Measuring the performance of health systems in Latin America

Abstract Background Efficiency has been identified as a key intermediate policy objective for Universal Health Coverage. Despite that, it was estimated that 20 to 40% of health sector resource utilization is wasteful globally. An efficient use of existing resources in healthcare is critical and a priority policy in sustaining positive health outcomes for the population. This study aimed to perform a longitudinal efficiency analysis was found concerning health systems specific to all the Latin America region over the last 13 years. Methods Health Adjusted Life Expectancy (HALE), Diphtheria Pertussis Tetanus (DPT)Immunization and Survivability Rate of under-5 were chosen as outputs, while Pooled Health Expenditure, Gross Domestic Product (GDP) per Capita and Population over 65 were selected as inputs. Cross sectional Data Envelopment Analysis using five-year averages and a longitudinal Data Envelopment Analysis (DEA) were performed creating several model iterations with our selected indicators. All the models had an output orientation, adjusted for variable returns to scale and incorporating a five-year time lag between inputs and outputs. Results Our cross-sectional DEA Analysis found that the best performing country ended up being Nicaragua, followed by Cuba, Honduras, Costa Rica and Chile, while the countries performing the worst were Suriname, Venezuela and Guatemala. When observing efficiency scores behaviors longitudinally, all our model iterations result in the region decreasing efficiency in their health systems by 2.5% to 6.9% from 2000 to 2013, depending on the model chosen. Conclusions The study reveals that all countries in Latin American can improve their health systems efficiency performance to different extents. Latin America reduced total health system productivity between 2000 and 2013. Further studies are required to uncover the extent and causes of this regression. A similar analysis in Europe may be warranted and could aid policy making. Key messages • Overall efficiency in Latin American health systems has decreased by 3% to 7% over the last thirteen years. • Nicaragua, Cuba, Honduras and Costa Rica seem to have the most efficient health systems in the region, whereas Venezuela and Guatemala are the least efficient.


Background:
Efficiency has been identified as a key intermediate policy objective for Universal Health Coverage. Despite that, it was estimated that 20 to 40% of health sector resource utilization is wasteful globally. An efficient use of existing resources in healthcare is critical and a priority policy in sustaining positive health outcomes for the population. This study aimed to perform a longitudinal efficiency analysis was found concerning health systems specific to all the Latin America region over the last 13 years.

Methods:
Health Adjusted Life Expectancy (HALE), Diphtheria Pertussis Tetanus (DPT)Immunization and Survivability Rate of under-5 were chosen as outputs, while Pooled Health Expenditure, Gross Domestic Product (GDP) per Capita and Population over 65 were selected as inputs. Cross sectional Data Envelopment Analysis using five-year averages and a longitudinal Data Envelopment Analysis (DEA) were performed creating several model iterations with our selected indicators. All the models had an output orientation, adjusted for variable returns to scale and incorporating a five-year time lag between inputs and outputs.

Results:
Our cross-sectional DEA Analysis found that the best performing country ended up being Nicaragua, followed by Cuba, Honduras, Costa Rica and Chile, while the countries performing the worst were Suriname, Venezuela and Guatemala. When observing efficiency scores behaviors longitudinally, all our model iterations result in the region decreasing efficiency in their health systems by 2.5% to 6.9% from 2000 to 2013, depending on the model chosen.

Conclusions:
The study reveals that all countries in Latin American can improve their health systems efficiency performance to different extents. Latin America reduced total health system productivity between 2000 and 2013. Further studies are required to uncover the extent and causes of this regression. A similar analysis in Europe may be warranted and could aid policy making. Key messages: Overall efficiency in Latin American health systems has decreased by 3% to 7% over the last thirteen years. Nicaragua, Cuba, Honduras and Costa Rica seem to have the most efficient health systems in the region, whereas Venezuela and Guatemala are the least efficient.

Background:
Diabetologists, as other specialists, are more likely concentrated in towns and cities rather than in the countryside so the people who live in these municipalities have a wider supply of health services. Our aim is to determine whether there are significant differences in the use of diabetology services between patients who live in the municipality with these services or not in Czechia.

Methods:
The sorted anonymized data obtained from the General Health Insurance Company of the Czech Republic (GHIC CR) were used. The studied patients were people with a diagnosis of type 2 diabetes mellitus (E11) who were insured by GHIC CR and used health services in 2019 in Czechia.

Results:
The distribution of providers of diabetology services (PDS) is relatively even throughout the country, and PDS are mainly concentrated in the municipality with a large population. In total, 52% of patients have the diabetologist in their municipality of residence. Patients living in the municipality with PDS have greater odds of using their services (OR 1.63, Cl 1.61-1.65). Specifically, 67% of the patients who have the diabetologist in their municipality of residence use diabetology services compared to 55% of the patients living in the municipality without PDS commute for diabetology services to the other municipality.

Conclusions:
The results show that diabetology services are concentrated mainly in towns and cities and patients living in the municipality with the diabetologist use more diabetology services compared to patients living in the municipality without them. At the same time, it seems that more than half of the patients in the municipality where is not PDS are willing and able to commute for diabetology services.

Key messages:
Although patients living in the municipality without the diabetologist use diabetology services less often than with them, due to the commuting for healthcare, the differences are blurred.
iii536 European Journal of Public Health, Volume 32 Supplement 3, 2022