Efficiency Measurement in Health Facilities: A Systematic Review in Low- and Middle-Income Countries.

Abstract

Limited healthcare resources in low- and middle-income countries (LMICs) have led policy-makers to improve healthcare efficiency. Therefore, it is essential to understand how efficiency has been measured in the LMIC setting. This paper reviews methodologies used for efficiency studies in health facilities in LMICs. We searched MEDLINE, Embase, Global Health, EconLit and ProQuest Dissertations and Theses databases to Week 6 in 2018. We included all types of quantitative analysis studies relating to the measurement of the efficiency of services at health facilities in LMICs. We extracted data from eligible studies, and assessed the validity for each study. Because of the substantial heterogeneity of the studies, results were presented narratively. A total of 137 papers were eligible for inclusion. These articles covered a wide range of health facility types, with more than half of the studies relating to hospitals. Our systematic review showed that there is an increasing trend in efficiency measurements in LMICs using various methods. Most studies employed data envelopment analysis as an efficiency measurement method. The studies typically included physical inputs and health services as outputs. Sixty-one percent of the studies analysed the contextual variables of the health facility efficiency. This review highlights the potential for methodological improvement and policy impacts in efficiency measurements.