Cílem tohoto příspěvku je zhodnotit dlouhodobý vývoj základních zdravotnických vstupů a výstupů a zhodnotit vývoj efektivnosti českého zdravotnictví. Efektivnost zdravotnictví hodnotíme dvěma indexy efektivnosti, které obsahují čtyři vstupy a dva, resp. tři výstupy zdravotnického systému. Váhy vstupů a výstupů byly získány na základě dotazníkového šetření mezi experty. Vytvořené indexy efektivnosti ukazují, že efektivnost českého zdravotnictví má klesající trend.
The objective of this paper is to evaluate the long-term development of main health system inputs and outputs and to evaluate the development of the efficiency of the Czech health system. We evaluate the health system efficiency by two indices of efficiency, which contain 4 inputs and 2, respectively 3 outputs of the health system. The weights of inputs and outputs were obtained by a questionnaire survey among experts. The developed efficiency indices show that the efficiency of the Czech health system has a downward trend.
- MeSH
- efektivita organizační MeSH
- lidé MeSH
- poskytování zdravotní péče * organizace a řízení MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- srovnávací studie MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: Policymakers, who are constantly discussing growing health expenditures, should know whether the health system is efficient. We can provide them with such information through international health system efficiency evaluations. The main objectives of this study are: (a) to evaluate the efficiency of health systems in 28 developed countries by multiple-criteria decision analysis (MCDA) and data envelopment analysis (DEA) and (b) to identify reasonable benchmark countries for the Czech Republic, for which we collect information on the relative importance of health system inputs and outputs. METHODS: We used MCDA and DEA to evaluate the efficiency of the health systems of 28 developed countries. The models included four health system inputs (health expenditure as a relative share of GDP, the number of physicians, nurses, and hospital beds) and three health system outputs (life expectancy at birth, healthy life expectancy, and infant mortality rate). The sample covers 27 OECD countries and Russia, which is also included in the OECD database. To determine the input and output weights, we used a questionnaire sent to health policy experts in the Czech Republic. RESULTS: We obtained subjective information on the relative importance of the health system inputs and outputs from 27 Czech health policy experts. We evaluated health system efficiency using four MCDA and two DEA models. According to the MCDA models, Turkey, Poland, and Israel were found to have efficient health systems. The Czech Republic ranked 16th, 19th, 15th, and 17th. The benchmark countries for the Czech Republic's health system were Israel, Estonia, Luxembourg, Italy, the UK, Spain, Slovenia, and Canada. The DEA model with the constant returns to scale identified four technically efficient health systems: Turkey, the UK, Canada, and Sweden. The Czech Republic was found to be one of the worst-performing health systems. The DEA model with the variable returns to scale identified 15 technically efficient health systems. We found that efficiency results are quite robust. With two exceptions, the Spearman rank correlations between each pair of models were statistically significant at the 0.05 level. CONCLUSIONS: During the model formulation, we investigated the pitfalls of efficiency measurement in health care and used several practical solutions. We consider MCDA and DEA, above all, as exploratory methods, not methods providing definitive answers.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: An international comparison of health system performance is a popular tool of health policy analysis. However, the efficiency evaluation of health systems is a practical example of an international comparison in which non-homogeneity is expected. The objective of this paper is to evaluate the efficiency of health systems by models in which a degree of non-homogeneity among countries is considered. METHODS: We study the problem of non-homogeneity of health systems in the theoretical framework of the data envelopment analysis (DEA), which is a popular method of efficiency evaluation with hundreds of applications from various fields. DEA assume the homogeneity of production units and the homogeneity of the environment in which the production units operate. Hence, we compiled a summary of 14 recommendations on how to deal with the non-homogeneity in the DEA models. The analysed sample includes 38 OECD member countries. The data are from the year 2019. RESULTS: As an example, we evaluated the health system efficiency of the Czech Republic. We used the DEA models with the neighbourhood measure of distance and the constraint limiting the comparison of countries with different levels of economic development. The health system inputs were the numbers of physicians, nurses, and hospital beds. In the production of the intermediate outputs (doctor consultations, inpatient care discharges), the Czech Republic should look at Poland, Slovakia and Slovenia. In the production of health outcomes (life expectancy), the peer countries are France, Italy and Switzerland. CONCLUSIONS: The results of the DEA analysis are only indicative because no single analytical method can determine whether a health system is better or worse than others. We need to combine different methods, and DEA is one of them. We consider DEA as an exploratory method, not a method providing definitive answers.
- MeSH
- efektivita organizační * MeSH
- lidé MeSH
- vládní programy MeSH
- výkonnost * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Francie MeSH
- Polsko MeSH
Mezinárodní srovnání zdravotnických systémů je velmi využívaný nástroj zdravotní politiky. Vychází z předpokladu, že mezinárodní zkušenosti jsou, alespoň do určité míry, přenositelné z jedné země do druhé. Cílem článku je posouzení vybraných metod mezinárodního srovnání zdravotnických systémů. Přitom si klademe otázku, jak užitečná je každá metoda pro hodnocení českého zdravotnického systému.
The international comparison of health systems is a frequently used tool of health policy. It assumes that international experiences are, at least to some extent, transferable from one country to another. The aim of this article is to review selected methods of international comparison of health systems. At the same time, we ask the question of how useful each method is for the evaluation of the Czech health system.
- MeSH
- lidé MeSH
- zdravotní politika * MeSH
- zdravotnické služby MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
- Geografické názvy
- Evropa MeSH
BACKGROUND: An analysis of the regional distribution of health resources is one of the tools for evaluating equal geographic access to health care. The usual analytical approach to an assessment of regional differences is to evaluate each health resource separately. This is a sensible approach, because there may be systematic reasons for any differences, for example, higher salaries in urban areas. However, a separate evaluation of the regional distribution of health resource capacities may be misleading. We should evaluate all health resource capacities as a whole and consider the substitutability of resources. OBJECTIVE: This study aims to measure regional inequalities in the Czech Republic with the help of alternative approaches to the evaluation of regional inequalities in the case of several substitutable health resources. METHODS: Five alternative evaluation methods (models) are described and applied: the separate evaluation, expert model, market model, common weights model, and production frontier model. RESULTS: The regional distribution of physicians and nurses in the Czech Republic in 2017 was evaluated. In spite of many regulations at the national and regional levels, we have found inequalities in regional resource distribution. The models that consider all health resources and the possibility of a resource substitution show lower inequalities between regional health resource capacities. CONCLUSION: Both researchers and policy-makers should always consider the possibility of resource substitutions in the assessment of regional inequalities.
- MeSH
- lidé MeSH
- poskytování zdravotní péče * MeSH
- zdravotnické zdroje * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
The existence of geographic differences in health resources, health expenditures, the utilization of health services, and health outcomes have been documented by a lot of studies from various countries of the world. In a publicly financed health system, equal access is one of the main objectives of the national health policy. That is why inequalities in the geographic allocation of health resources are an important health policy issue. Measures of inequality express the complexity of variation in the observed variable by a single number, and there is a variety of inequality measures available. The objective of this study is to develop a measure of the geographic inequality in the case of multiple health resources. The measure uses data envelopment analysis (DEA), which is a non-parametric method of production function estimation, to transform multiple resources into a single virtual health resource. The study shows that the DEA originally developed for measuring efficiency can be used successfully to measure inequality. For the illustrative purpose, the inequality measure is calculated for the Czech Republic. The values of separate Robin Hood Indexes (RHIs) are 6.64% for physicians and 3.96% for nurses. In the next step, we use combined RHI for both health resources. Its value 5.06% takes into account that the combinations of two health resources serve regional populations.
- Publikační typ
- časopisecké články MeSH
- MeSH
- dostupnost zdravotnických služeb * statistika a číselné údaje MeSH
- interpretace statistických dat MeSH
- oblast s nedostatečnou zdravotní péčí MeSH
- přidělování zdravotní péče organizace a řízení statistika a číselné údaje MeSH
- Publikační typ
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
- Maďarsko MeSH
- Polsko MeSH
- Slovenská republika MeSH
