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Efficiency Measurement in Health Facilities: A Systematic Review in Low- and Middle-Income Countries


  • Firdaus Hafidz

    () (University of Leeds
    Universitas Gadjah Mada)

  • Tim Ensor

    () (University of Leeds)

  • Sandy Tubeuf

    () (University of Leeds)


Abstract Background Limited healthcare resources in low- and middle-income countries (LMICs) have led policy-makers to improve healthcare efficiency. Therefore, it is essential to understand how efficiency has been measured in the LMIC setting. Objective This paper reviews methodologies used for efficiency studies in health facilities in LMICs. Methods We searched MEDLINE, Embase, Global Health, EconLit and ProQuest Dissertations and Theses databases to Week 6 in 2018. We included all types of quantitative analysis studies relating to the measurement of the efficiency of services at health facilities in LMICs. We extracted data from eligible studies, and assessed the validity for each study. Because of the substantial heterogeneity of the studies, results were presented narratively. Results A total of 137 papers were eligible for inclusion. These articles covered a wide range of health facility types, with more than half of the studies relating to hospitals. Our systematic review showed that there is an increasing trend in efficiency measurements in LMICs using various methods. Most studies employed data envelopment analysis as an efficiency measurement method. The studies typically included physical inputs and health services as outputs. Sixty-one percent of the studies analysed the contextual variables of the health facility efficiency. Conclusion This review highlights the potential for methodological improvement and policy impacts in efficiency measurements.

Suggested Citation

  • Firdaus Hafidz & Tim Ensor & Sandy Tubeuf, 2018. "Efficiency Measurement in Health Facilities: A Systematic Review in Low- and Middle-Income Countries," Applied Health Economics and Health Policy, Springer, vol. 16(4), pages 465-480, August.
  • Handle: RePEc:spr:aphecp:v:16:y:2018:i:4:d:10.1007_s40258-018-0385-7
    DOI: 10.1007/s40258-018-0385-7

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    References listed on IDEAS

    1. Audibert, Martine & Mathonnat, Jacky & Pelissier, Aurore & Huang, Xiao Xian & Ma, Anning, 2013. "Health insurance reform and efficiency of township hospitals in rural China: An analysis from survey data," China Economic Review, Elsevier, vol. 27(C), pages 326-338.
    2. Matranga, Domenica & Sapienza, Francesca, 2015. "Congestion analysis to evaluate the efficiency and appropriateness of hospitals in Sicily," Health Policy, Elsevier, vol. 119(3), pages 324-332.
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    5. Jacobs,Rowena & Smith,Peter C. & Street,Andrew, 2006. "Measuring Efficiency in Health Care," Cambridge Books, Cambridge University Press, number 9780521851442, March.
    6. Martine Audibert & Jacky Mathonnat & Aurore Pelissier & Xiao Xian Huang & Anning Ma, 2013. "Health insurance reform and efficiency of township hospitals in rural China: An analysis from survey data," Post-Print halshs-01230210, HAL.
    7. Pablo Arocena & Ariadna García‐Prado, 2007. "Accounting for quality in the measurement of hospital performance: evidence from Costa Rica," Health Economics, John Wiley & Sons, Ltd., vol. 16(7), pages 667-685, July.
    8. Emrouznejad, Ali & Parker, Barnett R. & Tavares, Gabriel, 2008. "Evaluation of research in efficiency and productivity: A survey and analysis of the first 30 years of scholarly literature in DEA," Socio-Economic Planning Sciences, Elsevier, vol. 42(3), pages 151-157, September.
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    Blog mentions

    As found by, the blog aggregator for Economics research:
    1. Thesis Thursday: Firdaus Hafidz
      by Chris Sampson in The Academic Health Economists' Blog on 2019-01-17 07:00:26


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    1. Akkan, Can & Karadayi, Melis Almula & Ekinci, Yeliz & Ülengin, Füsun & Uray, Nimet & Karaosmanoğlu, Elif, 2020. "Efficiency analysis of emergency departments in metropolitan areas," Socio-Economic Planning Sciences, Elsevier, vol. 69(C).

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