in healthcare development across ASEAN. Promoting balanced resource distribution and leveraging ASEAN's economic integration for regional collaboration will help bridge these gaps and foster more equitable healthcare systems.
公平与效率是世界卫生组织（WHO）倡导的卫生系统健康发展的两项基本原则。尽管东南亚国家联盟（ASEAN）在推进其卫生系统方面取得了显著进展，但在实现全球卫生目标方面仍存在差距。本文研究了东盟国家卫生系统各阶段的效率以及卫生资源分配的公平性，分析了现有差距的潜在原因，并提出了缩小差距的潜在解决方案。
本研究的数据来源于2011年至2019年的WHO全球卫生观测站和世界银行数据库。本研究采用增强的两阶段数据包络分析（DEA）来评估东盟国家卫生系统各阶段的效率。使用卫生资源集聚程度以及跨人口、地理和经济方面的集中度曲线来评估卫生资源分配的公平性。此外，运用熵权TOPSIS方法整合这些维度的公平性，衡量不同国家卫生资源分配的总体公平性。最后，比较卫生系统公平性和效率的排名，以评估卫生系统的总体发展水平。
2011年至2019年东盟卫生系统的总体效率平均为0.231，第一阶段效率呈上升趋势，为0.559，第二阶段呈下降趋势，为0.502。卫生资源集聚程度表明，新加坡、文莱和马来西亚的卫生资源集聚度（HRAD）和卫生资源人口密度（HRPD）值显著大于1，而柬埔寨、缅甸和老挝的指标主要显著小于1。医院床位的集中度曲线最接近绝对公平线。在研究期间，卫生资源集中度曲线越来越接近绝对公平，从集中度曲线上方转移到下方。新加坡、文莱和马来西亚始终位于象限图的第一象限，而缅甸和柬埔寨始终位于第三象限。
东盟国家的医疗保健系统面临两个关键挑战：第一，虽然印度尼西亚、泰国和越南等许多国家提高了资源分配效率，但这尚未转化为更好的卫生服务。要解决这一问题，建立国家卫生部门指导委员会、专注于劳动力培训和留用以及实施集中监测系统至关重要。第二，东盟各国医疗保健发展的差距日益扩大。促进资源均衡分配并利用东盟的经济一体化进行区域合作，将有助于缩小这些差距，并促进更公平的医疗保健系统。
