Introduction: The current health-financing situation it has become imperative for health facilities in Indonesia to ensure more efficient means of providing services. In the current scenario, there is very little price competition and little incentive to contain costs and ensure efficiency. This study focuses on analyzing the hospital efficiency of KMC. The study makes an attempt to provide an overview of the health services provided by hospitals in KMC in terms of their technical and allocative efficiency. The purpose of study addressing the efficiency issue is to provide empirical analysis of hospital in Indonesia.Methods: This cross-sectional descriptive study involved all the three years financial performance of KMC Hospital. Data collected from 2011-2013 based on financial report (audited). The production model for hospital sectors requires the treatment of multiple inputs and multiple outputs. In this study for variable inputs: cost of goods sold (COGS), operational cost (OC), general cost (GC), patient cost (PC) and doctor's fee (DF). For output variable: revenue (RV), gross margin (GM) and net margin (NM). Efficiency scores were computed using Data Envelopment Analysis (DEA).Result: The absolute efficiency of KMC as a whole was found to have improved after implemented lean. Two years before implemented lean represents not satisfactory level of efficiency. In 2011, efficiency level of input variable COGS: 91.1%, OC: 67.5%, GC: 77.9%, PC: 86.4% and DF: 86.4%. In 2012, COGS: 94.3%, OC: 89.7%, GC: 92.0%, PC : 86.7% and DF: 95.2%. In 2013, overall variable 100%. In 2011, efficiency level of output variable RV: 100.0%, GM: 85.3% and NM: -1,131.3%, in 2012, RV: 100.0%, GM: 90.9% and NM: -432.8%, in 2013, overall variable 100%.Discussion: In this study DEA has proven to be a useful methodology for measuring efficiency a sectorial analysis of hospital within a national setting. Furthermore, DEA allowed to analyze the inefficiencies of the hospital sectors in detail and helped to identify possible improvements and quantify the amount of money that could theoretically be saved, address of inefficiencies were eliminated.
{"title":"Hospital Efficiency and Data Envelopment Analysis (DEA): An Empirical Analysis of Kemang Medical Care (KMC)","authors":"A. H. Iswanto","doi":"10.2139/ssrn.2629898","DOIUrl":"https://doi.org/10.2139/ssrn.2629898","url":null,"abstract":"Introduction: The current health-financing situation it has become imperative for health facilities in Indonesia to ensure more efficient means of providing services. In the current scenario, there is very little price competition and little incentive to contain costs and ensure efficiency. This study focuses on analyzing the hospital efficiency of KMC. The study makes an attempt to provide an overview of the health services provided by hospitals in KMC in terms of their technical and allocative efficiency. The purpose of study addressing the efficiency issue is to provide empirical analysis of hospital in Indonesia.Methods: This cross-sectional descriptive study involved all the three years financial performance of KMC Hospital. Data collected from 2011-2013 based on financial report (audited). The production model for hospital sectors requires the treatment of multiple inputs and multiple outputs. In this study for variable inputs: cost of goods sold (COGS), operational cost (OC), general cost (GC), patient cost (PC) and doctor's fee (DF). For output variable: revenue (RV), gross margin (GM) and net margin (NM). Efficiency scores were computed using Data Envelopment Analysis (DEA).Result: The absolute efficiency of KMC as a whole was found to have improved after implemented lean. Two years before implemented lean represents not satisfactory level of efficiency. In 2011, efficiency level of input variable COGS: 91.1%, OC: 67.5%, GC: 77.9%, PC: 86.4% and DF: 86.4%. In 2012, COGS: 94.3%, OC: 89.7%, GC: 92.0%, PC : 86.7% and DF: 95.2%. In 2013, overall variable 100%. In 2011, efficiency level of output variable RV: 100.0%, GM: 85.3% and NM: -1,131.3%, in 2012, RV: 100.0%, GM: 90.9% and NM: -432.8%, in 2013, overall variable 100%.Discussion: In this study DEA has proven to be a useful methodology for measuring efficiency a sectorial analysis of hospital within a national setting. Furthermore, DEA allowed to analyze the inefficiencies of the hospital sectors in detail and helped to identify possible improvements and quantify the amount of money that could theoretically be saved, address of inefficiencies were eliminated.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129444929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Nazarov, Christopher Davis, Christopher J. Gerry, A. Polyakova, N. Sisigina, D. Sokolov
Keeping pace of development of the Russian health care system requires improving the efficiency of spending. In developed countries, an important role in this task plays a multilevel system of evaluation and control of cost-effectiveness and results of operations of the health system and its individual members, supported by the use of evaluation findings in political and administrative decisions in the health sector, financial incentives and information support of participants in the evaluation. Effective today in Russia, the system for monitoring the effectiveness of the health system is largely a formality and does not meet modern political tasks. The most acute problems in assessing the effectiveness of the country include the lack of evaluation of individual elements, first of all, health technology assessment; the poor quality of data collected, the weak development of mechanisms for the implementation of evaluation results, in particular, the development of public policies promoting health care providers, informing the public about the quality of services provided. The aim of the present work is the development of basic mechanisms for assessing the efficiency and effectiveness of the Russian health care system, taking into account the best international and domestic experience.
{"title":"Оценка Эффективности и Результативности Системы Здравоохранения (Evaluating the Effectiveness and Efficiency of the Health System)","authors":"V. Nazarov, Christopher Davis, Christopher J. Gerry, A. Polyakova, N. Sisigina, D. Sokolov","doi":"10.2139/ssrn.2624500","DOIUrl":"https://doi.org/10.2139/ssrn.2624500","url":null,"abstract":"Keeping pace of development of the Russian health care system requires improving the efficiency of spending. In developed countries, an important role in this task plays a multilevel system of evaluation and control of cost-effectiveness and results of operations of the health system and its individual members, supported by the use of evaluation findings in political and administrative decisions in the health sector, financial incentives and information support of participants in the evaluation. Effective today in Russia, the system for monitoring the effectiveness of the health system is largely a formality and does not meet modern political tasks. The most acute problems in assessing the effectiveness of the country include the lack of evaluation of individual elements, first of all, health technology assessment; the poor quality of data collected, the weak development of mechanisms for the implementation of evaluation results, in particular, the development of public policies promoting health care providers, informing the public about the quality of services provided. The aim of the present work is the development of basic mechanisms for assessing the efficiency and effectiveness of the Russian health care system, taking into account the best international and domestic experience.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126853410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We use Punctuated Equilibrium Theory (PET) to examine the distribution of annual change in national government spending on global health through bilateral agencies by 17 OECD nations for 1990–2009. Consistent with our expectations and the PET literature, we find that the distribution of annual log percent change in commitments and disbursements for global health is leptokurtic rather than close to the normal distribution anticipated under incrementalism. Our findings illustrate the value of PET's focus on distributions rather than on time trends in levels alone when examining government allocation behavior, while adding to the literature on global health finance. This study also highlights the impact of choice of log percent change or percent change in examining budgetary change distributions. Better understanding of allocation patterns in this arena can inform those interested in global health policy and its vital outcomes.
{"title":"Punctuated Equilibrium Theory: An Empirical Investigation of its Relevance for Global Health Expenditure","authors":"Marie H Martin, Megan E. Streams","doi":"10.1111/pbaf.12055","DOIUrl":"https://doi.org/10.1111/pbaf.12055","url":null,"abstract":"We use Punctuated Equilibrium Theory (PET) to examine the distribution of annual change in national government spending on global health through bilateral agencies by 17 OECD nations for 1990–2009. Consistent with our expectations and the PET literature, we find that the distribution of annual log percent change in commitments and disbursements for global health is leptokurtic rather than close to the normal distribution anticipated under incrementalism. Our findings illustrate the value of PET's focus on distributions rather than on time trends in levels alone when examining government allocation behavior, while adding to the literature on global health finance. This study also highlights the impact of choice of log percent change or percent change in examining budgetary change distributions. Better understanding of allocation patterns in this arena can inform those interested in global health policy and its vital outcomes.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125767815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Quebecers are carrying a $682 billion fiscal burden – the higher tax bill for increased healthcare costs over the next half-century – and should prepare now for the coming demographic squeeze, says a report released today from the C.D. Howe Institute. In “An Aging Population Fiscal Challenge: Planning for Healthcare Costs in Quebec,” authors William B.P. Robson, Colin Busby and Aaron Jacobs recommend that Quebec prefund selected healthcare services and benchmark against other provinces to get better health bang for their tax bucks.
{"title":"An Aging Population Fiscal Challenge: Planning for Healthcare Costs in Quebec","authors":"W. Robson, C. Busby, A. Jacobs","doi":"10.2139/SSRN.2540718","DOIUrl":"https://doi.org/10.2139/SSRN.2540718","url":null,"abstract":"Quebecers are carrying a $682 billion fiscal burden – the higher tax bill for increased healthcare costs over the next half-century – and should prepare now for the coming demographic squeeze, says a report released today from the C.D. Howe Institute. In “An Aging Population Fiscal Challenge: Planning for Healthcare Costs in Quebec,” authors William B.P. Robson, Colin Busby and Aaron Jacobs recommend that Quebec prefund selected healthcare services and benchmark against other provinces to get better health bang for their tax bucks.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116996466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this paper we explore political-economic determinants of health. We draw upon the unique natural experiment of post-communist transitions to show the effect on health (measured as life expectancy and cause-specific mortality) of the interaction between institutions for political (democratic rules) and economic (free market entry) competitiveness. To analyze this relationship empirically, we employ panel regression analysis with country and time fixed effects. We find that, ceteris paribus, political and economic institutions exert cumulative positive impact upon health (even if their separate effects are negative or insignificant). One potential causal pathway is that political-economic liberalization increases certainty and people start investing in their health. Our findings are highly relevant to other countries that experience similar reforms
{"title":"Institutional Deficit and Health Outcomes in Post-Communist States","authors":"V. Kozlov, Dina Balalaeva","doi":"10.2139/ssrn.2573692","DOIUrl":"https://doi.org/10.2139/ssrn.2573692","url":null,"abstract":"In this paper we explore political-economic determinants of health. We draw upon the unique natural experiment of post-communist transitions to show the effect on health (measured as life expectancy and cause-specific mortality) of the interaction between institutions for political (democratic rules) and economic (free market entry) competitiveness. To analyze this relationship empirically, we employ panel regression analysis with country and time fixed effects. We find that, ceteris paribus, political and economic institutions exert cumulative positive impact upon health (even if their separate effects are negative or insignificant). One potential causal pathway is that political-economic liberalization increases certainty and people start investing in their health. Our findings are highly relevant to other countries that experience similar reforms","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123828582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pallav Bhatt, V. Madge, Nachiket Mor, Vinod K. Paul, Navneet Jain, Subhash Hira, Priya Balasubramaniam
This document develops a framework for an Essential Health Package comprising 34 health categories. It provides detailed care pathways and associated costs and path-dependent conditional probabilities for Anaemia, Cardio Vascular Disease, Diabetes, and Tuberculosis. Using the frameworks developed here designers of health systems can provide detailed pathways and estimate resource requirements for all the elements of the Essential Health Package.
{"title":"Designing and Costing of an Adaptable and Flexible Essential Health Package (EHP) for Indian States","authors":"Pallav Bhatt, V. Madge, Nachiket Mor, Vinod K. Paul, Navneet Jain, Subhash Hira, Priya Balasubramaniam","doi":"10.2139/SSRN.2568297","DOIUrl":"https://doi.org/10.2139/SSRN.2568297","url":null,"abstract":"This document develops a framework for an Essential Health Package comprising 34 health categories. It provides detailed care pathways and associated costs and path-dependent conditional probabilities for Anaemia, Cardio Vascular Disease, Diabetes, and Tuberculosis. Using the frameworks developed here designers of health systems can provide detailed pathways and estimate resource requirements for all the elements of the Essential Health Package.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"201 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127648062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Fischer, Dean S. Karlan, M. McConnell, Pia J. Raffler
In a field experiment in Uganda, we find that demand after a free distribution of three health products is lower than after a sale distribution. This contrasts with work on insecticide-treated bed nets, highlighting the importance of product characteristics in determining pricing policy. We put forward a model to illustrate the potential tension between two important factors, learning and anchoring, and then test this model with three products selected specifically for their variation in the scope for learning. We find the rank order of shifts in demand matches with the theoretical prediction, although the differences are not statistically significant.
{"title":"To Charge or Not to Charge: Evidence from a Health Products Experiment in Uganda","authors":"G. Fischer, Dean S. Karlan, M. McConnell, Pia J. Raffler","doi":"10.2139/ssrn.2622765","DOIUrl":"https://doi.org/10.2139/ssrn.2622765","url":null,"abstract":"In a field experiment in Uganda, we find that demand after a free distribution of three health products is lower than after a sale distribution. This contrasts with work on insecticide-treated bed nets, highlighting the importance of product characteristics in determining pricing policy. We put forward a model to illustrate the potential tension between two important factors, learning and anchoring, and then test this model with three products selected specifically for their variation in the scope for learning. We find the rank order of shifts in demand matches with the theoretical prediction, although the differences are not statistically significant.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"102 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115745622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The note shows that there are several links between financial development and health. Using multiple pathways, these operate through both the Growth Channel and the Volatility Channel. However the note points out that both healthcare and financial access have special characteristics that have an important influence on how the benefits of financial development are transmitted to health. It make some suggestions on how access to healthcare and financial services needs to be designed so as to maximize the benefits of financial development on health.
{"title":"Financial Development and Health","authors":"Nachiket Mor, Bindu Ananth","doi":"10.2139/ssrn.2418861","DOIUrl":"https://doi.org/10.2139/ssrn.2418861","url":null,"abstract":"The note shows that there are several links between financial development and health. Using multiple pathways, these operate through both the Growth Channel and the Volatility Channel. However the note points out that both healthcare and financial access have special characteristics that have an important influence on how the benefits of financial development are transmitted to health. It make some suggestions on how access to healthcare and financial services needs to be designed so as to maximize the benefits of financial development on health.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124642887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Data from the British National Child Development Study show that, among 33-year-olds, ill health (as measured by cardinalized responses to a question on self-assessed health) is concentrated among the worse off. The authors seek to decompose the inequalities in health status into their socioeconomic causes. In this decomposition, inequalities in health status depend on inequalities in each of the underlying determinants of health and on the elasticities of health status with respect to each of these determinants. The authors estimate these elasticities using regression models that allow for unobserved heterogeneity at the community level. They find that inequalities in unobserved community-level influences account for only 6 percent of health inequality, and inequalities in parental education and social class for only 4 percent. Inequalities in income and housing tenure account for most health inequality, though inequalities in educational attainment and in math scores at age seven also play a part.
英国国家儿童发展研究(British National Child Development Study)的数据显示，在33岁的人群中，健康状况不佳(通过对自我评估健康问题的基数回答来衡量)的人群集中在状况较差的人群中。作者试图将健康状况的不平等分解为其社会经济原因。在这种分解中，健康状况的不平等取决于健康的每个基本决定因素的不平等，以及健康状况相对于这些决定因素的弹性。作者使用回归模型来估计这些弹性，该模型允许在社区水平上未观察到的异质性。他们发现，未被观察到的社区层面影响的不平等只占健康不平等的6%，父母教育和社会阶层的不平等只占4%。收入和住房使用权的不平等是造成健康不平等的主要原因，尽管受教育程度和7岁儿童数学成绩的不平等也有一定影响。
{"title":"Causes of Inequality in Health: Who are You? Where Do You Live? Or Who Your Parents Were?","authors":"A. Wagstaff, P. Paci, H. Joshi","doi":"10.1596/1813-9450-2713","DOIUrl":"https://doi.org/10.1596/1813-9450-2713","url":null,"abstract":"Data from the British National Child Development Study show that, among 33-year-olds, ill health (as measured by cardinalized responses to a question on self-assessed health) is concentrated among the worse off. The authors seek to decompose the inequalities in health status into their socioeconomic causes. In this decomposition, inequalities in health status depend on inequalities in each of the underlying determinants of health and on the elasticities of health status with respect to each of these determinants. The authors estimate these elasticities using regression models that allow for unobserved heterogeneity at the community level. They find that inequalities in unobserved community-level influences account for only 6 percent of health inequality, and inequalities in parental education and social class for only 4 percent. Inequalities in income and housing tenure account for most health inequality, though inequalities in educational attainment and in math scores at age seven also play a part.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"114 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2001-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128141414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper provides an overview of the intent of the Medicaid program and its budgetary implications. In 1965, when Medicaid was created under Title XIX of the Social Security Act to provide health insurance for low-income individuals, the program was considered an afterthought to Medicare. Today, however, more Americans receive coverage from Medicaid than any other health insurance program, including Medicare. Today Medicaid costs nearly $500 billion annually, funded by taxpayer dollars at the state and federal levels. This paper explains the budgetary implications of Medicaid for federal and state budgets and how these obligations will grow under the Patient Protection and Affordable Care Act.
{"title":"Medicaid Overview","authors":"Jason J. Fichtner, John Pulito","doi":"10.2139/ssrn.3191353","DOIUrl":"https://doi.org/10.2139/ssrn.3191353","url":null,"abstract":"This paper provides an overview of the intent of the Medicaid program and its budgetary implications. In 1965, when Medicaid was created under Title XIX of the Social Security Act to provide health insurance for low-income individuals, the program was considered an afterthought to Medicare. Today, however, more Americans receive coverage from Medicaid than any other health insurance program, including Medicare. Today Medicaid costs nearly $500 billion annually, funded by taxpayer dollars at the state and federal levels. This paper explains the budgetary implications of Medicaid for federal and state budgets and how these obligations will grow under the Patient Protection and Affordable Care Act.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125347153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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