Efficiency analysis of high-cost dental prosthetic service provision in Thai district hospitals under universal healthcare coverage scheme in fiscal year 2010-2011

Abstract

This study evaluates technical efficiency in provision of high-cost dental prosthetic service under Universal Healthcare Coverage Scheme in Thailand. The study takes 663 and 709 district hospitals of all sizes nationwide as analyzed firms in fiscal year 2010 and 2011, respectively. Data Envelopment Analysis (DEA) is applied for relative efficiency measurement based on assumption of variable returns to scale. Two production inputs comprise number of dentists in each hospitals and operating expenses. Four production outputs are defined by different types of removable acrylic dentures including single denture, complete denture, partial denture with not more than 5 replaced teeth and partial denture with more than 5 replaced teeth. Among all analyzed firms in fiscal year 2010, average efficiency is found to be around 69% and 133 technically efficient firms are identified. For 2011, average efficiency is decreased to be about 65% with 109 efficient firms identified. In addition to the technical efficiency measurement, relationship between explanatory factors and the dependent variable of efficiency scores is investigated by means of Tobit analysis. Hospital sizes (indicated by numbers of inpatient beds) and hospital location in the central region of the nation are positively related to efficiency in service production while increase in number of dentists is instead negatively associated with the technical efficiency. To gain better understanding of current situation of the dental prosthetic service provision and to generate lessons learned from best practice dental providers, qualitative part of this thesis is undertaken by means of in-depth interview in three technically efficient hospitals of different sizes. Key managerial strategies to achieve service efficiency of these efficient providers comprise allocation of working hours specific for the prosthetic service, assigning edentulous patients to all dentists instead of limiting the service to be served only by prosthodontist, and extension of the dental prosthetic service provision to Health Promoting Hospitals at sub-district level with public relation through local community network.