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Potential for improvement of efficiency in health systems : three empirical studies

Abstract : In the perspective of the third Sustainable Development Goal ("Good Health and Well-being"), it is necessary to increase financial resources for health in low income countries, but also to ensure that those resources are optimally allocated. To this purpose, efficiency measures appear as a useful tool to assess the performance of healh systems at the macroeconomic level, or of health facilities as the microeconomic level to get "more health for the money" (WHO,2010). Through its four chapters, this thesis provides some empirical evidence to the assessment of the efficiency of health system.The first chapter is a methodological review of nonparametric efficiency measures, used in the three empirical studies that follow. The second chapter assesses the efficiency of a sample of 120 low and middle income countries over the 1997/2014 period. Production function is defined as health expenditures producing health outcomes (maternal and juvenile survival). It concludes that, for the same health outcomes, countries could spend more than 20\% for the same health outcomes, and that inefficiency increases with the level of development of coutries. The last two chapters are case studies. The third one focuses on Township Health Centers in Weifang, Shandong province, China, relying on survey data. It highlights the potential for performance improvement and the role of demand side determinants and of the share of subsidies in incomes to explain efficiency scores. The fourth chapter deals with the efficiency of primary healthcare facilities in Ulan-Bator, Mongolia. It concludes that efficiency could be spurred by about 30\%. Demand side factors are positively associated to efficiency, but low levels of staff remuneration, as well as a suboptimal balance between medical and non-medical staff seem to hinder activity and efficiency of health facilities.
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Laurene Petitfour. Potential for improvement of efficiency in health systems : three empirical studies. Economics and Finance. Université Clermont Auvergne, 2017. English. ⟨NNT : 2017CLFAD012⟩. ⟨tel-02081620⟩

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