Efficiency of private and public primary health facilities accredited by the National Health Insurance Authority in Ghana
Efficiency of private and public primary health facilities accredited by the National Health Insurance Authority in Ghana
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DOI：
10.1186/s12962-015-0050-z
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发表时间：
2015-12-26
影响因子：
2.3
通讯作者：
de Wit, Tobias F. Rinke
中科院分区：
文献类型：
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作者：
Alhassan, Robert Kaba;Nketiah-Amponsah, Edward;de Wit, Tobias F. Rinke
背景资料：尽管部分由于国家健康保险计划，一些健康成果指标有所改善，但加纳不太可能在2015年底之前实现所有与健康有关的千年发展目标。对现有有限资源的低效利用被认为是造成这一困境的一个因素。本研究旨在探讨效率水平的NHIS认证的私人和公共卫生设施，确定因素，占效率的差异，并确定高质量的护理和效率levels.Methods之间的关联：本研究是一个横断面调查NHIS认证的初级卫生设施（n = 64）在加纳南部的两个地区。数据包络分析被用来估计抽样卫生设施的技术效率，而Tobit回归被用来预测与效率水平相关的因素。进行斯皮尔曼相关性检验，以确定质量护理和efficiency.Results之间的关联：总体而言，20的64个卫生设施（31%）是最佳效率相对于他们的同行。在20个高效率设施中，10个（50%）是公共/政府拥有的设施; 8个（40%）是私营营利设施，2个（10%）是私营非营利/使命设施。使命（系数= 52.1; p = 0.000）和公共（Coef. = 42.9; p = 0.002），位于西部地区（主要是农村）的设施比位于大阿克拉地区（主要是城市）的设施更有可能达到100%的技术效率基准。没有显着的关联之间的技术效率得分的卫生设施和许多技术质量的护理代理，除了在整体质量得分根据NHIS认证数据（Coef. = -0.3158; p < 0.05）和SafeCare Essentials质量评分对工作人员和患者的环境安全（Coef. = -0.2764; p < 0.05），相关性为负。结论：研究结果表明，许多医疗机构存在一定程度的卫生资源浪费，尤其是那些位于城市地区的机构。卫生部和相关利益攸关方应进行更有效的需求分析，为资源分配、分配和能力建设提供信息，以促进有效利用有限的资源，同时不影响优质护理标准。
Background: Despite improvements in a number of health outcome indicators partly due to the National Health Insurance Scheme (NHIS), Ghana is unlikely to attain all its health-related millennium development goals before the end of 2015. Inefficient use of available limited resources has been cited as a contributory factor for this predicament. This study sought to explore efficiency levels of NHIS-accredited private and public health facilities; ascertain factors that account for differences in efficiency and determine the association between quality care and efficiency levels.Methods: The study is a cross-sectional survey of NHIS-accredited primary health facilities (n = 64) in two regions in southern Ghana. Data Envelopment Analysis was used to estimate technical efficiency of sampled health facilities while Tobit regression was employed to predict factors associated with efficiency levels. Spearman correlation test was performed to determine the association between quality care and efficiency.Results: Overall, 20 out of the 64 health facilities (31 %) were optimally efficient relative to their peers. Out of the 20 efficient facilities, 10 (50 %) were Public/government owned facilities; 8 (40 %) were Private-for-profit facilities and 2 (10 %) were Private-not-for-profit/Mission facilities. Mission (Coef. = 52.1; p = 0.000) and Public (Coef. = 42.9; p = 0.002) facilities located in the Western region (predominantly rural) had higher odds of attaining the 100 % technical efficiency benchmark than those located in the Greater Accra region (largely urban). No significant association was found between technical efficiency scores of health facilities and many technical quality care proxies, except in overall quality score per the NHIS accreditation data (Coef. = -0.3158; p < 0.05) and SafeCare Essentials quality score on environmental safety for staff and patients (Coef. = -0.2764; p < 0.05) where the association was negative.Conclusions: The findings suggest some level of wastage of health resources in many healthcare facilities, especially those located in urban areas. The Ministry of Health and relevant stakeholders should undertake more effective need analysis to inform resource allocation, distribution and capacity building to promote efficient utilization of limited resources without compromising quality care standards.