J Korean Med Sci.  2015 Nov;30(Suppl 2):S143-S148. 10.3346/jkms.2015.30.S2.S143.

A New Approach of Measuring Hospital Performance for Lowand Middle-income Countries

• Adhikari S
• Sapkota VP
• Supakankunti S

• KMID: 2351152
• DOI: http://doi.org/10.3346/jkms.2015.30.S2.S143

Abstract

Efficiency of the hospitals affects the price of health services. Health care payments have equity implications. Evidence on hospital performance can support to design the policy; however, the recent literature on hospital efficiency produced conflicting results. Consequently, policy decisions are uncertain. Even the most of evidence were produced by using data from high income countries. Conflicting results were produced particularly due to differences in methods of measuring performance. Recently a management approach has been developed to measure the hospital performance. This approach to measure the hospital performance is very useful from policy perspective to improve health system from cost-effective way in low and middle income countries. Measuring hospital performance through management approach has some basic characteristics such as scoring management practices through double blind survey, measuring hospital outputs using various indicators, estimating the relationship between management practices and outputs of the hospitals. This approach has been successfully applied to developed countries; however, some revisions are required without violating the fundamental principle of this approach to replicate in low- and middle-income countries. The process has been clearly defined and applied to Nepal. As the results of this, the approach produced expected results. The paper contributes to improve the approach to measure hospital performance.

Keyword

Hospital Performance; Management Approach; Low- and Middle-income Countries; Output Indicators; Management Indicators

MeSH Terms

*Developing Countries
Efficiency, Organizational/*classification
Hospital Administration/*classification
Hospitals/*classification
Management Audit/methods/*organization & administration
Nepal
Outcome and Process Assessment (Health Care)/methods/*organization & administration

Reference

1. Wagstaff A. Estimating efficiency in the hospital sector: a comparison of three statistical cost frontier models. Appl Econ. 1989; 21:659–672.

2. Zuckerman S, Hadley J, Iezzoni L. Measuring hospital efficiency with frontier cost functions. J Health Econ. 1994; 13:255–280.

3. Rosko MD. Cost efficiency of US hospitals: a stochastic frontier approach. Health Econ. 2001; 10:539–551.

4. Li T, Rosenman R. Cost inefficiency in Washington hospitals: a stochastic frontier approach using panel data. Health Care Manag Sci. 2001; 4:73–81.

5. Deily ME, McKay NL. Cost inefficiency and mortality rates in Florida hospitals. Health Econ. 2006; 15:419–431.

6. Hollingsworth B, Street A. The market for efficiency analysis of health care organisations. Health Econ. 2006; 15:1055–1059.

7. Hollingsworth B. The measurement of efficiency and productivity of health care delivery. Health Econ. 2008; 17:1107–1128.

8. Hjalmarsson L, Kumbhakar SC, Heshmati A. DEA, DFA and SFA: a comparison. J Productiv Anal. 1996; 7:303–327.

9. Greene WH. The econometric approach to efficiency analysis. In : Fried HO, Lovell CAK, Schmidt SS, editors. The measurement of productive efficiency and productivity growth. . New York: Oxford University Press;2008. p. 92–250.

10. Kumbhakar SC, Tsionas EG. Some recent developments in efficiency measurement in stochastic frontier models. J Probab Stat. 2011; DOI: 10.1155/2011/603512.

11. Tsionas EG. Stochastic frontier models with random coefficients. J Appl Econ. 2002; 17:127–147.

12. Hsieh CT, Klenow PJ. Misallocation and manufacturing TFP in China and India. Quart J Econ. 2007; 124:1403–1448.

13. Bloom N, Van Reenen J. Measuring and explaining management practices across firms and countries. Quart J Econ. 2006; 122:1351–1408.

14. Bloom N, Sadun R. The organization of firms across countries. Quart J Econ. 2012; 127:1663–1705.

15. Delfgaauw J, Dur R, Propper C, Smith S. Management practices: are not-for-profits different? CEPR Discussion Paper No. DP8498. 2011. accessed on 15 June 2015. Available at http://ssrn.com/abstract=1898004.

16. McConnell KJ, Hoffman KA, Quanbeck A, McCarty D. Management practices in substance abuse treatment programs. J Subst Abuse Treat. 2009; 37:79–89.

17. Rasul I, Rogger D. Management of bureaucrats and public service delivery: evidence from the Nigerian civil service. . London, UK: London School of Economics and Political Science, Suntory and Toyota International Centres for Economics and Related Disciplines;2013. Public Economics Programme Papers PEP 20.

18. Bloom N, Propper C, Seiler S, Van Reenen J. The impact of competition on management practices in public hospitals. 2010: accessed on 15 June 2015. Available at http://www.webmeets.com/files/papers/ESWC/2010/1118/Hospital_Competition_stephan_seiler_ESWC.pdf.

19. Adhikari SR. Measuring hospital performance in Nepal. London UK: Private Enterprise Development in Low-Income Countries;2014.

20. Central Bureau of Statistics. Nepal Living Standards Survey 2010/011: statistical Report. Kathmandu, Nepal: Government of Nepal, National Planning Commission Secretariat, Central Bureau of Statistics;2011.

21. Ministry of Health and Population (MOHP) [Nepal]. Nepal demographic and health survey 2011. Kathmandu, Nepal: Ministry of Health and Population, New ERA, and Macro International Inc;2012.

22. Waheb Y, Kamel L, Mena R. Cost analysis and efficiency indicators for health care: report number 3, summary output for El Gamhuria General Hospital, 1993-1994. 1997. accessed on 15 June 2015. Available at https://www.hsph.harvard.edu/ihsg/publications/pdf/No-58.PDF.

23. Lindelöw M, Wagstaff A. Health facility surveys: an introduction. Washington: World Bank Publications;2003. Policy Research Working Paper No.; 2953.