I am looking for literature to support the write up of my study that concerns efficiency in the healthcare sector. In particular, I am interested to know is "Demand" of services a "Determinant" of service efficiency? I tried a few searches in Pubmed & Ebsco but not much material exists. Any domain expert can help point me a direction?
I believe the paper I am working on - and submitting very shortly - is on target here. What I talk about is that we cannot define efficiency without knowing what it is we are producing. Demand is relevant in the discussion of efficiency if we rely on capitalism, and the capitalism mechanism for rationing health care services. Then consumer sovereignty predicts optimal quantities. And that is based on preferences and demand because the goal is to maximize well-being - not necessarily health. If, however, you seek to maximize health, demand is less relevant. I can send you my article which elaborates on this. I am submitting it to the Journal of Political Economy shortly.
Thanks Shafig for the link.
Debra, I would be very interested to read your paper.
I found a World Bank Policy Research Working Paper written in 2003 by M Lindelow & A Wagstaff that have discussed this topic briefly :
How should the output of a health care provider should be appropriately measured? A
first issue concerns the distinction between “readiness-to-serve” capability and rendered services. At one level, we may think that the appropriate facility output is the capacity to provide services—e.g., outpatient care, immunizations, antenatal care, deliveries—rather than the actual number of cases seen. This is because households, as demanders of health services, play a part in influencing the level of utilization, so the amount of services delivered is not entirely under the control of providers. For example, low levels of utilization may be due tolow population density or a good overall health status in the catchment area. Insofar as
variation in output across facilities is driven by these types of factors, service capacity would appear a conceptually appealing measure of output, at least for the purpose of efficiency analysis. For example, one might measure potential inpatient days rather than actual days, just as one might measure school places rather than school enrolment or attendance.19 However, in many cases, a divergence between service capacity and rendered services is due to factors that are within the discretion of the facility. Here, of course, there is some scope for disagreement
as to precisely what is under the control of providers.20 In general, both readiness-to-serve” capability and rendered services are problematic as measures of output. Most surveys collect data on the number of units of services delivered, largely because these type of data are more readily available. However, for some types of analysis it is clearly important to try to remove the confounding effects of influences that are genuinely beyond the control of providers.
Source : https://openknowledge.worldbank.org/handle/10986/19163
https://openknowledge.worldbank.org/handle/10986/19163
Chee,
I have a general comment regarding demand and efficiency -- one that is already obvious to you but is a strong consideration. I should more correctly say, "variable demand" versus demand because that variation in demand and how we meet it (or the degree that we meet it) are key questions. The degree to which we meet the demand is a policy decision. As an example, a health center is staffed to meet a certain patient load on a given day or given shift. We can then look at efficiency after the "policy" of meeting the demand is decided.
Just a random comment -- best wishes on your research. The ability to deliver health services is an important thing. How to meet the gaps in a given country or a given region gives us all something to think about.
I am grateful for researchers like you who are interested in these critical questions.
. . . justin
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