Analysis of the Technical Efficiency of Public Hospitals in Togo: A non-Parametric Approach
Date
2018-01-02
Authors
Atake, Esso-Hanam
Journal Title
Journal ISSN
Volume Title
Publisher
AERC
Abstract
Most health facilities in Togo are poorly equipped. Consequently, the rate of post-natal consultation remains low and varies between 9.5% and 39.4%. Barely half of all deliveries (47.1%) take place in health facilities. In this study, we analysed technical efficiency scores of 139 Togolese public hospitals
over the period 2008–2010, and then identified the determinants of this efficiency. Double bootstrap
data envelopment analysis was used to draw consistent inferences. We first estimated bootstrapped
efficiency scores. Then, bootstrapped truncated regression was used to identify the determinants
of public hospitals efficiency. The results indicate that, on average, small-sized hospitals (periphery
care units) investigated, had the highest efficiency scores. The University Teaching Hospitals and
regional hospitals which have significant material, human and financial resources were associated
with lower efficiency. The most significant and robust factors of technical efficiency are per capita
income, competition, hospital’s balance, types of contract, and medical density. We found that income
constraint and accessibility to health facilities are obstacles to efficiency. According to our results, we
can infer that non-competitive public provision of health services is likely to be inefficient. Another
important practical implication is that Togo must vigorously promote reform of the management
system in public hospitals which regards corporate quality governance as the core. We hypothesize
that if subsidies are allocated according to performance, they can positively affect efficiency. Policy
makers should consider tying grant revenues to performance indicators.
Description
RA 410
Keywords
Public hospitals , double Bootstrap , Technical efficiency , governance , competition , Togo