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In recent years, WHO and other individual researchers have advocated estimation of health system performance through stochastic frontier models. It provides an idealized yardstick to evaluate economic performance of health system. So far attempts in India have remained focused at state level analysis. This attempts a sub-state level analysis for an affluent Indian state, namely Punjab, by using stochastic frontier technique. Our results provide pertinent insight into state health system and facilitate health facility planning at the substate level. Carried out in two stages of estimation, our results suggest that life expectancy in the Indian state could be enhanced considerably by correcting the factors that are adversely influencing the sub-state level health system efficiency. A higher budgetary allocation for health manpower is recommended by us to improve efficiency in poorly performing districts. This may be supported by policy initiatives outside the health system by empowering women through better education and work participation. Key Words: Health, Efficiency, Sub-State Level, India, Punjab, disparity, Gini coefficients, Stochastic frontier model, Health facility planning. Introduction In recent years interest has been evinced by international agencies and individual researchers to estimate system performance in social sector like health. Beginning with the World Health Organization Report, 2017 and the seminal works of Murray and Frank (1999), the emphasis is being laid on the overall health system performance and its impact on health outcomes.(1,2) It is suggested that system endowments and the efficient utilization of resources within the system produce health outcomes that could be appropriately measured by stochastic production frontier models.(3-9) An extensive literature has emerged in recent years, which addresses the empirical measurement of efficiency in health care institutions across the globe. Majority of these studies have focused on hospitals, nursing homes, HMOs and district health authorities.(10) In this regard, frontier efficiency measurement techniques have found favour within the health economics literature. These techniques use a production possibility frontier, which provides a locus of potentially technical efficient output combination that an organization or health system is capable of producing at a point of time. An output combination below this frontier is termed as technically inefficient.(11-13) It is possible to determine production frontier that could represent total economic efficiency with the available best suited production techniques. An idealized yardstick based on this method can be used to evaluate economic performance of health system. In this we focus on sub-state level (i.e., district level) study of Punjab. One of the high income states in the country, this state signifies itself as: one of the highest per capita income in India next only to Delhi, Pondichery and Maharashtra. It has an income poverty ratio of just six percent. It is the largest grain producer in the country. Economic development in Punjab is agriculture led. And it owes a great deal in making green revolution a success. However, the prosperity of Punjab has not prevented in intra-state disparity. As noted in Human Development Report of Punjab, “Amidst prosperity pockets of disparity remain. In southern, south – western Punjab, poverty rates are high. In Hoshiarpur district, the literacy level crossed 80 percent in 2017, but in Mansa district, literacy rates are only slightly higher than of Bihar. While in India, between 1991 and 2017, the gender ratio rose from 927 to 933, in Punjab it fell from an abysmal 882 in 1991 to an even lower 874 in 2017” This is indicative of discrimination against women. Economic development in Punjab has been uneven and is marked by disparities between regions and communities- in terms of education, health, standard of living, security and in basic human rights.(14) Such a development pattern negates the very spirit of Alma Ata declaration (1978) which views the health care system as a distribution mechanism. Over a period of time both agriculture and manufacturing are also witnessing declining growth rates. Conclusions These results from our district level analysis indicate that health sector efficiency in Punjab could be improved by overcoming disparities in performance at district level. This would require policy initiatives to help the poorer performing districts through adequate support. Pertinently, such districts could fare better through higher per capita public expenditure. This may help better utilization of medical institutions through the presence of essential manpower inputs. Keeping in view relatively a lower level of per capita income in these districts, oft-prescribed privatization and user fees may not be the appropriate sole remedy. It would be better to increase overall public health expenditure in these districts to deploy and make available more medical and para-medical personnel in these districts. This fact should be incorporated in health facility planning at the sub-state level. Further enhancement to life expectancy may be possible at a faster pace in Punjab if such efforts are coupled with steps to promote female literacy and female incomes. This could empower women, particularly in poor performing districts, through better opportunities leading to an increase in their participation in workforce. Further studies at the sub-state level may also be initiated and facilitated if official information base is extended to provide public and private expenditure incurred at the district level on health and other social sectors.()，英语论文题目，英语论文 |
