Background:The pursuit of efficiency and productivity is one of the goals of health systems.In the era of Sustainable Development Goals and particularly the move towards universal health coverage,it is imperative to c...Background:The pursuit of efficiency and productivity is one of the goals of health systems.In the era of Sustainable Development Goals and particularly the move towards universal health coverage,it is imperative to curb wastage of resources to ensure sustainable access of the population to needed and effective health services without enduring financial hardship.This study aims to assess total factor productivity change of national health systems of 20 countries in the WHO’s Eastern Mediterranean Region.Methods:Data Envelopment Analysis(DEA)-based Malmquist index is used to assess total factor productivity change and its components-efficiency change and technical change.To assess the robustness of the Malmquist index estimates,bootstrapping was performed.Outputs used are life expectancy at birth for both sexes and infant mortality;while total expenditure on health per capita in international dollars(PPP)is used as a measure of input.Panel data for the period 2003-2014 was extracted from databases of the WHO and the World Bank.Results:In all but five countries covered in the study,a decline in the mean total factor productivity is observed during the period 2003-2014.The decline is driven by technical regress.In all countries,the technical change component of the Malmquist TFP index is less than unity(range:0.896 to 0.945).All countries exhibited growth in efficiency(efficiency change exceeding one)except two countries(Djibouti and Iraq).The growth in efficiency was mainly due to change in scale efficiency.Overall,total factor productivity in the region declined by 3.8%.This was due to a 9.1%decline in technical change,which overshadowed the 5.8%increase in efficiency.Three countries-Libya,Qatar and Yemen-showed a marginal growth in total factor productivity.There was no change in total factor productivity in Kuwait and Lebanon.Conclusion:The decline in total factor productivity over the study period is likely to hamper achieving the targets of Sustainable Development Goal 3 of ensuring healthy lives and promoting well-being for all at all ages.It is recommended that country-level studies on efficiency and productivity of health systems be conducted in order to intensively examine the determinants of inefficiency and productivity decline and implement appropriate interventions that could enhance efficiency and productivity.展开更多
This paper attempts to explore the temporal and spatial nature of the marginal revenue of land, total factor productivity （TFP） change and its three components： technical change （TC）, technical efficiency change ...This paper attempts to explore the temporal and spatial nature of the marginal revenue of land, total factor productivity （TFP） change and its three components： technical change （TC）, technical efficiency change （TEC） and scale efficiency change （SEC） as seen in Chinese agricultural production from 1995 to 1999. Based on county-level data, the study utilized both stochastic frontier and mapping analyses methods. The results show that growth in the marginal revenue of land was diverse across various regions, where most gain occurred in eastern coastal zone, while loss was in Northwest and North China. China has experienced moderate decreases in annual TFP change （–0.26%） with considerable regional variations. Specifically, the administrative intervention in grain production and the deterioration of the agricultural technology diffusion system led to a moderate drop in annual TFP change. County-level mapping analyses took into account interregional variances in TFP and its components. Regarding components of TFP, TEC differences explain the majority of regional dispersions in TFP. As developed areas in China, the Huang-Huai-Hai region and the Beijing-Tianjin-Tangshan economic zone face the challenges of land conversion and grain security amidst the process of urbanization.展开更多
文摘Background:The pursuit of efficiency and productivity is one of the goals of health systems.In the era of Sustainable Development Goals and particularly the move towards universal health coverage,it is imperative to curb wastage of resources to ensure sustainable access of the population to needed and effective health services without enduring financial hardship.This study aims to assess total factor productivity change of national health systems of 20 countries in the WHO’s Eastern Mediterranean Region.Methods:Data Envelopment Analysis(DEA)-based Malmquist index is used to assess total factor productivity change and its components-efficiency change and technical change.To assess the robustness of the Malmquist index estimates,bootstrapping was performed.Outputs used are life expectancy at birth for both sexes and infant mortality;while total expenditure on health per capita in international dollars(PPP)is used as a measure of input.Panel data for the period 2003-2014 was extracted from databases of the WHO and the World Bank.Results:In all but five countries covered in the study,a decline in the mean total factor productivity is observed during the period 2003-2014.The decline is driven by technical regress.In all countries,the technical change component of the Malmquist TFP index is less than unity(range:0.896 to 0.945).All countries exhibited growth in efficiency(efficiency change exceeding one)except two countries(Djibouti and Iraq).The growth in efficiency was mainly due to change in scale efficiency.Overall,total factor productivity in the region declined by 3.8%.This was due to a 9.1%decline in technical change,which overshadowed the 5.8%increase in efficiency.Three countries-Libya,Qatar and Yemen-showed a marginal growth in total factor productivity.There was no change in total factor productivity in Kuwait and Lebanon.Conclusion:The decline in total factor productivity over the study period is likely to hamper achieving the targets of Sustainable Development Goal 3 of ensuring healthy lives and promoting well-being for all at all ages.It is recommended that country-level studies on efficiency and productivity of health systems be conducted in order to intensively examine the determinants of inefficiency and productivity decline and implement appropriate interventions that could enhance efficiency and productivity.
基金National Basic Research Program of China （973 Program）,No.2010CB950904 National Key Technology R＆D Program of China,No.2008BAK50B06+2 种基金 No.2008BAC43B01 National Natural Science Foundation of China,No.40801231 No.41071343
文摘This paper attempts to explore the temporal and spatial nature of the marginal revenue of land, total factor productivity （TFP） change and its three components： technical change （TC）, technical efficiency change （TEC） and scale efficiency change （SEC） as seen in Chinese agricultural production from 1995 to 1999. Based on county-level data, the study utilized both stochastic frontier and mapping analyses methods. The results show that growth in the marginal revenue of land was diverse across various regions, where most gain occurred in eastern coastal zone, while loss was in Northwest and North China. China has experienced moderate decreases in annual TFP change （–0.26%） with considerable regional variations. Specifically, the administrative intervention in grain production and the deterioration of the agricultural technology diffusion system led to a moderate drop in annual TFP change. County-level mapping analyses took into account interregional variances in TFP and its components. Regarding components of TFP, TEC differences explain the majority of regional dispersions in TFP. As developed areas in China, the Huang-Huai-Hai region and the Beijing-Tianjin-Tangshan economic zone face the challenges of land conversion and grain security amidst the process of urbanization.
