| | | Document Type | : | Latin Dissertation | | Language of Document | : | English | | Record Number | : | 53964 | | Doc. No | : | TL23918 | | Call number | : | 3244409 | | Main Entry | : | Mohammad A. Rahman | | Title & Author | : | Measuring and explaining the managerial efficiency of private medical clinics in Bangladesh: An exploratory studyMohammad A. Rahman | | College | : | Brandeis University, The Heller School for Social Policy and Management | | Date | : | 2006 | | Degree | : | Ph.D. | | student score | : | 2006 | | Page No | : | 173 | | Abstract | : | In Bangladesh, where health care is constitutionally considered as a 'basic right' of the people and public hospitals provide most of the inpatient care, little attention has been paid to the burgeoning private inpatient medical care sector and its performance. As the number of medical clinics in the private sector continues to grow, it is increasingly important to assess their level of efficiency and identify factors that may hinder their performances. This study aimed to: (1) assess the status of the health care services provided by these medical clinics in terms of their technical efficiency; (2) explore the potential cost-savings by eliminating inefficiency; and (3) examine what factors contributed to the inefficiencies. Based on the extended Pareto-Koopmans definition of efficiency and Leibenstein's X-inefficiency theory, this dissertation examined what organizational, clinical-management and environmental factors lead to inefficiency at the medical clinics. I used the Data Envelopment Analysis (DEA) technique to evaluate the efficiency of 202 medical clinics located nationwide. The data was obtained from the Survey of Private Medical Clinics in Bangladesh, a study undertaken by the Ministry of Health and Family Welfare. The Banker Charnes and Cooper model, which measures technical efficiency, was used under the assumption that the clinics may not be operating at the optimal scale level. After the efficiency measures were determined through the DEA model, the efficiency scores were regressed on some explanatory variables to test hypotheses using Tobit analysis. The study found that there is considerable inefficiency in the way medical clinics in the private sector currently operate. The study determined that as much as 1,146 beds, 406 doctors, 600 nurses and 2,475 staff could be reduced if all the clinics operated at the 'best practice' level. In contrast, an additional 14,386 outpatients, 2,844 surgical patients and 6,404 more gynecological patients could be treated with existing resources. In addition, regression analyses identified a number of variables that were associated with efficiency of the medical clinics. The research revealed that: (1) clinics located in rural areas, accredited by the health directorate and managed by professionals (rather than doctors themselves) were likely to be more efficient; (2) older clinics, possibly entangled with bureaucracy, tended to be less efficient which supported the 'structural inertia' theory of Hannan and Freeman (1984); (3) clinics can improve their efficiency by employing more nurses in the clinics; (4) market competition can drive efficient performance in medical clinics; (5) a positive relationship between efficiency and profitability, suggesting that clinics could increase their profitability by being more efficient. Based on these findings, I recommend that an 'independent' institution be set up which will be responsible for assessment and accreditation of the medical clinics. The clinics should institutionalize professional management practices and undergo external maintenance and management review to revamp their productive competency. I also suggest that health care management and nurse training be promoted and institutionalized in the health delivery mechanism to ensure more effective and quality health care service delivery. The growth of new clinics should be directed to remote areas to promote more competition and increase access. More extensive data management is suggested so that monitoring of health services and quality is made possible and more in depth research on efficiency can be undertaken for optimal resource utilization. Finally, this exploratory study contributes to the existing literature on the applicability of DEA in measuring efficiency of health care providers, measurement of the extent of inefficiency in the for-profit medical clinics and identification of possible factors that causes these inefficiencies. The successful application of DEA in this study demonstrates that researchers and policy-makers will find DEA a us ful method to measure efficiency of health care providers in the context of a developing country where pure price and wage data can be quite challenging to obtain because of market imperfections. The study provides a relevant and useful framework to regulate a sprawling private healthcare sector to reduce waste in a resource-constrained country like Bangladesh. | | Subject | : | Health and environmental sciences; Bangladesh; Efficiency; Managerial; Medical clinics; Health care; Managers; Clinics; Studies; Private enterprise; Cost reduction; Models; Accreditation; 0769:Health care | | Added Entry | : | J. Chilingerian | | Added Entry | : | Brandeis University, The Heller School for Social Policy and Management |
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