Abstract
BackgroundStudying and monitoring the efficiency of primary health care centers has a special place in the health system. Although studies have been conducted in the field of efficiency in Iran, few have focused on rural primary health care centers. In addition, previous studies have not used the child mortality rate and Behvarzes as input and output.ObjectiveThe present study was conducted aimed to estimate the technical efficiency of rural primary health care centers and determinant factors in Hamadan using data envelopment analysis and Tobit regression.MethodsThis is a Longitudinal study of rural primary health care centers in Hamadan province (2002–2016). Data Envelopment Analysis was employed to estimate technical efficiency of sampled health facilities while Panel Tobit Analysis was applied to predict factors associated with efficiency levels. The outputs were child mortality rate under 1 year of age and child mortality rate 1 year to 5 years of age. The input was Behvarzes (rural health workers).ResultsThe results of efficiency analysis showed that the average efficiency scores of the centers had a fluctuating trend during the period of the study, but the average performance scores generally decreased in 2016, as compared with 2002. The highest and lowest average performance scores were observed in 2003 (0.78) and 2013 (0.56), respectively. Number of physicians and rural primary healthcare centers per population had a positive statistically significant and the number of midwives and the total fertility per population had a negative statistically significant effect on efficiency.ConclusionsThe findings suggest some level of wastage of health resources in primary health centers. Findings indicate a level of waste of health resources in primary health centers. Behvarz functions in providing primary care services can be considered in the reallocation and optimal use of available resources at the level of rural health centers.
Highlights
Given the increasing growth in health care costs and the problems associated with financing the expenditures, policymakers have accepted that health care is not a mere social issue and should be addressed economically as well [1, 2]
Behvarz functions in providing primary care ser‐ vices can be considered in the reallocation and optimal use of available resources at the level of rural health centers
Due to the fact that the outputs considered in the model are affected by many variables and the rural health centers cannot affect them, inputorientation approach and variable returns to scale (VRS) model were selected for data analysis
Summary
Given the increasing growth in health care costs and the problems associated with financing the expenditures, policymakers have accepted that health care is not a mere social issue and should be addressed economically as well [1, 2]. According to the World Bank statistics and the World Health Organization reports, different countries spend an average of about 10% of their GDP on healthcare [3]. Health centers and rural health houses are among the most important providers of primary health care. Iran government has made many efforts to establish a broad network of primary health care facilities, especially in rural areas, through rural health centers and health houses, aimed at reducing the gap between rural and urban services [11, 12]. Studying and monitoring the efficiency of primary health care centers has a special place in the health system. Studies have been conducted in the field of efficiency in Iran, few have focused on rural primary health care centers. Previous studies have not used the child mortality rate and Behvarzes as input and output
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