Document Type : Original Article
Authors
- Fatemeh Rostami Golmohammadi 1
- Ali Kazemi Karyani 2
- Maryam Goudarzian 3
- Saeed Asefzadeh 4
- Sattar Mehraban 5
1 MSc., Department of Health Economic, Research Center of Social Determinants of Health, Qazvin University of Medical Sciences, Qazvin, Iran.
2 PhD Candidate, Department of Health Economic, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
3 MSc., Department of Geriatric Nursing, Iranian Research Center on Health Aging, Sabzevar University of Medical Sciences, Sabzevar, Iran.
4 Professor, Research Center of Social Determinants of Health, Qazvin University of Medical Sciences, Qazvin, Iran.
5 MSc., Researcher in Health Economics, Institute of Economic Studies, Faculty of Social Sciences & Economics, Alzahra University, Tehran, Iran.
Abstract
Background Given the scarcity of resources in the areas of health, the efficient use of these resources is very important. The purpose of this study was to assess the efficiency of rural health centers of Ghazvin province in the period of 2006-2010.
Materials & Methods This is a descriptive-analytical study, in which all rural health centers in Qazvin Province, 43 centers, were included. Independent variables were the number of physicians, health experts, technicians, and community health workers, and the dependent variables were percentages of screening for congenital hypothyroidism, percentages of iron supplementation in the first guidance school students, number of visits of public procurements and food distribution centers, number of general practitioner’s visit, and number of specialist referral by the general physician. In this study, input-oriented model and variable returns to scale (VRS) assumption were used. Also, time trend of efficiency was estimated with a regression model. Data envelopment analysis (DEA)-solver and Stata software were used to measure efficiency and estimate regression models, respectively.
Results The mean technical efficiencies during 2006 to 2010 were 0.77, 0.77, 0.78, 0.92, and 0.89, respectively. Also, the average scale efficiencies in these years were 0.98, 0.95, 0.95, 0.97, and 0.97, respectively. Average score of managerial efficiency increased from 0.78 to 0.92 during this period. The results of time trend showed that β-coefficient for average score of efficiency was 0.039 and statistically significant (P=0.03).
Conclusion The mean levels of efficiency and health outcomes have been improved in these years but some of resources are still wasted. It seems that some practices such as ongoing evaluation of performance, improving the quality and quantity of services, and programing for optimal use of inputs, can be particularly useful.
Keywords
Smith PC. Measuring health system performance. The European Journal of Health Economics. 2002; 3(3):145-48. doi: 10.1007/s10198-002-0138-1
Yaisawarng S. Performance measurement and resource allocation. Berlin: Springer; 2002. doi: 10.1007/978-1-4757-3592-5_4
Aletras V, Kontodimopoulos N, Zagouldoudis A, Niakas D. The short-term effect on technical and scale efficiency of establishing regional health systems and general management in Greek NHS hospitals. Health Policy. 2007;83(2):236-45. doi: 10.1016/j.healthpol.2007.01.008
Hollingsworth B. The measurement of efficiency and productivity of health care delivery. Health Economics. 2008; 17(10):1107-128. doi: 10.1002/hec.1391
Evans JR, Hall KL, Warford J. Health Care in the Developing World: Problems of Scarcity and Choice. Population. 1981; 305(19):1117-127. doi: 10.1056/nejm198111053051904
Karimi S, Sajadi H, Karami M, Torkzad L, Bidram R. [Efficiency Estimation in General Hospitals of Isfahan University of medical sciences during 2005-2006 by data envelopment analysis (Persian)]. Journal of Health Administration. 2009; 12(36):39-46.
World Health Organization. Declaration of Alma-Ata. Geneva: World Health Organization; 1975. Available from: http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf
World Health Organization. The world health report 2008: primary health care now more than ever. Geneva: World Health Organization; 2008.
Tavassoli M. Iranian health houses open the door to primary care: working in pairs out of modest, village-based facilities, the Islamic Republic of Iran's trained community health workers, the behvarzan, provide basic health care to most of the country's rural population. Bulletin of the World Health Organization. 2008; 86(8):585-87.
Shadpour K. Primary health care networks in the Islamic Republic of Iran. Eastern Mediterranean Health Journal. 2000; 6(4):822-25.
Kiadaliri AA, Najafi B, Haghparast-Bidgoli H. Geographic distribution of need and access to health care in rural population: an ecological study in Iran. International Journal for Equity in Health. 2011; 10(1):39-43. doi: 10.1186/1475-9276-10-39
Huang YG, McLaughlin CP. Relative efficiency in rural primary health care: an application of data envelopment analysis. Health Services Management Research. 1989;24(2):75-80. doi: 10.1258/hsmr.2010.010017
Akazili J, Adjuik M, Jehu-Appiah C, Zere E. Using data envelopment analysis to measure the extent of technical efficiency of public health centres in Ghana. BMC International Health and Human Rights. 2008; 8(1):11-15. doi: 10.1186/1472-698x-8-11
Yun YB, Nakayama H, Tanino T. A generalized model for data envelopment analysis. European Journal of Operational Research. 2004; 157(1):87-105. doi: 10.1016/s0377-2217(03)00140-1
Emrouznejad A, Podinovski V. Data envelopment analysis and performance management. Coventry: Warwick University; 2004.
Ghaderi H, Goudarzi GH, Gohari MR. [Determination technical efficiency of hospitals affiliated with Iran University of Medical Science by Data Envelopment Analysis (2000 - 2004) (Persian)]. Journal of Health Administration. 2006; 9(26):39-44.
Horev T, Pesis-Katz I, Mukamel DB. Trends in geographic disparities in allocation of health care resources in the US. Health Policy. 2004; 68(2):223-32. doi: 10.1016/j.healthpol.2003.09.011
Pourreza A, Goudarzi G, Azadi H. Determination of technical efficiency of hospitals affiliated with Tehran University of Medical Science by the data envelopment analysis method: 1996 - 2006. Journal of School of Public Health and Institute of Public Health Research. 2010; 7(4):79-86.
Torabipour A, Najarzadeh M, Mohammad A, Farzi F, Ghasemzadeh R. Hospitals productivity measurement using data envelopment analysis technique. Iranian Journal of Public Health. 2014; 43(11):1576-581.
Jat TR, San Sebastian M. Technical efficiency of public district hospitals in Madhya Pradesh, India: a data envelopment analysis. Global health action. 2013; 6. doi: 10.3402/gha.v6i0.21742
Ajlouni MM, Zyoud A, Jaber B, Shaheen H, Al-Natour M, Anshasi RJ. The relative efficiency of Jordanian public hospitals using data envelopment analysis and Pabon Lasso diagram. Global Journal of Business Research. 2013; 7(2):59-72.
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