scholarly journals Determinants of hospital efficiency: A literature review

2020 ◽  
Vol 6 (2) ◽  
pp. 44
Author(s):  
Eyob Z. Asbu ◽  
Maysoun D. Masri ◽  
Marwan Al Naboulsi
Keyword(s):  
Health System ◽  
Health Systems ◽  
Health Expenditure ◽  
Stochastic Frontier ◽  
Geographic Location ◽  
Analysis Data ◽  
Hospital Efficiency ◽  
World Health ◽  
Total Health Expenditure ◽  
Tobit Regression

Background: Inefficiency is a pervasive problem in health systems. The World Health Organization estimates that on average, 20%-40% of the global total health expenditure is wasted. The proportion of total health expenditure attributed to hospitals is high, which implies that improving the efficiency of hospitals will lead to more efficient health systems. This study aims to synthetize the major determinants of hospital inefficiency and to develop a framework to identify causes of inefficiency and develop multi-factor interventions to address inefficiencies.Methods: The study is based on survey of the literature on the determinants of hospital efficiency. The studies include those that employ ratio methods of efficiency analysis, data envelopment analysis and stochastic frontier models and econometric models such as the Tobit regression to assess determinants of technical efficiency. Data was extracted in a table format categorized as those that are within the hospital, outside the hospital but within the health system and those that are outside the hospital and health system in the broader macroeconomic system and analyzed.Results: Hospital efficiency is influenced by factors that may be internal to the hospital or external and thus could be wholly or partially out of the control of the hospital. Hospital-level characteristics that influence efficiency include ownership, size, specialization/scope economies, teaching status, membership of multihospital system and other factors such as case-mix and ratio of outpatients to inpatients. However, the effects of these variables are not definitive and consistent; all depends on the context. Factors out of the direct control of the hospital include geographic location, competition and reimbursement systems. The findings further elucidate that no single factor is effective in addressing hospital inefficiencies in isolation from others.Conclusion: There is no one single magic formula or intervention that can be adopted by different hospitals to improve hospital efficiencies. Multiple factors influence the efficiency of hospitals. To address hospital inefficiency multi-intervention packages focusing on the hospital and its environment should be developed.

scholarly journals Determinants of Hospital Efficiency: insights from the literature

2020 ◽  
Author(s):  
Eyob Zere Asbu ◽  
Maysoun Dimachkie Masri ◽  
Marwan Al Naboulsi
Keyword(s):  
Health System ◽  
Health Systems ◽  
Health Expenditure ◽  
Stochastic Frontier ◽  
Health Spending ◽  
Hospital Efficiency ◽  
World Health ◽  
Health Coverage ◽  
Total Health Expenditure ◽  
Tobit Regression

Abstract Background Achieving Universal Health Coverage and other health and health-related targets of the sustainable development goals entails curbing waste in health spending due to inefficiency. Inefficiency is a pervasive problem in health systems. The World Health Organization estimates that on average, 20-40% of the global total health expenditure is wasted. The proportion of total health expenditure attributed to hospitals is high, which implies that improving the efficiency of hospitals will lead to more efficient health systems. This study aims to synthetize the major determinants of hospital inefficiency and to develop a framework to identify causes of inefficiency and develop multi-factor interventions to address inefficiencies. Methods The study is based on survey of the literature on hospital efficiency and its determinants. The studies include those that employ ratio methods of efficiency analysis, data envelopment analysis and stochastic frontier models and econometric models such as the tobit regression to assess determinants of technical efficiency. Data was extracted in a table format categorized as those that are within the hospital, outside the hospital but within the health system and those that are outside the hospital and health system in the broader macroeconomic system and analyzed. Results Hospital efficiency is influenced by factors that may be internal to the hospital or external and thus could be wholly or partially out of the control of the hospital. Hospital-level characteristics that influence efficiency include ownership, size, specialization/scope economies, teaching status, membership of multihospital system and other factors such as case-mix and ratio of outpatients to inpatients. However, the effects of these variables are not definitive and consistent; all depends on the context. Factors out of the direct control of the hospital include geographic location, competition and reimbursement systems. The findings further elucidate that no single factor is effective in addressing hospital inefficiencies in isolation from others. Conclusion There is no one single magic formula or intervention that can be adopted by different hospitals and can be effective in improving hospital efficiencies. Multiple factors influence the efficiency of hospitals and to address hospital inefficiency multi-intervention packages focusing on the hospital and its environment should be developed.

scholarly journals Determinants of Hospital Efficiency: insights from the literature

2019 ◽  
Author(s):  
Eyob Zere Asbu ◽  
Maysoun Dimachkie Masri
Keyword(s):  
Health System ◽  
Health Systems ◽  
Health Expenditure ◽  
Stochastic Frontier ◽  
Health Spending ◽  
Hospital Efficiency ◽  
World Health ◽  
Health Coverage ◽  
Total Health Expenditure ◽  
Tobit Regression

Abstract Background Achieving Universal Health Coverage and other health and health-related targets of the sustainable development goals entails curbing waste in health spending due to inefficiency. Inefficiency is a pervasive problem in health systems. The World Health Organization estimates that on average, 20-40% of the global total health expenditure is wasted. The proportion of total health expenditure attributed to hospitals is high, which implies that improving the efficiency of hospitals will lead to more efficient health systems. This study aims to synthetize the major determinants of hospital inefficiency and to develop a framework to identify causes of inefficiency and develop multi-factor interventions to address inefficiencies.Methods The study is based on survey of the literature on hospital efficiency and its determinants. The studies include those that employ ratio methods of efficiency analysis, data envelopment analysis and stochastic frontier models and econometric models such as the tobit regression to assess determinants of technical efficiency. Data was extracted in a table format categorized as those that are within the hospital, outside the hospital but within the health system and those that are outside the hospital and health system in the broader macroeconomic system and analyzed.Results Hospital efficiency is influenced by factors that may be internal to the hospital or external and thus could be wholly or partially out of the control of the hospital. Hospital-level characteristics that influence efficiency include ownership, size, specialization/scope economies, teaching status, membership of multihospital system and other factors such as case-mix and ratio of outpatients to inpatients. However, the effects of these variables are not definitive and consistent; all depends on the context. Factors out of the direct control of the hospital include geographic location, competition and reimbursement systems. The findings further elucidate that no single factor is effective in addressing hospital inefficiencies in isolation from others.Conclusion There is no one single magic formula or intervention that can be adopted by different hospitals and can be effective in improving hospital efficiencies. Multiple factors influence the efficiency of hospitals and to address hospital inefficiency multi-intervention packages focusing on the hospital and its environment should be developed.

scholarly journals Health care financing in China prior to health reform 2009

2013 ◽  
Vol 1 (2) ◽  
pp. 46-64
Author(s):  
JR Khatri ◽  
Xiao Shuiyuan
Keyword(s):  
Health System ◽  
Health Reform ◽  
Health Expenditure ◽  
Health Financing ◽  
World Health ◽  
Total Health Expenditure ◽  
Financing System ◽  
Average Growth ◽  
Out Of Pocket Payments ◽  
Private Financing

Background and Objectives: The health system of China in 1970 was an exemplary model to the world but it began deteriorating after the economic reform in 1980. In order to address the deteriorating health system, government of China implemented the ambitious health reform program in 2009, with the aim to provide “safe, effective, convenient and affordable” health service to all people by 2020. In this study we try gain more insight about the health financing system of China prior to health system reform 2009. Methodology: Secondary data were collected from online data sets of World Health Organization (WHO), World Bank, Economic Co-operation and Development (OECD) and from publicly available reports and documents of related Ministries, and other published sources. Analysis was done with descriptive approach, focused on the three dimensions of health, namely the financing system: total health expenditure, financing source and financing scheme/agents. Results: China’s total health expenditure (THE) from 1995 to 2008 remained below 5% of GDP. From 1995 to 2001, the Government share on health expenditure decreased continuously and reached the lowest level of 36.4 % in 2001. Private financing was the primary funding mechanism and sources of revenue for private financing were private insurance and out-of-pocket payments. Household spending on health has increased with an average growth rate of 11.5 % from 2000 to 2008. Health financing scheme was social insurance type with fragmented risk pooling. Conclusions: Low level of public funding and heavy reliance on out-of-pocket payment were the major problem in the past decades. Hence the daunting problem of inadequate health financing ruled the last three decade of China health system. Janaki Medical College Journal of Medical Sciences (2013) Vol. 1 (2): 46-64 DOI: http://dx.doi.org/10.3126/jmcjms.v1i2.9270

scholarly journals 29.F. Workshop: The Health Systems and Policy Monitor network: reforms and health system changes in the spotlight

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Health Policy ◽  
Knowledge Transfer ◽  
Health System ◽  
Health Systems ◽  
Comparative Research ◽  
World Health ◽  
State Of Health ◽  
Wide Range ◽  
Cross Country ◽  
The Eu

Abstract The European Observatory established the Health Systems and Policy Monitor (HSPM) network in 2008, bringing together an international group of high-profile institutions from Europe and beyond with high academic standing in health systems and policy analysis. An important step was taken in 2011, when the Bertelsmann Health Policy Monitor, a 20-country-project with already significant overlap with the current HSPM network, merged with the Observatory's network of national lead institutions. Today, the network includes 40 institutions from 31 countries, with members participating in a wide range of activities and collaborations, such as writing the Observatory's flagship health system reports (HiTs), keeping the health policy community up-to-date on health system developments via the HSPM web platform, and contributing their expertise to reports, studies and knowledge transfer exercises co-ordinated by the Observatory for a variety of audiences, including ministries of health and international organisations such as the World Health Organization and the European Commission. In addition, network members participate in an annual meeting, hosted in a different member country every year, coming together over two days to exchange knowledge and experiences about the various health system reforms happening in their countries. The aim of these meetings is to present, discuss and start comparative research collaborations of the members that can inform policymaking. As part of a collaboration with the journal Health Policy, researchers of the HSPM network have published more than 100 articles on cross-country comparisons of policies or on ongoing nation health reforms in a special section - the Health Reform Monitor - of the journal. This workshop aims to provide the audience with an overview of the network and its expanding range of activities. An introductory presentation will briefly introduce the origins of the network and discuss its current line of work. The second presentation will provide an overview of reform trends that are routinely collected during the annual meetings as part of the “reform roundup”. The third presentation will give an example of how the network has contributed to the European Commission's State of Health in the EU initiative, by performing a 'rapid response” that informed the companion report to the State of Health in the EU country health profiles 2019. The fourth presentation is a typical example of the kind of collaborative work that the network is undertaking, i.e. involving multiple countries on a topic of shared interest. The workshop will conclude with a debate with the audience about the conceptual and methodological challenges as well as opportunities and future directions of cross-country comparative research and the HSPM network in particular. Key messages The Health Systems and Policy Monitor Network provides detailed descriptions of health systems and provides up to date information on reforms and changes that are particularly policy relevant. The Health Systems and Policy Monitor Network increasingly engages in comparative health systems research and knowledge transfer activities.

scholarly journals What makes health systems resilient against infectious disease outbreaks and natural hazards? Results from a scoping review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jennifer B. Nuzzo ◽  
Diane Meyer ◽  
Michael Snyder ◽  
Sanjana J. Ravi ◽  
Ana Lapascu ◽  
...  
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Health System ◽  
Natural Hazards ◽  
Health Systems ◽  
Scoping Review ◽  
Disease Outbreaks ◽  
World Health ◽  
Infectious Disease Outbreaks ◽  
System Resilience

Abstract Background The 2014–2016 Ebola outbreak was a wake-up call regarding the critical importance of resilient health systems. Fragile health systems can become overwhelmed during public health crises, further exacerbating the human, economic, and political toll. Important work has been done to describe the general attributes of a health system resilient to these crises, and the next step will be to identify the specific capacities that health systems need to develop and maintain to achieve resiliency. Methods We conducted a scoping review of the literature to identify recurring themes and capacities needed for health system resiliency to infectious disease outbreaks and natural hazards and any existing implementation frameworks that highlight these capacities. We also sought to identify the overlap of the identified themes and capacities with those highlighted in the World Health Organization’s Joint External Evaluation. Sources of evidence included PubMed, Web of Science, OAIster, and the websites of relevant major public health organizations. Results We identified 16 themes of health system resilience, including: the need to develop plans for altered standards of care during emergencies, the need to develop plans for post-event recovery, and a commitment to quality improvement. Most of the literature described the general attributes of a resilient health system; no implementation frameworks were identified that could translate these elements into specific capacities that health system actors can employ to improve resilience to outbreaks and natural hazards in a variety of settings. Conclusions An implementation-oriented health system resilience framework could help translate the important components of a health system identified in this review into specific capacities that actors in the health system could work to develop to improve resilience to public health crises. However, there remains a need to further refine the concept of resilience so that health systems can simultaneously achieve sustainable transformations in healthcare practice and health service delivery as well as improve their preparedness for emergencies.

OP109 Comparison Of The Health System Establishment Periods In Eighty-Eight Countries

2018 ◽  
Vol 34 (S1) ◽  
pp. 41-42
Author(s):  
Xuan Cheng ◽  
Hai-Chao Lei ◽  
Yu-Jie Yang ◽  
Na-Na Fan ◽  
Yi-Ming Pan ◽  
...  
Keyword(s):  
Cold War ◽  
Mortality Rate ◽  
Health System ◽  
Health Systems ◽  
Health Expenditure ◽  
Lower Mortality ◽  
Dependency Ratio ◽  
System Establishment ◽  
Per Capita ◽  
The Cold War

Introduction:Health system reform is considered a tough issue worldwide. Great efforts have been made toward health system building and strengthening. However, it is still unclear which health system is appropriate for different countries. This study aimed to systematically compare the characteristics of the establishment periods between eighty-eight counties of National Health Service (NHS) and Social Health Insurance (SHI).Methods:Forty-eight NHS countries and forty SHI countries with data availability were selected. The establishment years of current health systems and other eighteen indicators in economics, society, population and health during establishment periods were collected. Comparison between NHS and SHI was conducted by descriptive analysis of every indicator.Results:Most NHS countries were established during the cold war, while SHI had been set up since the cold war ended. The median of gross domestic product (GDP) per capita, urbanization rate and aging rate of SHI were USD 1535 in current dollars, 58.2 percent and 9.8 percent, respectively; compared with USD 1387, 41.2 percent and 4.7 percent, respectively of NHS. NHS countries had a smaller total population, lower mortality rate and elderly dependency ratio, while the birth rate and children's dependency ratio were higher. SHI countries showed a higher life expectancy and lower mortality rate in infants and children. NHS countries spent less in total health expenditure and a lower proportion of GDP. The median health expenditure per capita of SHI and NHS were USD 188 and USD 131 in current dollars, respectively. There was little difference among maternal mortality rates, and public and private health expenditure proportions.Conclusions:NHS and SHI countries had different characteristics during the health system establishment periods. NHS was established earlier than SHI overall, so that SHI revealed higher levels in economic and social development. Health outcomes of NHS countries were slightly lower than SHI ones, while health expenditure was more in SHI countries. Specific social, economic, demographic and health conditions should be considered when countries are building their own health systems.

scholarly journals Health systems readiness to provide geriatric friendly care services in Uganda: a cross-sectional study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jude Thaddeus Ssensamba ◽  
Moses Mukuru ◽  
Mary Nakafeero ◽  
Ronald Ssenyonga ◽  
Suzanne N. Kiwanuka
Keyword(s):  
Public Health ◽  
Health System ◽  
Health Facility ◽  
Health Systems ◽  
Building Blocks ◽  
Health Facilities ◽  
Health Centers ◽  
World Health ◽  
Care Services ◽  
Southern Central

Abstract Background As ageing emerges as the next public health threat in Africa, there is a paucity of information on how prepared its health systems are to provide geriatric friendly care services. In this study, we explored the readiness of Uganda’s public health system to offer geriatric friendly care services in Southern Central Uganda. Methods Four districts with the highest proportion of old persons in Southern Central Uganda were purposively selected, and a cross-section of 18 randomly selected health facilities (HFs) were visited and assessed for availability of critical items deemed important for provision of geriatric friendly services; as derived from World Health Organization’s Age-friendly primary health care centres toolkit. Data was collected using an adapted health facility geriatric assessment tool, entered into Epi-data software and analysed using STATA version 14. Kruskal-Wallis and Dunn’s post hoc tests were conducted to determine any associations between readiness, health facility level, and district. Results The overall readiness index was 16.92 (SD ±4.19) (range 10.8–26.6). This differed across districts; Lwengo 17.91 (SD ±3.15), Rakai 17.63 (SD ±4.55), Bukomansimbi 16.51 (SD ±7.18), Kalungu 13.74 (SD ±2.56) and facility levels; Hospitals 26.62, Health centers four (HCIV) 20.05 and Health centers three (HCIII) 14.80. Low readiness was due to poor scores concerning; leadership (0%), financing (0%), human resources (1.7%) and health management information systems (HMIS) (11.8%) WHO building blocks. Higher-level HFs were statistically significantly friendlier than lower-level HFs (p = 0.015). The difference in readiness between HCIIIs and HCIVs was 2.39 (p = 0.025). Conclusion There is a low readiness for public health facilities to provide geriatric friendly care services in Uganda. This is due to gaps in all of the health system building blocks. There is a need for health system reforms in Uganda to adequately cater for service provision for older adults if the 2020 global healthy ageing goal is to be met.

scholarly journals Management of chronic lung diseases in Sudan and Tanzania: how ready are the country health systems?

2021 ◽  
Author(s):  
Uzochukwu Egere ◽  
Elizabeth Shayo ◽  
Nyanda Ntinginya ◽  
Rashid Osman ◽  
Bandar Noory ◽  
...  
Keyword(s):  
Health System ◽  
Health Facility ◽  
Health Systems ◽  
Lung Diseases ◽  
Health Centre ◽  
Sub Saharan Africa ◽  
World Health ◽  
Service Availability ◽  
Chronic Lung Diseases ◽  
Service Readiness

Abstract BackgroundChronic Lung Diseases (CLDs), responsible for 4 million deaths globally every year, are increasingly important in low- and middle-income countries where most of the global mortality due to CLDs currently occurs. As existing health systems in resource-poor contexts, especially sub-Saharan Africa (SSA), are not generally oriented to provide quality care for chronic diseases, a first step in re-imagining them is to critically consider readiness for service delivery across all aspects of the existing system. MethodsWe conducted a mixed-methods assessment of CLD service readiness in 18 purposively selected health facilities in two differing SSA health system contexts, Tanzania and Sudan. We used the World Health Organization’s (WHO) Service Availability and Readiness Assessment checklist, qualitative interviews of key health system stakeholders, health facility registers review and assessed clinicians’ capacity to manage CLD using patient vignettes. CLD service readiness was scored as a composite of availability of service-specific tracer items from the WHO service availability checklist in three domains: staff training and guidelines, diagnostics and equipment, and basic medicines. Qualitative data were analysed using the same domains.ResultsOne health facility in Tanzania and five in Sudan, attained a CLD readiness score of ≥50% for CLD care. Scores ranged from 14.9% in a dispensary to 53.3% in a health centre in Tanzania, and from 36.4% to 86.4% in Sudan. The least available tracer items across both countries were trained human resources and guidelines, and peak flow meters. Only two facilities had COPD guidelines. Patient vignette analysis revealed significant gaps in clinicians’ capacity to manage CLD. Key informants identified low prioritization as key barrier to CLD care. Conclusion: Gaps in service availability and readiness for CLD care in Tanzania and Sudan threaten attainment of universal health coverage in these settings. Detailed assessments by health systems researchers in discussion with stakeholders at all levels of the health system can identify critical blockages to reimagining CLD service provision with people-centred, integrated approaches at its heart.

scholarly journals Assessing health system challenges and opportunities for better noncommunicable disease outcomes: the case of Mauritius

2019 ◽  
Author(s):  
Laurent Musango ◽  
Maryam TIMOL ◽  
Premduth BURHOO ◽  
Faisal SHAIKH ◽  
Philippe DONNEN ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health System ◽  
Health Systems ◽  
Community Empowerment ◽  
Noncommunicable Disease ◽  
Coordination Mechanism ◽  
World Health ◽  
Health Management Information System ◽  
Malignant Neoplasms ◽  
Challenges And Opportunities

Abstract Background This study provides an overview of NCD mortality, morbidity and risk factors; rates coverage of core population NCD interventions and individual NCD services in Mauritius; assesses health systems challenges and opportunities for better NCD outcomes; and recommends priority action areas to accelerate gains in NCD outcomes in Mauritius. Methods The Mauritius country assessment applied the guidelines developed by the World Health Organization Regional Office for Europe for systematically assessing health system challenges and opportunities for improving NCD outcomes. The assessment used mixed approaches to provide a fuller picture of the health system. Results In 2016, Mauritius sustained a total of 10 022 deaths from all causes. About 8,893 (88.7%) were from NCDs. Of the deaths due to NCDS, 6,935 (78%) were caused by cardiovascular diseases (CVD), diabetes and malignant neoplasms (cancers). Majority of NCDs are attributed to alcohol abuse, tobacco use, physical inactivity, and unhealthy diet. Of the 24-core population-based interventions for addressing these risk factors, 16.7% were rated extensive, 37.5% moderate and 45.8% limited. Three (20%), 8 (53%) and 4 (27%) of the 15 individual/personal CVD, diabetes and cancer services were rated extensive, moderate and limited respectively. Some of the challenges hindering NCD intervention scale-up include: lack of a government-led coordination mechanism; limited community empowerment for behavioural change; inefficient primary health care; insufficiently integrated health management information system; lack of explicit processes for prioritizing public health expenditures; and weak health workforce management. Conclusion There is urgent need to establish a high-level multisectoral/multistakeholder committee to oversee implementation of multisectoral activities for strengthening national health systems and other systems that address NCD risk factors and social determinants of health.

scholarly journals Health System Resilience: What Are We Talking About? A Scoping Review Mapping Characteristics and Keywords

2019 ◽  
Vol 9 (1) ◽  
pp. 6-16 ◽  
Author(s):  
My Fridell ◽  
Sanna Edwin ◽  
Johan von Schreeb ◽  
Dell D. Saulnier
Keyword(s):  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
World Health ◽  
Systems Research ◽  
Quality Health ◽  
System Resilience ◽  
Health Organization ◽  
Key Terms

Background: Health systems are based on 6 functions that need to work together at all times to effectively deliver safe and quality health services. These functions are vulnerable to shocks and changes; if a health system is unable to withstand the pressure from a shock, it may cease to function or collapse. The concept of resilience has been introduced with the goal of strengthening health systems to avoid disruption or collapse. The concept is new within health systems research, and no common description exists to describe its meaning. The aim of this study is to summarize and characterize the existing descriptions of health system resilience to improve understanding of the concept. Methods and Analysis: A scoping review was undertaken to identify the descriptions and characteristics of health system resilience. Four databases and gray literature were searched using the keywords "health system" and "resilience" for published documents that included descriptions, frameworks or characteristics of health system resilience. Additional documents were identified from reference lists. Four expert consultations were conducted to gain a broader perspective. Descriptions were analysed by studying the frequency of key terms and were characterized by using the World Health Organization (WHO) health system framework. The scoping review identified eleven sources with descriptions and 24 sources that presented characteristics of health system resilience. Frequently used terms that were identified in the literature were shock, adapt, maintain, absorb and respond. Change and learning were also identified when combining the findings from the descriptions, characteristics and expert consultations. Leadership and governance were recognized as the most important building block for creating health system resilience. Discussion: No single description of health system resilience was used consistently. A variation was observed on how resilience is described and to what depth it was explained in the existing literature. The descriptions of health system resilience primarily focus on major shocks. Adjustments to long-term changes and the element of learning should be considered for a better understating of health system resilience.

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