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Abstract
Objectives Public hospitals in Nepal account for a major share of the total health budget. Therefore, questions are often asked about the performance of these hospitals. Existing measures of performance are limited to historical ratio analyses without any benchmarks. The objective of this study is to explore the trends in inputs, outputs and productivity changes in Nepalese public hospitals from 2011–2012 to 2013–2014.
Setting and participants The study was conducted among 32 Nepalese public hospitals (23 district level and 9 higher level) for the three fiscal years from 2011–2012 to 2013–2014.
Outcome measures First, basic ratio analyses were conducted for the input and output measures over the study years. Then, Malmquist productivity change scores were obtained using data envelopment analysis. Aggregated as well as separate analyses were conducted for district level and higher level hospitals.
Results Real expenditures of the sampled hospitals declined over the 3-year period from an average of US$ 371 000 in year 1 to US$ 368 730 in year 2 and US$ 328680 in year 3. The average aggregated hospital outputs increased marginally from 8276 in 2011–2012 to 8613 in 2013–2014. The total factor productivity of the study hospitals declined by 6.9% annually from 2011–2012 to 2013–2014. Of the total 32 hospitals, productivity increased in only 12 (37.5%) hospitals and declined in the remaining 20 hospitals. The total factor productivity loss was influenced by a decline in technology change, despite an increase in efficiency.
Conclusions In general, productivity of the study hospitals declined over the study period. Availability and accessibility of accurate, detailed and consistent measures of hospital inputs and outputs is a major challenge for this type of analysis.
- Nepal
- Data Envelopment Analysis
- Hospital
- Productivity
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Footnotes
Contributors PRS came up with the concept and shared with TA. PRS was involved in data collection, analysis and write-up which was continuously supervised by TA. PRS drafted the manuscript and TA analysed it critically. PRS and TA worked together in finalising the design of the work, decided on the final draft and agreed to submit. For the comments from reviewers and the editor, PRS worked first and TA reviewed it.
Funding This study received no specific funding. Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) – Support to the Health Sector Programme (S2HSP), Nepal, agreed to provide partial funding for data collection by enumerators. However, this could not be activated because the enumerator team could not go outside of Kathmandu valley due to the Earthquake that hit Nepal in April 2015 followed by a long strike in the Terai region.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement A copy of the thesis report from which this manuscript has been prepared is available at the University of Auckland, New Zealand library database.