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BMC Health Services Research

, 15:349

First Online: 28 August 2015Received: 16 July 2014Accepted: 18 August 2015DOI: 10.1186-s12913-015-1011-0

Cite this article as: Foo, C.Y., Lim, K.K., Sivasampu, S. et al. BMC Health Serv Res 2015 15: 349. doi:10.1186-s12913-015-1011-0


BackgroundRising demand of ophthalmology care is increasingly straining Malaysia’s public healthcare sector due to its limited human and financial resources. Improving the effectiveness of ophthalmology service delivery can promote national policy goals of population health improvement and system sustainability. This study examined the performance variation of public ophthalmology service in Malaysia, estimated the potential output gain and investigated several factors that might explain the differential performance.

MethodsData for 2011 and 2012 on 36 ophthalmology centres operating in the Ministry of Health hospitals were used in this analysis. We first consulted a panel of ophthalmology service managers to understand the production of ophthalmology services and to verify the production model. We then assessed the relative performance of these centres using Data Envelopment Analysis DEA. Efficiency scores ES were decomposed into technical, scale, and congestion component. Potential increase in service output was estimated. Sensitivity analysis of model changes was performed and stability of the result was assessed using bootstrap approach. Second stage Tobit regression was conducted to determine if hospital type, availability of day services and population characteristics were related to the DEA scores.

ResultsIn 2011, 33 % of the ophthalmology centres were found to have ES > 1 mean ES = 1.10. Potential output gains were 10 % SE ± 2.92, 7.4 % SE ± 2.06, 6.9 % SE ± 1.97 if the centres could overcome their technical, scale and congestion inefficiencies. More centres moved to the performance frontier in 2012 mean ES = 1.07, with lower potential output gain. The model used has good stability. Robustness checks show that the DEA correctly identified low performing centres. Being in state hospital was significantly associated with better performance.

ConclusionsUsing DEA to benchmarking service performance of ophthalmology care could provide insights for policy makers and service managers to intuitively visualise the overall performance of resource use in an otherwise difficult to assess scenario. The considerable potential output gain estimated indicates that effort should be invested to understand what drove the performance variation and optimise them. Similar performance assessment should be undertaken for other healthcare services in the country in order to work towards a sustainable health system.

AbbreviationsDEAData Envelopment Analysis

ESEfficiency scores

MOHMinistry of Health

OSMWCOphthalmology Service Management Working Committee

SFAStochastic frontier analysis

DMUDecision making unit

NHEWSNational Healthcare Establishment and Workforce Survey

NEDNational Eye Database

NCRNational Cataract Registry

VRSVariable return to scale

CRSConstant return to scale

IQRInter-quartile ranges

SDStandard deviation

SEStandard error

FETFull-time equivalence

Electronic supplementary materialThe online version of this article doi:10.1186-s12913-015-1011-0 contains supplementary material, which is available to authorized users.

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Author: Chee Yoong Foo - Ka Keat Lim - Sheamini Sivasampu - Kamilah Binti Dahian - Pik Pin Goh


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