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The efficiency of the local health systems: investigating the roles of health administrations and health care providers

Published online by Cambridge University Press:  02 May 2017

Laura Anselmi ,
Mylène Lagarde  and
Kara Hanson
Laura Anselmi*
Affiliation:
Manchester Centre For Health Economics, The University of Manchester, Manchester, UK
Mylène Lagarde
Affiliation:
Department of Social Policy, London School of Economics, London, UK
Kara Hanson
Affiliation:
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
*
*Correspondence to: Laura Anselmi, Manchester Centre for Health Economics, University of Manchester, Room 4.311, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK. Email: laura.anselmi@manchester.ac.uk
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Abstract

The analysis of efficiency in health care has largely focussed either on individual health care providers, or on sub-national health systems conceived as a unique decision-making unit. However, in hierarchically organized national health services, two separate entities are responsible for turning financial resources into services at the local level: health administrations and health care providers. Their separate roles and the one of health administrations in particular have not been explicitly considered in efficiency analysis. We applied stochastic frontier analysis to district-level panel data from Mozambique (2008-2011) to assess district efficiency in delivering outpatient care. We first assessed the efficiency of the whole district considered as an individual decision-making unit, and then we assessed separately the efficiency of health administrations and health care providers within the same district. We found that on average only 73% of the outpatient consultations deliverable using available inputs were realized, with large differences in performance across districts. Individual districts performed differently in administrative or health care delivery functions. On average, a reduction of administrative inefficiency by 10 percentage points, for a given expenditure would increase by 0.2% the volume of services delivered per thousand population per year. Identifying and targeting the specific drivers of administrative inefficiencies can contribute to increase service.

Type
Articles
Information
Health Economics, Policy and Law , Volume 13 , Issue 1 , January 2018 , pp. 10 - 32
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Copyright
© Cambridge University Press 2017 

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