Using hospital activity indicators to evaluate performance in Andhra Pradesh, India.

Abstract

The performance of secondary level public hospitals in Andhra Pradesh. India was evaluated with the help of input-output ratios of hospital activity and service mix. Indicators for emergency, clinical, diagnostic and medico-legal services have been defined. Wide variability of global hospital activities was observed. Variability of turnover rate and bed occupancy was much more than length of stay. Combined utilization and productivity analysis showed that all outlying hospitals were either in the low turnover, low occupancy group or in the high turnover, high occupancy group. Low productivity or inadequate hospital capacity seem to be the major problems. All low turnover, low occupancy hospitals also had low levels of outpatient consultations, and high turnover, high occupancy hospitals had above-average outpatient activity. About 40 per cent of hospitals did not provide emergency services. About 10 per cent of hospitals were not performing any diagnostic tests. Strengthening emergency service delivery capacity, as well as diagnostic facilities, could improve productivity and capacity utilization. Extremes of turnover and occupancy were not associated with any particular case-mix pattern. Thus, neither poor productivity and capacity utilization nor over-crowding can be explained by case-mix differences. Problems of poor performance and inadequate capacity seem to be real.