Efficiency and productivity assessment of public hospitals in Greece during the crisis period 2009-2012.

BACKGROUND: This study is an initial effort to examine the dynamics of efficiency and productivity in Greek public hospitals during the first phase of the crisis 2009-2012. Data were collected by the Ministry of Health after several quality controls ensuring comparability and validity of hospital inputs and outputs. Productivity is estimated using the Malmquist Indicator, decomposing the estimated values into efficiency and technological change. METHODS: Hospital efficiency and productivity growth are calculated by bootstrapping the non-parametric Malmquist analysis. The advantage of this method is the estimation efficiency and productivity through the corresponding confidence intervals. Additionally, a Random-effects Tobit model is explored to investigate the impact of contextual factors on the magnitude of efficiency. RESULTS: Findings reveal substantial variations in hospital productivity over the period from 2009 to 2012. The economic crisis of 2009 had a negative impact in productivity. The average Malmquist Productivity Indicator (MPI) score is 0.72 with unity signifying stable production. Approximately 91% of the hospitals score lower than unity. Substantial increase is observed between 2010 and 2011, as indicated by the average MPI score which fluctuates to 1.52. Moreover, technology change scored more than unity in more than 75% of hospitals. The last period (2011-2012) has shown stabilization in the expansionary process of productivity. The main factors contributing to overall productivity gains are increases in occupancy rates, type and size of the hospital. CONCLUSIONS: This paper attempts to offer insights in efficiency and productivity growth for public hospitals in Greece. The results suggest that the average hospital experienced substantial productivity growth between 2009 and 2012 as indicated by variations in MPI. Almost all of the productivity increase was due to technology change which could be explained by the concurrent managerial and financing healthcare reforms. Hospitals operating under decreasing returns to scale could achieve higher efficiency rates by reducing their capacity. However, certain social objectives should also be considered. Emphasis perhaps should be placed in utilizing and advancing managerial and organizational reforms, so that the benefits of technological improvements will have a continuing positive impact in the future.

Survey sheds new light on marriage and sexuality in the Philippines.

PIP: The Young Adults Fertility and Sexuality Study (YAFS-II) was conducted in 1994 by interviewing 10,879 men and women aged 15-24 years in households on dating, marriage, and onset of sexual activity in the Philippines. In addition, screening data were collected on all households visited and on the 959 sampled local communities. Direct questions on premarital sex revealed that at least 52% of married women had sex before marriage. Among married respondents, 57% of men and 51% of women reported having had sex with their spouse before they were married. Only 3% of the women had additional premarital partners vs. 37% of the men. Questions on premarital sex and social patterns showed that about 20% of the single women and 28% of the single men had been in a serious relationship by the time they were 17. By age 20, 44% of the single women and 63% of the single men had been in a serious relationship, while the respective figures by age 24 were 60% and 68%. Altogether 24% of the women and 10% of the men described themselves as married. 34% of all women who either eloped or lived with their spouses had been married in church by the time of the survey, 23% had had civil ceremonies, and 41% designated their marital status as cohabitation. With regard to the risk of HIV/AIDS and other sexually transmitted diseases, 25% of the 24-year old men who never had a girlfriend reported sexual experience and 22% of those still single at age 24 reported that they had visited a commercial sex worker. Marital status was not the best basis for providing family planning services, and the provision of reproductive health services to young people living in consensual union would reduce accidental pregnancy.^ieng

Partner patterns in the sexual behavior of unmarried, rural Thai men.

"After a brief discussion of related studies of Thai youths' attitudes toward sexual activity, data from a 1988 national survey of young males (ages 15-24) about their family planning knowledge, attitudes, and practices are used to document the age pattern of sexual initiation, the prevalence of youths' encounters with commercial sex workers, the prevalence of their experience with non-commercial partners...and the degree to which the two patterns--commercial and noncommercial--are 'networked' because young men engage in both types of sexual activity. Finally, background characteristics of male youths that are associated with these patterns of sexual activity are examined."

A look at Asia's changing youth population.

PIP: This report summarizes findings from a recent East-West Center study on demographic and social changes among young people aged 15-24 years in 17 countries in East, Southeast, and South Asia. Nearly every country in Asia has experienced fertility decline. Decline began in Japan and Singapore during the 1950s, followed by declines in Hong Kong, South Korea, Sri Lanka, the Philippines, Brunei, Taiwan, Malaysia, Thailand, and China during the 1960s. Declines occurred during the 1970s in Indonesia, India, and Myanmar. A "youth bulge" occurred about 20 years later due to declines in infant and child mortality. This bulge varies by country with the timing and magnitude of population growth and subsequent fertility decline. The proportion of youth population rises from 16% to 18% about 20 years after the beginning of fertility decline and declines to a much lower stable level after several decades. The bulge is large in countries with rapid fertility decline, such as China. Governments can minimize the effects of bulge on population growth by raising the legal age at marriage, lengthening the interval between first marriage and first birth, and increasing birth intervals. School enrollments among adolescents are rising. In South Korea, the population aged 15-24 years increased from 3.8 to 8.8 million during 1950-90, a rise of 132% compared to a rise of 653% among school enrollments. It is expected that the number of out-of-school youths will decline from 5.1 to 3.6 million during 1990-2025. Youth employment varies by gender. Policies/programs in family planning and reproductive health will need to address the changing needs of youth population.^ieng