Background District hospitals (DHs) provide secondary level of healthcare to a wide range of population in Bangladesh. Efficient utilization of resources in these secondary hospitals is essential for delivering health services at a lower cost. Therefore, we aimed to estimate the technical efficiency of the DHs in Bangladesh. Methods We used input-oriented data envelopment analysis method to estimate the variable returns to scale (VRS) and constant returns to scale (CRS) technical efficiency of the DHs using data from Local Health Bulletin, 2015. In this model, we considered workforce as well as number of inpatient beds as input variables and number of inpatient, outpatient, and maternal services provided by the DHs as output variables. A Tobit regression model was applied for assessing the association of institutional and environmental characteristics with the technical efficiency scores. Results The average scale, VRS, and CRS technical efficiency of the DHs were estimated to 85%, 92%, and 79% respectively. Population size, poverty headcount, bed occupancy ratio, administrative divisions were significantly associated with the technical efficiency of the DHs. The mean VRS and CRS technical efficiency demonstrated that the DHs, on an average, could reduce their input mix by 8% and 21% respectively while maintaining the same level of output. Conclusion Since the average technical efficiency of the DHs was 79%, there is little scope for overall improvements in these facilities by adjusting inputs. Therefore, we recommend to invest further in the DHs for improvement of services. The Ministry of Health and Family Welfare (MoHFW) should improve the efficiency in resource allocation by setting an input-mix formula for DHs considering health and socio-economic indicators (e.g., population density, poverty, bed occupancy ratio). The formula can be designed by learning from the input mix in the more efficient DHs. The MoHFW should conduct this kind of benchmarking study regularly to assess the efficiency level of health facilities which may contribute to reduce the wastage of resources and consequently to provide more affordable and accessible public hospital care.
This paper examines the introduction of a prioritized list of fifty-six health conditions in Chile, for which access to treatment is guaranteed. This is an important health reform issue, and the discussion of Chile's rich and complex approach may benefit other countries. Conditions on the list were selected using multiple criteria: burden of disease, inequality, high costs, social preferences, rule of rescue, and cost-effectiveness. The dominant criteria were high burden of disease and social preferences. Cost-effectiveness was introduced after the fact to identify effective treatments at a cost that the country could afford. [Health Affairs 27, no. 3 (2008): 782-792; 10.1377/hlthaff.27.3.782] C h i le 's h e a lt h s ys t e m i s a t wo -t i e r s ys t e m . One tier is composed of public health insurance (FONASA), covering about 69 percent of the population; the other is private insurance plans, called ISAPREs, covering 17 percent of the population. The remaining population segment is affiliated with other public agencies (such as Military Health Services) or is without coverage. The Ministry of Health is the entity responsible for the design of policies and programs; it also provides public health, secondary, and tertiary services. Most primary health care is provided through the municipal system. The ISAPREs provide outpatient and inpatient services through their own clinics and hospitals or by contracting with public or private facilities. Regulation of both the private and public sectors is undertaken by the superintendent of health. 1Chile scores favorably on health indicators. Life expectancy at birth is eighty years for women and seventy-three years for men, and the infant mortality rate is 8.6 per 1,000 live births. This success largely stems from good socioeconomic living conditions and strong efforts in preventive care. The epidemiological profile has changed significantly, evolving from communicable diseases to an increase in noncommunicable and chronic diseases. This transition is associated with the aging of the population, urbanization, deterioration of the environment, and lifestyle factors.
Global health care payment systems reflect enormous differences in provider characteristics, health systems, and development levels. Risk adjustment is used for payment and performance measurement to correct for demand heterogeneity and incentives for plans and providers to prefer healthy, low-cost patients, and to provide quality care. This article reviews the practical, theoretical, and statistical aspects of risk adjustment models, which use socio-demographic variables and more recently morbidity and pharmaceuticals, to predict outcomes. Diverse uses of risk adjustment include geographical budget allocations, health plan premium equalization, pay for performance, primary care provider payment, integrated provider networks, and rewards for good doctor performance. Settings in more than 30 countries are examined, which include high-, middle-and low-income countries, competitive health plans and single payer systems, integrated provider networks, clinics, and solo practice primary care doctors. Recent concepts in health economics are highlighted that hold potential for improving efficiency and equitable patient access to health care.
IntroductionMaternal delivery is the costliest event during pregnancy, especially if a complicated delivery occurs that requires emergency hospital services. A health financing scheme or program that covers comprehensive maternal services, including specialized hospital services in the benefits health package, enhances maternal survival and improves financial risk protection.ObjectivesThe objective of this study is to identify factors that enable the inclusion of comprehensive maternal services in the benefits package of emerging health financing schemes in low and middle-income countries across selected world regions. Comprehensive care is presumed if, in addition to normal delivery, primary health care, and secondary or tertiary hospital care are included.MethodsMultilevel regression analysis is performed on 220 health financing schemes and programs initiated during the period 1990–2014, in 40 countries in Sub-Saharan Africa, Asia, and Latin America.FindingsAbout two-thirds of emerging health financing schemes explicitly include maternal care in the benefits package, and less-than-half cover comprehensive maternal services. Provision of any type of maternal services and comprehensive services is significantly associated with the presence of donors/philanthropies as funders, and beneficiaries possessing an ID card that links them to entitled services. Other enabling factors are prepayment and risk pooling. However, private and community insurances are negatively associated with covering comprehensive maternal services, because they are subject to market failures, such as adverse and risk selection.ConclusionsEmerging health financing schemes in low and upper-middle-income countries lag in coverage of maternal care. Advancing financial protection of these services in the health package needs policy attention, including government oversight and mandatory regulations. The enabling factors identified can enrich the ongoing discourse on Universal Health Coverage.
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