Efficiency dynamics among onion growers in Maharashtra: a comparative analysis of drip irrigation adopters and non-adopters.

BACKGROUND: Onions are economically and nutritionally important vegetable crops. Despite advances in technology and acreage, Indian onion growers face challenges in realizing their full productivity potential. This study examines the technical efficiency of onion growers, the factors influencing it, and the constraints faced by those adopting drip irrigation in the Ghod river basin of western Maharashtra. A sample of 480 farmers including those practicing drip irrigation and those not practicing it, was selected from Junnar, Shirur, Parner, and Shrigonda blocks of the basin. The primary data was collected through semi-structured interviews. Analytical tools such as the Cobb-Douglas production function (represents technological relationship between multiple inputs and the resulting output), a single-stage stochastic frontier model, the Tobit model, and descriptive statistics were used to assess the technical efficiency of onion production at the farm level. RESULTS: According to the maximum likelihood estimates of the stochastic frontier analysis, drip adopters exhibited a mean technical efficiency of 92%, while for non-adopters it was 65%. It indicates that the use of drip irrigation technology is associated with higher technical efficiency. The association of technical efficiency and socio-economic characters of households showed that education, extension contacts, social participation, and use of information sources had a positive influence on technical efficiency, while family size had a negative influence on the drip irrigation adopters. For non-drip adopters, significant positive effects were observed for landholding, extension contact, and information source use. The major constraints faced by drip system adopters included a lack of knowledge about the proper operating techniques for drip systems and the cost of maintenance. CONCLUSION: The differences with inputs associated with two irrigation methods showed that the response of inputs to increase onion yield is greater for farmers who use drip irrigation than for farmers who do not, and are a result of the large differences in the technical efficiencies. These inefficiencies and other limitations following the introduction of drip irrigation, such as lack of knowledge about the proper operations, need to be addressed through tailored training for farmers and further interventions.

The efficiency of clinical laboratories: the case of Kerman province.

BACKGROUND: Medical diagnostic laboratories are an essential work environment that plays an important role in diagnosing, treating, and being sensitive to diseases. One way to evaluate laboratories' performance is to calculate their efficiency. This study investigates the efficiency of laboratories that are related to health centers in the south of Iran. METHODS: This study was conducted in 2021. The input numbers include: the number of technical personnel and the number of cell counters, and the output data includes: the scores obtained from the level 2 health laboratory evaluation list. And efficiency was calculated with DEAP software. The analysis is accomplished by the assumption of input-oriented. FINDINGS: The efficiency of laboratories of Orzueeyeh and Ravar Cities had the highest efficiency with the assumption of variable returns to scale efficiency 1, and the model of all laboratories is the laboratory of Ravar City. The laboratories of Kuhbanan and Rabor cities had the lowest efficiency with the assumption of variable returns to scale efficiency of 0.859 and 0.899, respectively. The average scale efficiency, Variable returns to scale, and constant returns to scale for laboratories in the cities of Kerman province are 0.842, 0.943, and 0.895, respectively. CONCLUSIONS: To increase the efficiency of laboratories, significant resources and funds should be used, as well as few studies have been done on the efficiency of laboratories, which requires more attention.

Do adjustment costs constrain public healthcare providers' technical efficiency? Evidence from the New Zealand Public Healthcare System.

Efficiency analysis is crucial in healthcare to optimise resource allocation and enhance patient outcomes. However, the prompt adaptation of inputs can be hindered by adjustment costs, which impact Long-Run Technical Efficiency (LRTE). To bridge this gap in healthcare literature, this research employs a Bayesian Dynamic Stochastic Frontier Model to estimate parameters and explore healthcare efficiency dynamics over time. The study reveals the LRTE for New Zealand District Health Boards (DHBs) as 0.76, indicating around 32% more input utilisation due to adjustment costs. Most DHBs exhibit consistent short-run operational efficiency, with the national Short-Run Technical Efficiency (SRTE) very close to the LRTE. Among the tertiary providers, Auckland and Capital & Coast DHBs operate below the LRTE level, setting them apart from other tertiary providers. Similarly, Tairawhiti and West Coast DHBs also fall below the LRTE level, as indicated by their SRTE scores, potentially influenced by their unique healthcare settings and resource challenges. This research brings a new perspective to policy discussions by incorporating the temporal dynamics of decision-making and considering adjustment costs. It underscores the need to balance short-term and long-term technical efficiency, underlining their collective significance in fostering a sustainable and efficient healthcare system in New Zealand.

Assessment of care provision integration in a community-based mental health system: balanced care model implementation in Andalusia (Spain).

BACKGROUND: Andalusia is the second largest region in Spain, and it has developed a comprehensive mental health (MH) plan that encourages the consolidation of the balanced care model. However, its geographical and socioeconomic disparity is a great challenge for a community-based MH system. Both the assessment of the implementation of the MH plan and the development of new tools to support decision-making can be considered critical. OBJECTIVES: The present study aims (i) to assess how the integration of different types of MH care may influence system performance and (ii) to check the performance evolution of the integration process geographically regarding the small MH areas of Andalusia. METHODS: The performance of the Andalusian MH system was assessed by combining Monte Carlo simulation, fuzzy inference and data envelopment analysis. The relative technical efficiency was the main performance indicator. RESULTS: A correct integration of appropriate types of MH care, according to population needs, increases the performance of the Andalusian MH system both from global and regional perspectives. The spatial representation (based on small MH areas) of the results highlights how the performance depends on specific geographical characteristics. By analyzing the identified spatial clusters, defined by different management patterns depending on user and socioeconomic characteristics, benchmark areas and areas for improvement can be studied to design evidence-informed policies and interventions. CONCLUSIONS: A global analysis of MH system performance was carried out, including both the successive integration of different types of care and its spatial evolution. Although an appropriate integration of different types of MH care has a positive effect on the Andalusian MH system, this process has different profiles depending on specific geographically based user and socioeconomic characteristics. The balanced care model can be considered the paradigm for assessing the performance of a large and populated territory such as Andalusia, which has a community-based MH system. This methodological approach (performance assessment and spatial analysis) may be used as a guide for developing future evidence-informed policies and managerial interventions.

Technical efficiency and its determinants in health service delivery of public health centers in East Wollega Zone, Oromia Regional State, Ethiopia: Two-stage data envelope analysis.

BACKGROUND: Priority-setting becomes more difficult for decision-makers when the demand for health services and health care resources rises. Despite the fact that the Ethiopian healthcare system places a strong focus on the efficient utilization and allocation of health care resources, studies of efficiency in healthcare facilities have been very limited. Hence, the study aimed to evaluate efficiency and its determinants in public health centers. METHODS: A cross-sectional study was conducted in the East Wollega zone, Oromia Regional State, Ethiopia. Ethiopian fiscal year of 2021-2022 data was collected from August 01-30, 2022 and 34 health centers (decision-making units) were included in the analysis. Data envelope analysis was used to analyze the technical efficiency. A Tobit regression model was used to identify determinants of efficiency, declaring the statistical significance level at P < 0.05, using 95% confidence interval. RESULTS: The overall efficiency score was estimated to be 0.47 (95% CI = 0.36-0.57). Out of 34 health centers, only 3 (8.82%) of them were technically efficient, with an efficiency score of 1 and 31 (91.2%) were scale-inefficient, with an average score of 0.54. A majority, 30 (88.2%) of inefficient health centers exhibited increasing return scales. The technical efficiency of urban health centers was (ß = -0.35, 95% CI: -0.54, -0.07) and affected health centers' catchment areas by armed conflicts declined (ß = -0.21, 95% CI: -0.39, -0.03) by 35% and 21%, respectively. Providing in-service training for healthcare providers increased the efficiency by 27%; 95% CI, ß = 0.27(0.05-0.49). CONCLUSIONS: Only one out of ten health centers was technically efficient, indicating that nine out of ten were scale-inefficient and utilized nearly half of the healthcare resources inefficiently, despite the fact that they could potentially reduce their inputs nearly by half while still maintaining the same level of outputs. The location of health centers and armed conflict incidents significantly declined the efficiency scores, whereas in-service training improved the efficiency. Therefore, the government and health sector should work on the efficient utilization of healthcare resources, resolving armed conflicts, organizing training opportunities, and taking into account the locations of the healthcare facilities during resource allocation.

Level of technical efficiency and associated factors among health centers in East Gojjam Zone, Northwest Ethiopia: an application of the data envelopment analysis.

BACKGROUND: Besides the scarcity of resources, inefficient utilization of available health service resources has been the bottleneck to deliver quality health services in Ethiopia. However, Information regarding the efficiency of health service providers is limited in the country. Health service managers and policy makers must be well informed about the efficiency of health service providers and ways of using limited resources efficiently to make evidence-based decisions. This study aimed to assess the level of technical efficiency and associated factors among health centers in East Gojjam Zone, Northwest Ethiopia. METHODS: A facility-based cross-sectional study was conducted among 27 randomly selected health centers in East Gojjam zone, Northwest Ethiopia, from October 30, 2022, to April 30, 2023. Using an interviewer-administered questionnaire and document review checklist, health centers' data was collected and entered to Epi-Data version 4.6. The data was exported to Microsoft office excel and Stata version 14 for analysis. A two-stage output-oriented data envelopment analysis with a variable return to scale assumption was employed to determine the level of technical efficiencies. Finally, the tobit regression model was applied to identify the associated factors at 5% level of significance. RESULTS: In this study, 59.3% of the health centers were technically efficient. The mean technical efficiency score of the health centers was 0.899 ± 0.156. Inefficient health centers could provide more 22, 433 outpatient visits, 1,351 family planning visits, 155 referral services, 206 skilled deliveries and 385 fully vaccinations of children if they were technically efficient as their peer health centers for the same year. From the tobit regression, the catchment population and number of administrative staffs were statistically significant determinants of the technical efficiency of health centers. CONCLUSIONS: The mean technical efficiency of the health centers in East Gojjam zone, Northwest Ethiopia was high. However, nearly half of the health centers were technically inefficient, which indicates the exitance of a space for further improvements in the productivity of these health centers. Employing excess number administrative staffs (above the optimal level) should be discouraged and selecting appropriate sites where the health centers to be constructed (to have large catchment population coverage) could improve the productivity of health centers.

Exploring the association between primary care efficiency and health system characteristics across European countries: a two-stage data envelopment analysis.

BACKGROUND: Primary care is widely seen as a core component of resilient and sustainable health systems, yet its efficiency is not well understood and there is a lack of evidence about how primary care efficiency is associated with health system characteristics. We examine this issue through the lens of diabetes care, which has a well-established evidence base for effective treatment and has previously been used as a tracer condition to measure health system performance. METHODS: We developed a conceptual framework to guide the analysis of primary care efficiency. Using data on 18 European countries during 2010-2016 from several international databases, we applied a two-stage data envelopment analysis to estimate (i) technical efficiency of primary care and (ii) the association between efficiency and health system characteristics. RESULTS: Countries varied widely in terms of primary care efficiency, with efficiency scores depending on the range of population characteristics adjusted for. Higher efficiency was associated with bonus payments for the prevention and management of chronic conditions, nurse-led follow-up, and a financial incentive or requirement for patients to obtain a referral to specialist care. Conversely, lower efficiency was associated with higher rates of curative care beds and financial incentives for patients to register with a primary care provider. CONCLUSIONS: Our results underline the importance of considering differences in population characteristics when comparing country performance on primary care efficiency. We highlight several policies that could enhance the efficiency of primary care. Improvements in data collection would enable more comprehensive assessments of primary care efficiency across countries, which in turn could more effectively inform policymaking.

Impact of the workforce allocation on the technical performance of mental health services: the collective case of Helsinki-Uusimaa (Finland).

BACKGROUND: Long-term mental health (MH) policies in Finland aimed at investing in community care and promoting reforms have led to a reduction in the number of psychiatric hospital beds. However, most resources are still allocated to hospital and community residential services due to various social, economic and political factors. Despite previous research focussing on the number and cost of these services, no study has evaluated the emerging patterns of use, their technical performance and the relationship with the workforce structure. OBJECTIVE: The purpose of this study was to observe the patterns of use and their technical performance (efficiency) of the main types of care of MH services in the Helsinki-Uusimaa region (Finland), and to analyse the potential relationship between technical performance and the corresponding workforce structure. METHODS: The sample included acute hospital residential care, non-hospital residential care and outpatient care services. The analysis was conducted using regression analysis, Monte Carlo simulation, fuzzy inference and data envelopment analysis. RESULTS: The analysis showed a statistically significant linear relationship between the number of service users and the length of stay, number of beds in non-hospital residential care and number of contacts in outpatient care services. The three service types displayed a similar pattern of technical performance, with high relative technical efficiency on average and a low probability of being efficient. The most efficient acute hospital and outpatient care services integrated multidisciplinary teams, while psychiatrists and nurses characterized non-hospital residential care. CONCLUSIONS: The results indicated that the number of resources and utilization variables were linearly related to the number of users and that the relative technical efficiency of the services was similar across all types. This suggests homogenous MH management with small variations based on workforce allocation. Therefore, the distribution of workforce capacity should be considered in the development of effective policies and interventions in the southern Finnish MH system.

Is the technical efficiency green? The environmental efficiency of agricultural production in the MENA region.

There is widespread recognition of the global environmental impact of agricultural production on greenhouse gas emissions, but evidence is sparse regarding the impact in the Middle East and North Africa (MENA) region. In this study, we treat agricultural emissions as an undesirable output from agricultural production and apply the directional distance function to measure environmentally-adjusted technical efficiency, defined as environmental efficiency in agricultural production, in six countries in the MENA region (Algeria, Egypt, Israel, Jordan, Morocco, Tunisia) during the period 1980-2016. The results show that all six countries have clear scope to improve their environmental efficiency. Agricultural production is greener in Jordan and Israel, while environmental efficiency is currently lowest in Egypt and Morocco. Estimated relative shadow price of agricultural emissions is -1.002, implying that the 'cost' of removing agricultural emissions is almost equal to the value of producing one unit of good output. These findings suggest there is a trade-off between agriculture emissions and production, which should be considered in efforts to enhance the sustainability of agricultural production in the MENA region.

Managing nitrogen environmental impacts to improve green technical efficiency in Philippines rice cultivation.

The efficient use of nitrogen fertilisers is a global priority to optimise the economic and environmental outcomes of farming. This paper is the first to consider pollution in the form of nitrous oxide emissions and excess nitrogen to analyse technical efficiency (TE) in farming. This is done by extending the two-stage double bootstrap Data Envelopment Analysis to explicitly model nitrogen pollutants as undesirable outputs. We compared green TE (when undesirable pollutants are considered) and conventional TE (without pollutants) using a case study of 33 rice-producing provinces in the Philippines. Provinces in Mindanao, Luzon, and Visayas islands experienced improvements in green TE but stagnant conventional TE from 2006 to 2017. Although transplanting rice seedlings (rather than direct sowing of seeds) improved both green and conventional TE, seed quality was also identified as an important factor for green TE but not for conventional TE. Our analysis has implications for sustainable rice production and such analysis can be extended to other crops. To advance the effective green transformation of rice production, future research should analyse farm-level data to understand farmers' decisions regarding seed quality, crop establishment method and nitrogen fertiliser application to devise comprehensive farm integrated management plans.

Efficiency analysis of primary healthcare facilities in Afghanistan.

BACKGROUND: Afghanistan's health system is unique in that primary healthcare is delivered by non-governmental organizations funded by multilateral or bilateral donors, not the government. Given the wide range of implementers providing the basic package of health services, there may be performance differences in service delivery. This study assessed the relative technical efficiency of different levels of primary healthcare services and explored its determinants. METHOD: Data envelopment analysis was used to assess the relative technical efficiency of three levels of primary healthcare facilities (comprehensive, basic, and sub-health centers). The inputs included personnel and capital expenditure, while the outputs were measured by the number of facility visits. Data on inputs and outputs were obtained from national health information databases for 1263 healthcare facilities in 31 provinces. Bivariate analysis was conducted to assess the correlation of various elements with efficiency scores. Regression models were used to identify potential factors associated with efficiency scores at the health facility level. RESULTS: The average efficiency score of health facilities was 0.74 when pooling all 1,263 health facilities, with 102 health facilities (8.1%) having efficiency scores of 1 (100% efficient). The lowest quintile of health facilities had an average efficiency score of 0.36, while the highest quintile had a score of 0.96. On average, efficiency scores of comprehensive health centers were higher than basic and sub-health centers by 0.11 and .07, respectively. In addition, the difference between efficiency scores of facilities in the highest and lowest quintiles was highest in facilities that offer fewer services. Thus, they have the largest room for improvement. CONCLUSIONS: Our findings show that public health facilities in Afghanistan that provide more comprehensive primary health services use their resources more efficiently and that smaller facilities have more room for improvement. A more integrated delivery model would help improve the efficiency of providing primary healthcare in Afghanistan.

Changes in productivity in healthcare services in the Kingdom of Saudi Arabia.

BACKGROUND: Amid the rising demand for healthcare services in Saudi Arabia, there is a need to monitor, evaluate, and improve performance in the delivery of these services. In this regard, the aim of this study was to estimate changes in total factor productivity (TFP) in healthcare services across the health system administrative regions in Saudi Arabia from 2006 to 2018. The contributions of changes in efficiency and technology to the observed changes in TFP were further evaluated. METHODS: The data used for this study were extracted from annual Ministry of Health Statistical Yearbooks for the period of 2006-2018. TFP changes were estimated using the Malmquist Productivity Index, in which technology frontiers were constructed through data envelopment analysis. The changes in TFP were decomposed into changes in technology, changes in pure technical efficiency, and changes in scale efficiency following the Färe-Grosskopf-Norris-Zhang method. As robustness checks, we used bootstrapping to construct intervals and applied alternative decomposition methods. The changes in TFP and its sources were also compared between public and private hospitals. RESULTS: Over the period from 2006 to 2018, TFP for healthcare services has decreased on average by 5.6% per year solely on account of a technical regress. Public hospitals registered a higher deterioration in productivity (6.0% per year) than private hospitals (4.8% per year). CONCLUSION: Using the available resources, there is potential for realising gains in productivity of healthcare services by addressing existing technological challenges. Since the decline in TFP is entirely a problem of technical regress, the primary solution should focus on strategies for achieving technical progress (innovation) through investment in more or better machinery, equipment, and structures for healthcare service provision.

Can a global budget improve health care efficiency? Experimental evidence from China.

Health care in China suffers from substantial allocative inefficiency in the delivery system and technical inefficiency within hospitals. To ameliorate this problem in rural areas, the Analysis of Provider Payment Reforms on Advancing China's Health (APPROACH) project shifted the payment method of China's rural health insurance scheme for county hospitals from fee-for-service to a novel global budget. In particular, APPROACH global budget incentivized system-level allocative efficiency by reimbursing county hospitals at higher tariffs for gatekeeping and averting out-of-county (OOC) admissions among local patients they could treat. APPROACH conducted a large-scale randomized controlled trial of the global budget in 56 counties (22 million enrollees) of Guizhou province during 2016-2017. Applying randomization inference to claims data, we find a significant shift of inpatient utilization and expenditure from OOC hospitals to county hospitals. At county hospitals, average expenditure per admission and length of stay decreased, though not significantly. Effects on readmissions show no clear sign of compromised quality. We further find limited effect heterogeneity with respect to treatment and hospital characteristics. Overall, APPROACH global budget may offer a framework for improving health care efficiency without sacrificing quality.

Analysis of factors influencing technical efficiency of public district hospitals in KwaZulu-Natal province, South Africa.

BACKGROUND: District hospitals are crucial in supporting primary health care and serve as a gateway to more specialist care through a referral system. Majority of South Africans access health care services through the public sector district health system. Given the enormous task assigned to the public district hospital within the country, this study examined factors influencing their technical efficiency. METHOD: Data were collected for 38 public district hospitals in KwaZulu-Natal province from 2014/15 to 2016/17. Data envelopment analysis (DEA) was used to determine the technical efficiency of the hospitals, adopting both the constant return to scale (CRS) and variable return to scale (VRS) models. Tobit regression model was used to determine factors related to the technical efficiency of the district hospitals. RESULTS: This study showed that a significant proportion of the district hospitals were technically inefficient. The Tobit regression model identified catchment population, the proportion of inpatients treated per medical personnel, the proportion of inpatients treated per nursing personnel and expenditure per patient day equivalent as factors influencing technical efficiency of the district hospitals. CONCLUSION: Findings from this study suggest that the technical efficiency of the district hospitals can be enhanced through an effective referral system and improved peoples' health-seeking behaviour. In addition, a standard mix of clinical staff toward efficient service delivery and periodic cost analysis of health services with the view to saving cost and maintaining the quality of health care should be considered.

The technical efficiency of maternal and child health hospitals in China: a case study of Hubei Province.

BACKGROUND: Maternal and child health (MCH) hospitals play an essential role in providing MCH services in China, while the supply has become increasingly challenging in the past decade, especially among secondary MCH hospitals. In this study we aimed to evaluate the technical efficiency (TE) of secondary MCH hospitals in Hubei province (China) to generate evidence-based decision-making for efficiency improvement. METHODS: The data were collected from the Department of Maternal and Child Health of Health Commission of Hubei Province in 2019. A total of 59 out of 74 secondary MCH hospitals were included as our study sample. Four input indicators (number of health professionals, number of beds, number of equipment with value greater than 10,000 RMB Yuan, building area for hospital operations) and three output indicators (number of total diagnostic patients, number of discharged patients, and number of birth deliveries) were selected based on previous literature. TE scores of the sample hospitals were estimated by using Bootstrap-Data Envelopment Analysis (Bootstrap-DEA). RESULTS: After bias-correction with Bootstrap-DEA model, the average TE score of the MCH hospitals was 0.673. 20 (33.89%) MCH hospitals had TE scores below the average. No MCH hospitals achieved excellent efficiency; 16 (27.11%) MCH hospitals reached good efficiency; and 26 (44.06%) MCH hospitals fell into poor and failing efficiency. Besides, 17 MCH hospitals had TE scores of 1 before bias-corrections, while none of them reached 1 after bias correction. CONCLUSIONS: Significant capacity variations existed among the secondary MCH hospitals in terms of input and output indicators and their overall TE was low in Hubei of China. For better improvement, the secondary MCH hospitals in Hubei need to improve their internal management and strengthen the construction of their information systems. A series of policy supports are needed from the health and insurance administrations to optimize health resources. Third-party performance evaluation can be piloted to improve efficiency and overall performance of the MCH hospitals. The policy recommendations we raise for MCH hospitals in Hubei can be worth learning for some low- and middle- income countries.

Green fodder cultivation improves technical efficiency of dairy farmers in semi-arid tropics of central India: a micro-analysis.

This study assessed the impact of improved green fodder production activities on technical efficiency (TE) of dairy farmers in climate vulnerable landscapes of central India. We estimated stochastic production frontiers, considering potential self-selection bias stemming from both observable and unobservable factors in adoption of fodder interventions at farm level. The empirical results show that TE for treated group ranges from 0.55 to 0.59 and that for control ranges from 0.41 to 0.48, depending on how biases are controlled. Additionally, the efficiency levels of both adopters and non-adopters would be underestimated if the selectivity bias is not appropriately accounted. As the average TE is consistently higher for adopter farmers than the control group, promoting improved fodder cultivation would increase input use efficiency, especially in resource-deprived small holder dairy farmers in the semi-arid tropics.

The productive efficiency of community health service stations in China: Taking Shandong province as a case.

The present study evaluated the efficiencies of community health service (CHS) stations based on a survey of 1246 CHS stations, covering nine subcategories in 16 cities in Shandong province. Data envelopment analysis (DEA) was applied to investigate the overall efficiency, the technical and the scale efficiency of community health care resources. The results are, the overall efficiency was 9.47%, and the overall efficiency was generally higher in the central-west region than in the east. There were 23.27% of CHS stations showing technically efficient. The technical efficiency was higher in the east (31.11%) relative to the central-west (19.72%), and 72.71% of CHS stations had a technical efficiency higher than the regional average efficiency. The scale efficiency was 9.31% for CHS stations in Shandong province, being the decisive factor for overall efficiency, and 68.96% of CHS stations showed a scale efficiency above the regional average. Stations held by enterprises and universities, and extended by tertiary hospitals had lower efficiencies than other types of CHS stations. In conclusion, the CHS stations had low efficiencies in general, and scale inefficiencies were the main cause. Related suggestions to improve the efficiency are provided accordingly.

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

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.

The executive function of bilingual and monolingual children: A technical efficiency approach.

This paper introduces a novel approach to evaluate performance in the executive functioning skills of bilingual and monolingual children. This approach targets method- and analysis-specific issues in the field, which has reached an impasse (Antoniou et al., 2021). This study moves beyond the traditional approach towards bilingualism by using an array of executive functioning tasks and frontier methodologies, which allow us to jointly consider multiple tasks and metrics in a new measure; technical efficiency (TE). We use a data envelopment analysis technique to estimate TE for a sample of 32 Greek-English bilingual and 38 Greek monolingual children. In a second stage, we compare the TE of the groups using an ANCOVA, a bootstrap regression, and a k-means nearest-neighbour technique, while controlling for a range of background variables. Results show that bilinguals have superior TE compared to their monolingual counterparts, being around 6.5% more efficient. Robustness tests reveal that TE yields similar results to the more complex conventional MANCOVA analyses, while utilising information in a more efficient way. By using the TE approach on a relevant existing dataset, we further highlight TE's advantages compared to conventional analyses; not only does TE use a single measure, instead of two principal components, but it also allows more group observations as it accounts for differences between the groups by construction.

Does specialization matter for technical efficiency in beef cattle farming?

The objective of this study was to examine the impact of specialization on technical efficiency of beef cattle farms in Samsun province, Turkey. Farm-level cross-sectional data was collected from randomly selected 171 beef cattle farms. Stochastic frontier analysis was used to determine technical efficiency of beef farming and to identify inefficiency determinants. The model results revealed that mean technical efficiency of specialized and combined cattle farms was 0.66 and 0.55, respectively, whereas it was 0.61 on average. Besides, mean technical efficiency of 29.76% of combined cattle farms were lower than 0.50 whereas this rate was solely 5.74% for specialized cattle farms. The results of the study highlighted that specialization increased technical efficiency in beef production. Efficiency model revealed that an increase in use of all inputs except for roughage increases the amount of beef. The higher elasticity of concentrate feed, capital expense and other expense relative to other inputs indicated that these inputs are more effective on beef production. On the other hand, the variable of labor had no significant effect and indicated that beef production was not labor-intensive. The sum of input elasticity was 0.52 and highlighted that cattle farms operated under decreasing return to scale. Inefficiency model revealed that record keeping and herd size reduced the level of inefficiency, whereas non-agricultural income, fodder crop area and external input rate increased. Cattle farms should be encouraged to improve farm size and keep farm record with specialization, and the government should direct a large part of its support to specialized cattle farms to improve beef farming with technical efficiency.