A New Approach of Measuring Hospital Performance for Lowand Middle-income Countries

Efficiency of the hospitals affects the price of health services. Health care payments have equity implications. Evidence on hospital performance can support to design the policy; however, the recent literature on hospital efficiency produced conflicting results. Consequently, policy decisions are uncertain. Even the most of evidence were produced by using data from high income countries. Conflicting results were produced particularly due to differences in methods of measuring performance. Recently a management approach has been developed to measure the hospital performance. This approach to measure the hospital performance is very useful from policy perspective to improve health system from cost-effective way in low and middle income countries. Measuring hospital performance through management approach has some basic characteristics such as scoring management practices through double blind survey, measuring hospital outputs using various indicators, estimating the relationship between management practices and outputs of the hospitals. This approach has been successfully applied to developed countries; however, some revisions are required without violating the fundamental principle of this approach to replicate in low- and middle-income countries. The process has been clearly defined and applied to Nepal. As the results of this, the approach produced expected results. The paper contributes to improve the approach to measure hospital performance.

Towards universal health coverage: an example of malaria intervention in Nepal

A comprehensive and integrated assessment of health-system functioningrequires measurement of universal health coverage (UHC) for disease-specificinterventions. This paper aims to contribute to measurement of UHC by utilizinglocally available data related to malaria in Nepal. This paper utilizes the elementsof UHC as outlined by the World Health Organization (WHO). The concept ofUHC represents both improvements in health outcomes and protection of peoplefrom poverty induced by health-care costs. Measuring UHC focusing on a tropicaldisease highlights the progress made towards elimination of the disease andexhibits health-system bottlenecks in achieving elimination of the disease. Severalbottlenecks are found in the Nepalese health system that strongly suggest the needto focus on health-system strengthening to shift the health production function ofmalaria intervention. The disaggregated data clearly show the inequality of servicecoverage among subgroups of the population. Analysis of effective coverage ofmalaria interventions indicates the insufficient quality of current interventions. Noneof households faced catastrophic impact due to payment for malaria care in Nepal.However, the costs of hospital-based care of malaria were not captured in thisanalysis. The paper provides the current status of UHC for malaria interventionsand reveals system bottlenecks on which policy-makers and stakeholders shouldfocus to improve Nepal’s malaria control strategy. It concludes that financialcoverage of the malaria intervention is at an acceptable level; however, servicecoverage needs to be improved

Choice of providers for treating a neglected tropical disease: an empirical analysis of kala azar in Nepal

OBJECTIVE@#To examine the choice of healthcare providers for treating kala azar (KA) in Nepal.@*METHODS@#Information was collected from clinically diagnosed KA patients seeking care from public hospitals located in KA endemic districts. The survey collected information from more than 25 percent of total KA cases in the country. For empirical estimation of probability of choosing a provider-type as a first contact healthcare provider, a multinomial logit model was defined with five alternative options with self care as the reference category.@*RESULTS@#The empirical model found that price of medical care services, income of households, knowledge of patients on KA and KA treatment, borrowing money, age of patient, perceived quality of provider types, etc. determine the likelihood of seeking care from the alternative options considered in the analysis. All variables have expected signs and are consistent with earlier studies. The price and income elasticity were found to be very high indicating that poorer households are very sensitive to price and income changes, even for a severe disease like KA. Using the empirical models, we have analyzed two policy instruments: demand side financing and interventions to improve the knowledge index about KA.@*CONCLUSIONS@#Due to high price elasticity of KA care and high spillover effects of KA on the society, policy makers may consider demand side financing as an instrument to encourage utilization of public hospitals.