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Zhang T, Lu W, Tao H. Efficiency of health resource utilisation in primary-level maternal and child health hospitals in Shanxi Province, China: a bootstrapping data envelopment analysis and truncated regression approach. BMC Health Serv Res 2020; 20:179. [PMID: 32143651 PMCID: PMC7059375 DOI: 10.1186/s12913-020-5032-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 02/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND District- and county-level maternal and child health hospitals (MCHHs) are positioned to provide primary maternal and child healthcare in rural and urban areas of China. Their efficiencies and productivity largely affect the equity and accessibility of maternal and child health care. This study aimed to assess the efficiency of district- and county-level MCHHs in China and identify their associated factors. METHODS Thirty-three district- and 84 county-level MCHHs were selected from Shanxi Province in 2017. At the first stage, bootstrapping data envelopment analysis (DEA) models were established to calculate the technical efficiency (TE), pure technical efficiency (PTE) and scale efficiency (SE) of district- and county-level hospitals. At the second stage, the estimated efficiency scores were regressed against external and internal hospital environmental factors by using bootstrap truncated regression to identify their determinants. RESULTS The average TE, PTE and SE scores for district-level MCHHs were 0.7433, 0.8633 and 0.9335, respectively. All hospitals were found to be weakly efficient, although more than 50% of the hospitals performed with efficient SE (SE scores≥100%). As for county-level MCHHs, their average TE, PTE and SE scores were 0.5483, 0.6081 and 0.9329, respectively. The hospitals with TE and PTE scores less than 0.7 accounted for more than 60%, and no hospital was observed to operate effectively. Truncated regressions suggested that the proportion of health professionals, including doctors, nurses, pharmacists, inspection technician and image technician (district level: β = 0.57, 95% CI = 0.30-0.85; county level: β = 0.33, 95% CI = 0.15-0.52), and the number of health workers who received job training (district level: β = 0.67, 95% CI = 0.26-1.08; county level: β = 0.34, 95% CI = 0.14-0.54) had a positive association with efficiency scores. The amount of financial subsidy (β = 0.07, 95% CI = 0.05-0.09) was found to be directly proportional to the productive efficiency of the county-level MCHHs. CONCLUSION The operational inefficiency of district- and county-level MCHHs in Shanxi Province is severe and needs to be substantially improved, especially in terms of TE and PTE. Hiring additional medical personnel and ensuring the stability of the workforce should be prioritised. The Chinese government must provide sufficient financial subsidy to compensate for service costs.
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Affiliation(s)
- Tao Zhang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No.13, Aviation Road, Qiaokou District, Wuhan, Hubei Province, China
| | - Wei Lu
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No.13, Aviation Road, Qiaokou District, Wuhan, Hubei Province, China.
| | - Hongbing Tao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No.13, Aviation Road, Qiaokou District, Wuhan, Hubei Province, China
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Lunze K, Higgins-Steele A, Simen-Kapeu A, Vesel L, Kim J, Dickson K. Innovative approaches for improving maternal and newborn health--A landscape analysis. BMC Pregnancy Childbirth 2015; 15:337. [PMID: 26679709 PMCID: PMC4683742 DOI: 10.1186/s12884-015-0784-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 12/09/2015] [Indexed: 12/31/2022] Open
Abstract
Background Essential interventions can improve maternal and newborn health (MNH) outcomes in low- and middle-income countries, but their implementation has been challenging. Innovative MNH approaches have the potential to accelerate progress and to lead to better health outcomes for women and newborns, but their added value to health systems remains incompletely understood. This study’s aim was to analyze the landscape of innovative MNH approaches and related published evidence. Methods Systematic literature review and descriptive analysis based on the MNH continuum of care framework and the World Health Organization health system building blocks, analyzing the range and nature of currently published MNH approaches that are considered innovative. We used 11 databases (MedLine, Web of Science, CINAHL, Cochrane, Popline, BLDS, ELDIS, 3ie, CAB direct, WHO Global Health Library and WHOLIS) as data source and extracted data according to our study protocol. Results Most innovative approaches in MNH are iterations of existing interventions, modified for contexts in which they had not been applied previously. Many aim at the direct organization and delivery of maternal and newborn health services or are primarily health workforce interventions. Innovative approaches also include health technologies, interventions based on community ownership and participation, and novel models of financing and policy making. Rigorous randomized trials to assess innovative MNH approaches are rare; most evaluations are smaller pilot studies. Few studies assessed intervention effects on health outcomes or focused on equity in health care delivery. Conclusions Future implementation and evaluation efforts need to assess innovations’ effects on health outcomes and provide evidence on potential for scale-up, considering cost, feasibility, appropriateness, and acceptability. Measuring equity is an important aspect to identify and target population groups at risk of service inequity. Innovative MNH interventions will need innovative implementation, evaluation and scale-up strategies for their sustainable integration into health systems. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0784-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karsten Lunze
- Department of Medicine Boston, Boston University, Boston, MA, USA. .,Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA.
| | - Ariel Higgins-Steele
- Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA. .,Concern Worldwide, 355 Lexington Avenue, New York, NY, 10017, USA.
| | - Aline Simen-Kapeu
- Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA.
| | - Linda Vesel
- Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA. .,Concern Worldwide, 355 Lexington Avenue, New York, NY, 10017, USA.
| | - Julia Kim
- Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA. .,GNH Centre Bhutan, Jaffa's Commercial Building, Room 302, Thimphu, Bhutan.
| | - Kim Dickson
- Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA.
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