Productivity of public hospitals in Nepal: a data envelopment analysis

Silwal, Pushkar Raj; Ashton, Toni

doi:10.1136/bmjopen-2016-015327

Cited by 14 publications

(15 citation statements)

References 15 publications

(17 reference statements)

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“…Since this deterioration in TFP is primarily accounted for by technical regress, the solution to realise productivity growth among hospitals in the KSA is technical progress. To achieve such technical progress (innovation), the requirement is investment in more or better machinery, equipment, and structures that will make it possible for hospitals to produce greater output [ 16 , 32 ]. Other studies have found that productivity growth can be achieved by raising physician productivity, which is in turn dependent on the compensation mechanism [ 17 , 36 – 39 ].…”

Section: Discussionmentioning

confidence: 99%

“…The set of outputs generally includes the numbers of inpatient visits, outpatient visits, surgical operations, laboratory investigations, radiology films, and patients; bed turnover rate; bed occupancy rates; and average length of stay [ 7 , 15 ]. Some studies adjusted for the case-mix and complexity of surgical procedures [ 14 , 16 , 17 ].…”

Section: Methodsmentioning

confidence: 99%

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Changes in productivity in healthcare services in the Kingdom of Saudi Arabia

Al-Hanawi

Makuta

2022

Cost Eff Resour Alloc

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Background Amid the rising demand for healthcare services in Saudi Arabia, there is a need to monitor, evaluate, and improve performance in the delivery of these services. In this regard, the aim of this study was to estimate changes in total factor productivity (TFP) in healthcare services across the health system administrative regions in Saudi Arabia from 2006 to 2018. The contributions of changes in efficiency and technology to the observed changes in TFP were further evaluated. Methods The data used for this study were extracted from annual Ministry of Health Statistical Yearbooks for the period of 2006–2018. TFP changes were estimated using the Malmquist Productivity Index, in which technology frontiers were constructed through data envelopment analysis. The changes in TFP were decomposed into changes in technology, changes in pure technical efficiency, and changes in scale efficiency following the Färe-Grosskopf-Norris-Zhang method. As robustness checks, we used bootstrapping to construct intervals and applied alternative decomposition methods. The changes in TFP and its sources were also compared between public and private hospitals. Results Over the period from 2006 to 2018, TFP for healthcare services has decreased on average by 5.6% per year solely on account of a technical regress. Public hospitals registered a higher deterioration in productivity (6.0% per year) than private hospitals (4.8% per year). Conclusion Using the available resources, there is potential for realising gains in productivity of healthcare services by addressing existing technological challenges. Since the decline in TFP is entirely a problem of technical regress, the primary solution should focus on strategies for achieving technical progress (innovation) through investment in more or better machinery, equipment, and structures for healthcare service provision.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Changes in productivity in healthcare services in the Kingdom of Saudi Arabia

Al-Hanawi

Makuta

2022

Cost Eff Resour Alloc

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“…Specifically, the temporal changes in technology, in terms of the operational management of the respective inputs and outputs, provide an opportunity for DMUs to optimise their efficiency. In Nepal, Silwal and Ashton [76] notes the potential for hospitals to increase their outputs given the additional resources through the years. While in Greece, Polyzos [77] observed that middle-sized hospitals were able to achieve 100% technical efficiency in the span of 2009–2011 as a result of technological changes (i.e.…”

Section: Discussionmentioning

confidence: 99%

Assessing frontline HIV service provider efficiency using data envelopment analysis: a case study of Philippine social hygiene clinics (SHCs)

Seposo

Okubo²,

Kondo

2019

BMC Health Serv Res

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Background Globally, local and frontline HIV service delivery units have been deployed to halt the HIV epidemic. However, with the limited resources, there is a need to understand how these units can deliver their optimum outputs/outcomes efficiently given the inputs. This study aims to determine the efficiency of the social hygiene clinics (SHC) in the Philippines as well as to determine the association of the meta-predictor to the efficiencies. Methods In determining efficiency, we used the variables from two data sources namely the 2012 Philippine HIV Costing study and 2011 Integrated HIV Behavioral and Serologic Surveillance, as inputs and outputs, respectively. Various data management protocols and initial assumptions in data matching, imputation and variable selection, were used to create the final dataset with 9 SHCs. We used data envelopment analysis (DEA) to analyse the efficiency, while variations in efficiencies were analysed using Tobit regression with area-specific meta-predictors. Results There were potentially inefficient use of limited resources among sampled SHC in both aggregate and key populations. Tobit regression results indicated that income was positively associated with efficiency, while HIV prevalence was negatively associated with the efficiency variations among the SHCs. Conclusions We were able to determine the inefficiently performing SHCs in the Philippines. Though currently inefficient, these SHCs may adjust their inputs and outputs to become efficient in the future. While there were indications of income and HIV prevalence to be associated with the efficiency variations, the results of this case study may only be limited in generalisability, thus further studies are warranted. Electronic supplementary material The online version of this article (10.1186/s12913-019-4163-5) contains supplementary material, which is available to authorized users.

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“…While maternal and child mortality indicators have seen steady improvements over the years [ 24 ], several health challenges persist in Nepal. For instance, hospital care is only free for people in verified poverty situations and other vulnerable groups [ 25 , 26 ], leaving a substantial share of the population paying out-of-pocket for health care. On Saturday, 25 April 2015, a high-magnitude earthquake Nepal, followed by many aftershocks, a major one on May 12 th .…”

Section: Methodsmentioning

confidence: 99%

“Recovering, not recovered” Hospital disaster resilience: a case-study from the 2015 earthquake in Nepal

Almeida

2022

Global Health Action

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Background Disasters are an increasing threat to human health, but we know little about their impact on health services, particularly in low and middle-income settings. ‘Resilient hospitals’ have been increasingly recognized as a cornerstone of disaster management. While various frameworks of hospital resilience exist, they emerged from pre-disaster considerations, and do not incorporate evidence from post-disaster settings. Objective This dissertation investigated the impact of a large-scale sudden onset disaster in a tertiary hospital in Nepal, and explored its resilience mechanisms. Methodology This consists of an in-depth case-study combining quantitative data from routinely generated hospital records and qualitative data from semi-structured interviews with hospital staff. We used both advanced statistical methods and mixed inductive and deductive coding to analyze the data. Results Most of the admitted earthquake victims required surgical interventions and long hospitalizations, considerably straining the hospital. For six weeks, the average number of daily admissions decreased. During this period, the share of injury-related admissions was particularly high, and such admissions were particularly long compared to the baseline. Admissions due to other conditions relatively decreased and were shorter. We found that the hospital’s resilience was highly dependent on emerging adaptations, in addition to the pre-existing disaster plan. Individual resilience of staff also played a major role, and was influenced by senses of safety, meaningfulness, and belonging. Conclusion Hospitals should prepare resources and plan for their known disaster risks, but should also allow for a certain flexibility to innovative adaptions to emerging, unforeseen challenges. Challenges faced by hospital workers should not be undermined, and addressing them will increase hospital resilience.

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Productivity of public hospitals in Nepal: a data envelopment analysis

Cited by 14 publications

References 15 publications

Changes in productivity in healthcare services in the Kingdom of Saudi Arabia

Changes in productivity in healthcare services in the Kingdom of Saudi Arabia

Assessing frontline HIV service provider efficiency using data envelopment analysis: a case study of Philippine social hygiene clinics (SHCs)

“Recovering, not recovered” Hospital disaster resilience: a case-study from the 2015 earthquake in Nepal

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