Assessing health facility performance in Indonesia using the Pabón‐Lasso model and unit cost analysis of health services

Abstract

Total health care costs have dramatically increased in Indonesia, and health facilities consume the largest share of health resources. This study aims to provide a better understanding of the characteristics of the best-performing health facilities. We use 4 national Indonesian datasets for 2011 and analysed 200 hospitals and 95 health centres. We first apply the Pabón-Lasso model to assess the relative performance of health facilities in terms of bed occupancy rate and the number of admissions per bed; the model gathers together health facilities into 4 sectors representing different levels of productivity. We then use a step-down costing method to estimate the cost per outpatient visit, inpatient, and bed days in hospitals and health centres. We combined both ratio analysis and applied bivariate and multivariate analyses to identify the predictors of the best-performing health facility; 37% of hospitals and 33% of health centres were located in the high-performing sector of the Pabón-Lasso model. The wide variation in unit costs across health facilities presented a basis for benchmarking and identifying relatively efficient units. Combining the unit cost analysis and Pabón-Lasso model, we find that health facility performance is affected by both internal (size and capacity, financing, type of patients, ownership, accreditation status, and staff availability) and external factors (economic status, population education level, location, and population density). Our study demonstrates that it is feasible to identify the best-performing health facilities and provides information about how to improve efficiency using simplistic methods.

Costing for universal health coverage: insight into essential economic data from three provinces in Cambodia

“…Similar to our findings, drugs and supplies constituted the highest proportion of costs of a 200-bed hospital in Myanmar, while in Bangladesh it constituted more than half of the unit costs for service delivery [5, 52]. On the other hand, at Indonesian hospitals and Indian primary and tertiary health facilities, personnel constituted the largest cost component [3, 39, 53]. These differences may be due to the costs of drugs and materials and staff remuneration being below the market rate for the Cambodian public sector [54].…”

“…Conversely, this decision may improve the structural quality of hospitals and utilisation of services, as observed in India [43]. While noting that these types of facilities are considered efficient when bed occupancy rates are more than 80% [3, 39], the low rates observed at HCBs and the CPA1 hospital in this study suggest the need for caution in expanding or maintaining these types of health facilities.…”

“…In that respect, judging efficiencies on the basis of average costs per service or contact alone may not be equitable, as poor people tend to reside in remote areas which are sparsely populated and where it is challenging to post and retain staff members [37, 38]. Hafidz et al [39] found in Indonesia that the most efficient health facilities were located in areas with easy access and high population density. Thus, there is a need to consider such contextual factors.…”

Determinants of Technical Efficiency in Public Hospitals: The Case of Saudi Arabia

“…Further, many literatures argued that poorer people appeared to be more frequently in illness and needed more healthcare services [36]. The findings could be attributable to the fact that public facilities were more utilized by deprived people than the wealthier ones, which facilitated service production compared to the hospitals with a lower proportion of poor people [37,38].…”

Evaluation of performance at Palestinian public hospitals using Pabón Lasso model

“…This was consistent with results of three studies have been conducted in Iran, one in Tunisia, and one in Indonesia. 22,26,[37][38][39] In 2011, Sajadi and her colleagues have also revealed that the percentage of efficient hospitals in Iran in 2006 and 2007 was 45% and 43%, respectively, meanwhile Ajlouni and other researchers found that the efficiently performing hospitals in Jordan were 46.6%, and 60% for the same years. 40,41 Nevertheless, some other hospitals exhibited a lower performance when compared with Gazan hospitals in this study as only 15% and 24% were in zone 3.…”