IDEAS home Printed from https://ideas.repec.org/a/bla/ijhplm/v37y2022i4p2240-2255.html
   My bibliography  Save this article

Association between efficiency and quality of care of public healthcare facilities: Evidence from Pakistan

Author

Listed:
  • Saima Bashir
  • Muhammad Nasir
  • Katja Grasic
  • Marc Moulin
  • Shehzad Ali

Abstract

Background Maternal and child health is an important component of the Sustainable Development Goals. Pakistan has one of the worst maternal and neonatal health outcomes in the world. This is despite significant health system investments across the country. Aims The objectives of this study are twofold. First, the study estimates the technical efficiency of the public healthcare facilities in Pakistan, defined as the number of obstetric deliveries compared to the number of medical specialists, nurses, and other health and non‐health staff members. Second, the study evaluates the relationship between efficiency and quality of care; the latter is measured in terms of maternal and neonatal mortality. Materials & Methods The data were taken from the Pakistan Health Facility Assessment Survey. Efficiency score was calculated for 843 public healthcare facilities, using Stochastic Frontier Analysis. We then used two‐stage residual inclusion approach with bootstrapping to evaluate the relationship between efficiency and quality. Results and Discussion The average efficiency score was 0.48 (range: 0–1) and none of the public healthcare facilities were on the frontier, implying that efficiency gains can be made across the board. The relationship between efficiency and quality is found to be positive and statistically significant, that is, more efficient healthcare facilities also had lower rates of maternal and neonatal mortality. Conclusion We conclude that more efficient public healthcare facilities also had lower mortality rates, probably due to better infrastructure and health system financing.

Suggested Citation

  • Saima Bashir & Muhammad Nasir & Katja Grasic & Marc Moulin & Shehzad Ali, 2022. "Association between efficiency and quality of care of public healthcare facilities: Evidence from Pakistan," International Journal of Health Planning and Management, Wiley Blackwell, vol. 37(4), pages 2240-2255, July.
    • Handle: RePEc:bla:ijhplm:v:37:y:2022:i:4:p:2240-2255
    DOI: 10.1002/hpm.3465
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hpm.3465
    Download Restriction: no
    File URL: https://libkey.io/10.1002/hpm.3465?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Haroon Jamal, 2016. "Spatial Disparities in Socioeconomic Development: The Case of Pakistan," The Pakistan Development Review, Pakistan Institute of Development Economics, vol. 55(4), pages 421-435.
    2. Hentschker, Corinna & Mennicken, Roman, 2012. "The Relationship between Quality and Hospital Case Volume – An Empirical Examination with German Data," Ruhr Economic Papers 341, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    3. Murad Ali & Megersa Debela & Tewfik Bamud, 2017. "Technical efficiency of selected hospitals in Eastern Ethiopia," Health Economics Review, Springer, vol. 7(1), pages 1-13, December.
    4. Jan Clement & Vivian Valdmanis & Gloria Bazzoli & Mei Zhao & Askar Chukmaitov, 2008. "Is more better? An analysis of hospital outcomes and efficiency with a DEA model of output congestion," Health Care Management Science, Springer, vol. 11(1), pages 67-77, March.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Ferreira, D.C. & Marques, R.C., 2019. "Do quality and access to hospital services impact on their technical efficiency?," Omega, Elsevier, vol. 86(C), pages 218-236.
    2. Thorsen, Maggie & McGarvey, Ronald & Thorsen, Andreas, 2020. "Diabetes management at community health centers: Examining associations with patient and regional characteristics, efficiency, and staffing patterns," Social Science & Medicine, Elsevier, vol. 255(C).
    3. Kuhn, Michael & Wrzaczek, Stefan & Prskawetz, Alexia & Feichtinger, Gustav, 2011. "Externalities in a life cycle model with endogenous survival," Journal of Mathematical Economics, Elsevier, vol. 47(4-5), pages 627-641.
    4. Daniel L. Friesner & Matthew Q. McPherson & Robert Rosenman, 2010. "Are Hospital Pharmacies More Efficient if They Employ Nurses?," Economics Bulletin, AccessEcon, vol. 30(1), pages 139-156.
    5. Li, Sung Ko & He, Xinju, 2019. "The impacts of marketization and subsidies on the treatment quality performance of the Chinese hospitals sector," China Economic Review, Elsevier, vol. 54(C), pages 41-50.
    6. Thorsen, Maggie L. & Thorsen, Andreas & McGarvey, Ronald, 2019. "Operational efficiency, patient composition and regional context of U.S. health centers: Associations with access to early prenatal care and low birth weight," Social Science & Medicine, Elsevier, vol. 226(C), pages 143-152.
    7. Yauheniya Varabyova & Jonas Schreyögg, 2018. "Integrating quality into the nonparametric analysis of efficiency: a simulation comparison of popular methods," Annals of Operations Research, Springer, vol. 261(1), pages 365-392, February.
    8. Hu, Hsin-Hui & Qi, Qinghui & Yang, Chih-Hai, 2012. "Analysis of hospital technical efficiency in China: Effect of health insurance reform," China Economic Review, Elsevier, vol. 23(4), pages 865-877.
    9. Leleu, Hervé, 2013. "Shadow pricing of undesirable outputs in nonparametric analysis," European Journal of Operational Research, Elsevier, vol. 231(2), pages 474-480.
    10. Nils Gutacker & Chris Bojke & Silvio Daidone & Nancy J. Devlin & David Parkin & Andrew Street, 2013. "Truly Inefficient Or Providing Better Quality Of Care? Analysing The Relationship Between Risk‐Adjusted Hospital Costs And Patients' Health Outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 22(8), pages 931-947, August.
    11. Hentschker, Corinna & Mennicken, Roman, 2014. "Selective-referral and Unobserved Patient Heterogeneity – Bias in the Volume-outcome Relationship," Ruhr Economic Papers 527, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    12. Sebastian Kohl & Jan Schoenfelder & Andreas Fügener & Jens O. Brunner, 2019. "The use of Data Envelopment Analysis (DEA) in healthcare with a focus on hospitals," Health Care Management Science, Springer, vol. 22(2), pages 245-286, June.
    13. repec:ebl:ecbull:v:30:y:2010:i:1:p:139-156 is not listed on IDEAS
    14. Jan Clement & Vivian Valdmanis & Gloria Bazzoli & Mei Zhao & Askar Chukmaitov, 2011. "Response to modeling and notation of DEA with strong and weak disposable outputs," Health Care Management Science, Springer, vol. 14(4), pages 391-391, November.
    15. Anne Hvenegaard & Jacob Arendt & Andrew Street & Dorte Gyrd-Hansen, 2011. "Exploring the relationship between costs and quality: Does the joint evaluation of costs and quality alter the ranking of Danish hospital departments?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(6), pages 541-551, December.
    16. Ortega-Díaz, M. Isabel & Martín, Juan Carlos, 2022. "How to detect hospitals where quality would not be jeopardized by health cost savings? A methodological approach using DEA with SBM analysis," Health Policy, Elsevier, vol. 126(10), pages 1069-1074.
    17. : Álvaro Almeida & José Pedro Fique, 2011. "Evaluating Hospital Efficiency Adjusting for Quality Indicators: an Application to Portuguese NHS Hospitals," FEP Working Papers 435, Universidade do Porto, Faculdade de Economia do Porto.
    18. Habib Zare & Madjid Tavana & Abbas Mardani & Sepideh Masoudian & Mahyar Kamali Saraji, 2019. "A hybrid data envelopment analysis and game theory model for performance measurement in healthcare," Health Care Management Science, Springer, vol. 22(3), pages 475-488, September.
    19. Jana Borůvková & Martina Kuncová, 2012. "Comparison of the Ophthalmology Departments of the Vysocina Region Hospitals Using DEA Models [Porovnání očních oddělení nemocnic kraje Vysočina pomocí DEA modelů]," Acta Oeconomica Pragensia, Prague University of Economics and Business, vol. 2012(5), pages 75-84.
    20. Christoph Pross & Christoph Strumann & Alexander Geissler & Helmut Herwartz & Nadja Klein, 2018. "Quality and resource efficiency in hospital service provision: A geoadditive stochastic frontier analysis of stroke quality of care in Germany," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-30, September.
    21. Ferreira, D.C. & Marques, R.C. & Nunes, A.M., 2018. "Economies of scope in the health sector: The case of Portuguese hospitals," European Journal of Operational Research, Elsevier, vol. 266(2), pages 716-735.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:bla:ijhplm:v:37:y:2022:i:4:p:2240-2255. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www.blackwellpublishing.com/journal.asp?ref=0749-6753 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.