A Data Envelopment Analysis in Measuring Efficiency of the Community Health Clinics: A Comparative Study between Rural Bangladesh and San Joaquin Valley in California

There is much similarity in health status, healthcare infrastructure and availability of healthcare providers among rural Bangladesh and the rural counties in the Central Valley in California. This study presents a comparative efficiency analysis of health clinics in Bangladesh and community health clinics in the San Joaquin Valley in California. This analysis aimed to: 1) assess the status of the health care services provided by these 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 in order to draw parallels in their performance and identify lessons that could be learned from each others experience. The study used the Data Envelopment Analysis (DEA) technique to evaluate the efficiency of 202 health clinics located in Bangladesh and 90 health clinics in the Central Valley. The data for health clinics were obtained from the Survey of Private Medical Clinics in Bangladesh and ALIRTS database from OSHPD. 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 findings from the study showed major differences in efficiency among the clinics in the two areas and could be explained by various environmental factors and existing managerial practices. The study asserts that there is a scope for cutting cost and improving efficiency if a number of management changes are mandated on the clinics. It can also been deduced from the analysis that shortages of health care providers in these regions is a major impediment in achieving efficient capacity at the health centers. The study recommends changes in a number of managerial practices to improve performance at the clinics in both regions. The study also recommends various policy changes that can influence how clinics compete and cooperate among each other. There are several lessons that clinic managers in one region can learn from the other in terms of resource mix and services provided.