Estimation of Production Function of Direct Health Care Services Delivered by Iranian Social Security Organization

Sattar Mehraban, H. Raghfar
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引用次数: 5

Abstract

Background and Objectives: Social Security Organization (SSO) is the second largest organization to the Ministry of Health and Medical Education (MOHME) in providing health care services in Iran. In recent years the gap between the SSO’s resources and expenditures has shown an unprecedented growing trend due to the rapidly increasing demand. Continuation of this trend may lead to financial imbalance in the following years, which would negatively impact access of public to health care services. This study, thus, seeks to explore factors affecting the efficiency of SSO’s health care services in quest for solutions to alleviate the potentially critical situation ahead. Methods: A microeconomic analysis was carried out by Panel SFA method. Cobb-Douglas production function was estimated based on Maximum Likelihood Estimation (MLE), using seven-year panel data derived from the yearbooks of SSO (2008-2015). The annual admission rate was selected as the output variable and it was assumed to be a function the number of physicians, nurses, active beds, paraclinical and other staff, and the bed restoration interval. Calculation was carried out using Frontier Version 4.1 Software. Findings: Significant elasticity coefficient of 0.835, 0.073, 0.0273, -0.199 was obtained for active beds, physicians, nurses, and bed restoration interval respectively. The marginal production of inputs was calculated to be 79.14, 9.48, and 1.73 for active beds, physicians and nurses, respectively. The marginal rate of technical substitution (MRTS) was identified to be 0.18 for nurse-physician, 0.02 for nurse-bed, and 0.12 for physician-bed substitution. The η and  were calculated to be 0.015 and 0.581, respectively. Conclusions: Our results clearly shows that the production (annual patient admission rate) in SSO’s hospital is capital intensive being highly dependent on number of active beds with increasing return to scale. The inefficiency has only marginally decreased over time, yet there is room to improve production by increasing efficiency. The MRTS for nurse-physician substitution suggests that the escalating burden of physicians’ wage may be reduced by employing nurses in the services they can deliver instead of physicians. The negative contribution of bed restoration interval to production highlights the challenging nature of quality improvement by increased ALS, which is currently low in SSO’s hospitals. The problem of inconsistency between quality services and high production, thus, persists pointing to the need for in-depth reform in the structure of health care delivery.
伊朗社会保障组织提供的直接卫生保健服务的生产函数估计
背景和目标:社会保障组织(SSO)是伊朗卫生和医学教育部(MOHME)提供医疗保健服务的第二大组织。近年来,由于需求的迅速增长,SSO的资源与支出之间的差距呈现出前所未有的增长趋势。如果这一趋势继续下去,可能会导致今后几年的财政不平衡,这将对公众获得保健服务产生负面影响。因此,本研究旨在探讨影响SSO医疗保健服务效率的因素,以寻求解决方案,以缓解未来潜在的危急情况。方法:采用Panel SFA方法进行微观经济分析。Cobb-Douglas生产函数基于最大似然估计(MLE),使用来自SSO年鉴(2008-2015)的7年面板数据。选取年入院率作为输出变量,假设年入院率是医生、护士、有效床位、临床辅助及其他人员数量、床位恢复间隔的函数。采用Frontier Version 4.1软件进行计算。结果:有效床位弹性系数为0.835、0.073、0.0273、-0.199,医生弹性系数为0.073,护士弹性系数为0.0273,床位恢复间隔弹性系数为-0.199。投入物的边际产出分别为79.14、9.48和1.73。技术替代的边际率(MRTS)被确定为护士-医生替代0.18,护士-床替代0.02,医生-床替代0.12。η和η值分别为0.015和0.581。结论:我们的研究结果清楚地表明,SSO医院的生产(年患者入院率)是资本密集型的,高度依赖于有效床位数量,规模回报不断增加。随着时间的推移,低效率只略微下降,但仍有通过提高效率来改善生产的空间。护士-医生替代的MRTS表明,通过雇用护士来代替医生提供服务,可能会减轻医生工资不断上升的负担。床位恢复间隔对生产的负贡献凸显了ALS增加对质量改善的挑战性,目前SSO医院的ALS水平很低。因此,高质量服务与高产量之间不一致的问题仍然存在,这表明需要对保健服务结构进行深入改革。
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