scholarly journals Analyzing the technical efficiency of health systems in Asian countries: What Myanmar can learn from Bangladesh and Sri Lanka.

2020 ◽  
Author(s):  
Zin Mar Win ◽  
Curt Löfgren
Keyword(s):  
Health Care ◽  
Sri Lanka ◽  
Life Expectancy ◽  
Health Outcomes ◽  
Health System ◽  
Technical Efficiency ◽  
Health Systems ◽  
Infant Mortality Rate ◽  
Asian Countries ◽  
Middle Income

Abstract Background: Advancements in medicine leads, among other things, to increasing life expectancy and quality of life. However, at the same time, health care costs are increasing, and this may not be sustainable in the future. Governments and health care organizations need to implement efficiency measures in order to maximize health outcomes within available resources. This study aims to compare the technical efficiency of health systems in middle-income Asian countries, and to identify “efficient peers” for each “inefficient country”: in particular for Myanmar. Methods: A data envelopment analysis (DEA) variable returns to scale output-oriented model was used to evaluate technical efficiency in middle-income Asian countries. The input variables were current health expenditure per capita, the density of doctors, and the density of nurses and midwifery personnel. The output variables were health adjusted life expectancy (HALE) and the infant mortality rate (IMR). Myanmar may learn how to improve efficiency of its health care system through studying its efficient peers from DEA results. A review of relevant English language literature was used as a basis for informing a comparative analysis of the health systems of Myanmar and its efficient peers: Bangladesh and Sri Lanka.Results: Among the twenty-eight middle-income Asian countries studied, 39.3% of countries were technically efficient. Myanmar is one of the inefficient countries, and it should look at the health systems of its efficient peers, Bangladesh and Sri Lanka, to make its health system technically more efficient.Conclusions: The results of this study suggested that countries with inefficient health systems can improve their health outcomes without increasing their health care resources. As DEA measures efficiency only, future studies should take into account equity to assess comprehensive health system performance.

Analyzing the technical efficiency of health systems in Asian countries: What Myanmar can learn from Bangladesh and Sri Lanka.

2020 ◽  
Author(s):  
Zin Mar Win ◽  
Curt Löfgren
Keyword(s):  
Health Care ◽  
Sri Lanka ◽  
Life Expectancy ◽  
Health Outcomes ◽  
Health System ◽  
Technical Efficiency ◽  
Health Systems ◽  
Infant Mortality Rate ◽  
Asian Countries ◽  
Middle Income

Abstract Background: Advancements in medicine leads, among other things, to increasing life expectancy and quality of life. However, at the same time, health care costs are increasing, and this may not be sustainable in the future. Governments and health care organizations need to implement efficiency measures in order to maximize health outcomes within available resources. This study aims to compare the technical efficiency of health systems in middle-income Asian countries, and to identify “efficient peers” for each “inefficient country”: in particular for Myanmar. Methods: A data envelopment analysis (DEA) variable returns to scale output-oriented model was used to evaluate technical efficiency in middle-income Asian countries. The input variables were current health expenditure per capita, the density of doctors, and the density of nurses and midwifery personnel. The output variables were health adjusted life expectancy (HALE) and the infant mortality rate (IMR). Myanmar may learn how to improve efficiency of its health care system through studying its efficient peers from DEA results. A review of relevant English language literature was used as a basis for informing a comparative analysis of the health systems of Myanmar and its efficient peers: Bangladesh and Sri Lanka.Results: Among the twenty-eight middle-income Asian countries studied, 39.3% of countries were technically efficient. Myanmar is one of the inefficient countries, and it should look at the health systems of its efficient peers, Bangladesh and Sri Lanka, to make its health system technically more efficient.Conclusions: The results of this study suggested that countries with inefficient health systems can improve their health outcomes without increasing their health care resources. As DEA measures efficiency only, future studies should take into account equity to assess comprehensive health system performance.

scholarly journals Analysing the performance of health systems in Asian countries: What Myanmar can learn from Bangladesh and Vietnam

2020 ◽  
Author(s):  
Curt Löfgren ◽  
Zin Mar Win
Keyword(s):  
Health Care ◽  
Life Expectancy ◽  
Health Outcomes ◽  
Health System ◽  
Technical Efficiency ◽  
Health Systems ◽  
English Language ◽  
Returns To Scale ◽  
Infant Mortality Rate ◽  
Asian Countries

Abstract Background Advancements in medicine leads, among other things, to increasing life expectancy. However, at the same time, health care costs are increasing, and this may not be sustainable in the future. Governments and health care organizations need to implement efficiency measures in order to maximize health outcomes within available resources. This study aims to compare the technical efficiency of health systems in Asian countries, and to identify “efficient peers” for each “inefficient country”: in particular, for Myanmar. Methods A DEA variable returns to scale output-oriented model was used to evaluate technical efficiency in thirteen Asian countries. The input variables were current health expenditure per capita, the density of doctors, and the density of nurses and midwifery personnel. Two output variables, health adjusted life expectancy (HALE) and the infant mortality rate were (IMR) analysed separately. Myanmar may learn how to improve efficiency of its health care system through studying its efficient peers from DEA results. A review of relevant English language literature was used as a basis for informing a comparative analysis of the health systems of Myanmar and its efficient peers, Bangladesh and Vietnam. Results Among the thirteen Asian countries studied, 38.5% and 53.8% of countries were technically efficient when HALE and IMR were used as the measured output respectively. More countries were efficient at reducing IMR than increasing HALE. Myanmar is one of the most inefficient countries, and it should look at the health systems of its efficient peers, Bangladesh and Vietnam, to make its health system technically more efficient. Conclusions The results of this study suggested that countries with inefficient health systems can improve their health outcomes without increasing their health care resources. As DEA measures efficiency only, future studies should take into account equity to assess comprehensive health system performance.

scholarly journals Measuring the efficiency of health systems in Asia: a data envelopment analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e022155 ◽  
Author(s):  
Sayem Ahmed ◽  
Md Zahid Hasan ◽  
Mary MacLennan ◽  
Farzana Dorin ◽  
Mohammad Wahid Ahmed ◽  
...  
Keyword(s):  
Data Envelopment Analysis ◽  
Health System ◽  
Technical Efficiency ◽  
Health Systems ◽  
Income Group ◽  
Data Envelopment ◽  
System Efficiency ◽  
Asian Countries ◽  
Middle Income ◽  
Health System Efficiency

ObjectiveThis study aims to estimate the technical efficiency of health systems in Asia.SettingsThe study was conducted in Asian countries.MethodsWe applied an output-oriented data envelopment analysis (DEA) approach to estimate the technical efficiency of the health systems in Asian countries. The DEA model used per-capita health expenditure (all healthcare resources as a proxy) as input variable and cross-country comparable health outcome indicators (eg, healthy life expectancy at birth and infant mortality per 1000 live births) as output variables. Censored Tobit regression and smoothed bootstrap models were used to observe the associated factors with the efficiency scores. A sensitivity analysis was performed to assess the consistency of these efficiency scores.ResultsThe main findings of this paper demonstrate that about 91.3% (42 of 46 countries) of the studied Asian countries were inefficient with respect to using healthcare system resources. Most of the efficient countries belonged to the high-income group (Cyprus, Japan, and Singapore) and only one country belonged to the lower middle-income group (Bangladesh). Through improving health system efficiency, the studied high-income, upper middle-income, low-income and lower middle-income countries can improve health system outcomes by 6.6%, 8.6% and 8.7%, respectively, using the existing level of resources. Population density, bed density, and primary education completion rate significantly influenced the efficiency score.ConclusionThe results of this analysis showed inefficiency of the health systems in most of the Asian countries and imply that many countries may improve their health system efficiency using the current level of resources. The identified inefficient countries could pay attention to benchmarking their health systems within their income group or other within similar types of health systems.

scholarly journals The impact of economic sanctions on health and health systems in low- and middle-income countries

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Suhrcke ◽  
M Pinna Pintor ◽  
C Hamelmann
Keyword(s):  
Health Outcomes ◽  
Health System ◽  
Health Systems ◽  
Grey Literature ◽  
Economic Sanctions ◽  
Political Crisis ◽  
Middle Income ◽  
Financial Flows ◽  
Adverse Health ◽  
The Impact

Abstract Background Economic sanctions, understood as measures taken by one state or a group of states to coerce another into a desired conduct (eg by restricting trade and financial flows) do not primarily seek to adversely affect the health or health system of the target country's population. Yet, there may be indirect or unintended health and health system consequences that ought to be borne in mind when assessing the full set of effects of sanctions. We take stock of the evidence to date in terms of whether - and if so, how - economic sanctions impact health and health systems in LMICs. Methods We undertook a structured literature review (using MEDLINE and Google Scholar), covering the peer-reviewed and grey literature published from 1970-2019, with a specific focus on quantitative assessments. Results Most studies (23/27) that met our inclusion criteria focus on the relationship between sanctions and health outcomes, ranging from infant or child mortality as the most frequent case over viral hepatitis to diabetes and HIV, among others. Fewer studies (9/27) examined health system related indicators, either as a sole focus or jointly with health outcomes. A minority of studies explicitly addressed some of the methodological challenges, incl. control for relevant confounders and the endogeneity of sanctions. Taking the results at face value, the evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. Conclusions Quantitatively assessing the impact of economic sanctions on health or health systems is a challenging task, not least as it is persistently difficult to disentangle the effect of sanctions from many other, potentially major factors at work that matter for health (as, for instance, war). In addition, in times of severe economic and political crisis (which often coincide with sanctions), the collection of accurate and comprehensive data that could allow appropriate measurement is typically not a priority. Key messages The existing evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. There is preciously little good quality evidence on the health (system) impact of economic sanctions.

scholarly journals Mental health system governance in Nigeria: challenges, opportunities and strategies for improvement

2016 ◽  
Vol 3 ◽  
Author(s):  
J. Abdulmalik ◽  
L. Kola ◽  
O. Gureje
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Policy ◽  
Health System ◽  
Health Systems ◽  
Mental Health System ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health System Governance ◽  
Low And Middle Income

IntroductionA health systems approach to understanding efforts for improving health care services is gaining traction globally. A component of this approach focuses on health system governance (HSG), which can make or mar the successful implementation of health care interventions. Very few studies have explored HSG in low- and middle-income countries, including Nigeria. Studies focusing on mental health system governance, are even more of a rarity. This study evaluates the mental HSG of Nigeria with a view to understanding the challenges, opportunities and strategies for strengthening it.MethodologyThis study was conducted as part of the project, Emerging Mental Health Systems in Low and Middle Income Countries (Emerald). A multi-method study design was utilized to evaluate the mental HSG status of Nigeria. A situational analysis of the health policy and legal environment in the country was performed. Subsequently, 30 key informant interviews were conducted at national, state and district levels to explore the country's mental HSG.ResultsThe existing policy, legislative and institutional framework for HSG in Nigeria reveals a complete exclusion of mental health in key health sector documents. The revised mental health policy is however promising. Using the Siddiqi framework categories, we identified pragmatic strategies for mental health system strengthening that include a consideration of existing challenges and opportunities within the system.ConclusionThe identified strategies provide a template for the subsequent activities of the Emerald Programme (and other interventions), towards strengthening the mental health system of Nigeria.

scholarly journals Health Outcomes And The Cost-Quality Trade-Off In Health Care: Empirical Study Of OECD Countries

2011 ◽  
Vol 3 (7) ◽  
Author(s):  
Adora D. Holstein
Keyword(s):  
Health Care ◽  
Infant Mortality ◽  
Life Expectancy ◽  
Health Outcomes ◽  
Health System ◽  
Oecd Countries ◽  
World Health ◽  
Healthy Life Expectancy ◽  
Healthy Life ◽  
Trade Off

This study applies multivariate regression analysis to cross-section data of 30 OECD countries to determine if there is a trade-off between health care cost and the quality of the health system on one hand, and better health outcomes on the other. It also investigates whether a higher quality health system leads to superior health outcomes. The empirical results provide positive answers to the above two questions. Indices of responsiveness, fairness or accessibility, and overall efficiency of the health system developed by the World Health Organization were used in this study to measure health system quality. The rate of infant mortality and a disability-free or healthy life expectancy measure developed by the WHO are used as indicators of health outcomes. The empirical models control for the effects of cross-country differences in literacy level and health-risk or lifestyle. The study finds evidence that the more responsive and accessible the countrys health system is, the longer is the healthy life expectancy of its people. Moreover, the more accessible and efficient the countrys health system is, the lower is the rate of infant mortality.

scholarly journals The Health Systems of Low- and Middle-Income Countries

Public Health ◽  
2020 ◽  
Author(s):  
Anne Mills
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health System ◽  
Political Science ◽  
20Th Century ◽  
Health Systems ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

“Health system” is a term generally considered to be relatively recent. It is defined as all organizations, institutions, and resources that produce actions whose primary purpose is to improve health, whether these be targeted at individuals (such as health-care delivery) or populations (such as public health measures). Health-care and public health institutions have a long history, but the notion of an organized “health system” is a relatively recent development (dating from the mid-20th century). In low- and middle-income countries (LMICs), Western medicine was often introduced by former colonial authorities through the construction of public hospitals, health centers, and training schools, with church authorities also making a major contribution. As in high-income countries, there was a gradual process over the latter half 20th century to construct an organized and coordinated national health system. However, health systems became a key focus of international attention only in the late 1990s, when it became apparent that achieving the health-related Millennium Development Goals (e.g., reduction of child and maternal mortality; control of HIV, TB, and malaria) was threatened less by the availability of technical solutions and more by the ability of health systems to put them into practice. More recently, the Ebola epidemic in West Africa highlighted the critical importance of health systems in ensuring health security. In response to the increased awareness of the role of health systems, significant attention has been paid to defining the health system and its goals, categorizing its elements, assessing problems and testing solutions, and seeking to identify the relationship between different health system configurations and overall performance. Over time, specific issues within the general area of health systems have received special attention, including achieving universal health coverage (where the whole population of a country has access to health care and protection against its costs), the role of primary health care, the relative merits of different ways of financing a health system, the relative roles of public and private health sectors, and the appropriate mix of different types of health worker. Many disciplines can contribute to improved understanding of health systems, including economics, sociology, anthropology, history, political science, and management science. Until recently, the discipline of economics has tended to dominate the study of health systems. However, with the emergence of health policy and systems research as an important area of study, other disciplines have been making growing contributions, especially political science and the behavioral sciences concerned with the behavior of both individuals and organizations.

Equity Impacts of Neoliberal Reforms: What Should the Policy Responses Be?

2007 ◽  
Vol 37 (4) ◽  
pp. 693-709 ◽  
Author(s):  
Di McIntyre ◽  
Margaret Whitehead ◽  
Lucy Gilson ◽  
Göran Dahlgren ◽  
Shenglan Tang
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Systems ◽  
Poverty Reduction ◽  
Special Section ◽  
Health Sector ◽  
Lessons Learned ◽  
Public Health Services ◽  
Middle Income ◽  
Policy Responses

The final article in this special section draws together the lessons learned from the ALPS analyses and considers a range of potential policy responses. The country case studies highlight that health systems in many low- and middle-income countries are failing not only the poor but also other income groups, who are faced with wide-ranging barriers to accessing the health care they need. A key policy intervention to address these health system failures is that of challenging the status quo in relation to the public-private health care mix. There is an urgent need to strengthen public health services that have been systematically neglected over the past few decades while also regulating the worst excesses of the private health sector. Promoting a greater reliance on financing mechanisms that are progressive and that strengthen cross-subsidies in the overall health system is critical, as is ensuring that available financial and human resources are equitably allocated among geographic areas and groups. Finally, health system interventions of this nature should be supported by broader poverty-reduction strategies. Such interventions to fundamentally change ailing health systems are essential to break the vicious cycle of poverty, ill-health, and (further) impoverishment.

scholarly journals The impacts of health systems financing fragmentation in low- and middle-income countries: a systematic review protocol

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Marina Siqueira ◽  
Maíra Coube ◽  
Christopher Millett ◽  
Rudi Rocha ◽  
Thomas Hone
Keyword(s):  
Systematic Review ◽  
Health Outcomes ◽  
Health System ◽  
Health Systems ◽  
Cochrane Library ◽  
Financial Risk Protection ◽  
Middle Income ◽  
Middle Income Countries ◽  
Patient Reported ◽  
Low And Middle Income

Abstract Background Health systems are often fragmented in low- and middle-income countries (LMICs). This can increase inefficiencies and restrict progress towards universal health coverage. The objective of the systematic review described in this protocol will be to evaluate and synthesize the evidence concerning the impacts of health systems financing fragmentation in LMICs. Methods Literature searches will be conducted in multiple electronic databases, from their inception onwards, including MEDLINE, EMBASE, LILACS, CINAHL, Scopus, ScienceDirect, Scielo, Cochrane Library, EconLit, and JSTOR. Gray literature will be also targeted through searching OpenSIGLE, Google Scholar, and institutional websites (e.g., HMIC, The World Bank, WHO, PAHO, OECD). The search strings will include keywords related to LMICs, health system financing fragmentation, and health system goals. Experimental, quasi-experimental, and observational studies conducted in LMICs and examining health financing fragmentation across any relevant metric (e.g., the presence of different health funders/insurers, risk pooling mechanisms, eligibility categories, benefits packages, premiums) will be included. Studies will be eligible if they compare financing fragmentation in alternative settings or at least two-time points. The primary outcomes will be health system-related goals such as health outcomes (e.g., mortality, morbidity, patient-reported outcome measures) and indicators of access, services utilization, equity, and financial risk protection. Additional outcomes will include intermediate health system objectives (e.g., indicators of efficiency and quality). Two reviewers will independently screen all citations, abstract data, and full-text articles. Potential conflicts will be resolved through discussion and, when necessary, resolved by a third reviewer. The methodological quality (or risk of bias) of selected studies will be appraised using established checklists. Data extraction categories will include the studies’ objective and design, the fragmentation measurement and domains, and health outcomes linked to the fragmentation. A narrative synthesis will be used to describe the results and characteristics of all included studies and to explore relationships and findings both within and between the studies. Discussion Evidence on the impacts of health system fragmentation in LMICs is key for identifying evidence gaps and priority areas for intervention. This knowledge will be valuable to health system policymakers aiming to strengthen health systems in LMICs. Systematic review registration PROSPERO CRD42020201467

scholarly journals Inequalities and convergence of health outcomes in South Asian countries

2016 ◽  
Vol 5 (2) ◽  
pp. 71-76
Author(s):  
Sumit Kumar
Keyword(s):  
Infant Mortality ◽  
Life Expectancy ◽  
Health Outcomes ◽  
Health Inequalities ◽  
South Asian ◽  
Infant Mortality Rate ◽  
Asian Countries ◽  
The South ◽  
Convergence Clubs ◽  
Policy Measures

For human development of South Asian countries, which houses more than one-fifth of world’s population, it becomes crucial to study health inequalities between and within these countries. The aim of this paper is to explore the extent of health inequalities and convergence of health outcomes as represented by life expectancy and infant mortality rates among the South Asian countries. The statistical methods Gini coefficient, ?, and ?-convergence analysis are utilized to study inequalities and convergence-divergence, which are well established in macro-economic growth analyses. For the study longitudinal data over the period 1996-2012 for Infant Mortality rate (IMR) and Life expectancy (LE) is utilized. The results of the analysis indicate that there have been large inequalities in IMR and these are still increasing among the countries. However, in case of LE the inequalities are small and are on decline over the period of time. Further, the tests for convergence reveal that the IMR and LE have not been converged in the period 1996-2012 and no convergence clubs has been formed. The present analyses high-lights that the relative positions of countries among the South Asia have changed little and the trend of large inequalities among the countries continues. Further research to identify economic and social policy measures which decline the large inequalities among the countries can be rewarding exposition for all the stakeholders.South East Asia Journal of Public Health Vol.5(2) 2015: 71-76

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