Stochastic frontier approach to efficiency analysis of health facilities in providing services for non-communicable diseases in eight LMICs.

BACKGROUND: The rising burden of non-communicable diseases presents an increasing public health challenge to many low- and middle-income countries. This problem may be compounded in health systems with lower levels of technical efficiency (TE). METHODS: This study used recent Service Provision Assessments data to estimate the level of TEs of health facilities in eight countries. Initially, the general and disease-specific service readiness indexes are estimated. Finally, the production function is estimated using the exposures and the outcomes of the model. RESULTS: Evidence shows that the general and disease-specific service readiness indexes are significantly associated with an increase in the number of outpatient visits. Outpatient visits may increase by 14% with an increase in health worker density. Similarly, outpatient visits may increase by 0.3% with a unit increase in the general and diabetes service readiness indexes. Furthermore, outpatient visits may increase by 0.4% and 0.8% with an increase in services readiness for cardiovascular and respiratory diseases. respectively. Overall, the level of TE score suggests the need for improvement. CONCLUSIONS: Facility-level service readiness for chronic diseases is quite low. Therefore, improving health outcomes related to chronic diseases requires urgent investment in high-quality health systems in these countries.

Predicting key drivers for health care expenditure growth in the Middle East region: a Grossman-PLS modeling approach.

BACKGROUND: Numerous studies have provided evidence to the literature on the demand side of the determinants of health-care expenditure by employing the Grossman model. However, understanding the supply side of the determinants of health-care expenditure will be of crucial importance for improving health outcomes. METHODS: This study has used panel data for 15 Middle-East region countries for the time period of 2000-2016 Initially, Grossman's model of the demand for care is estimated. Furthermore, a Parallel model of the supply of care is estimated for contradistinction analysis. Finally, an integrated partial least square structural equation model is being developed. RESULTS: Results show that the relative wage rate and aging variables are the only indicators that are statistically significant with theoretically consistent signs as postulated by Grossman's theoretical model. The opposite is true with schooling and the proxy of the medical care relative prices. However, in the parallel model, all the four drivers of the demand for care are statistically significant determinants of health-care spending. CONCLUSIONS: Therefore, expansion of health insurance coverage particularly for the elderly cohort of the population could be a promising mechanism to boost the demand for care and eventually improve health outcomes.

The dynamics of public and private health expenditure on health outcome in Southeast Asia.

Though the level of public and private health expenditure per capita in Southeast Asia is comparatively below the level of health expenditure in Organisation for Economic Co-operation and Development (OECD) countries, the former has higher rates of under-five and non-communicable disease mortality rates than the latter. Similarly, life expectancy at birth is considerably higher in OECD compared to Southeast Asia, despite the global progress in recent decades. This study examines the dynamics of public and private health expenditure on health outcomes in Southeast Asia, vis-a-vis two of the Sustainable Development Goals targets. The techniques of fixed effect, random effect and feasible generalised least squares methods are used to obtain robust estimates. Furthermore, the analysis dives deep into the analysis of country-specific impacts of public and private health expenditure on health outcomes using the technique of seemingly unrelated regression. Estimates show that, across Southeast Asia, public health expenditure alone contributes to improving life expectancy at birth, lower level of under-five and non-communicable disease mortality rates. Unlike public health expenditure, private health expenditure contributes to better health outcomes only in Brunei and Singapore but not across the countries of Southeast Asia. The implications of the findings and possible future research areas are highlighted further.