In a recent paper published in Health Policy and Planning, cluster faculty member Elizabeth Radin and her colleagues develop the concept of demand-side efficiency–or the efficiency with which health system users convert public health resources into health outcomes. They also propose methods to analyze it and apply them to understand how efficiently pregnant women in Northern Vietnam convert health system resources into the outcome of appropriate maternal care as defined by national policy. Most importantly, they assess whether some social groups are more likely to be efficient than others.
In this context, Radin and her colleagues find that the women who are most likely to achieve the best health outcomes are not necessarily the most likely to do so efficiently. Women who live in non-mountainous geographies and who are formally employed are both more likely to achieve appropriate care and to do so efficiently. Yet ethnic minority women, who do not systematically achieve better care overall, are more likely to be efficient, meaning they achieve optimal care when compared to those with an equal endowment of public health resources.
This finding suggests that if ethnic minority women do not achieve equally good care, the gap likely lies in the resources available to them rather than their use of those resources. It also begs the question why? Why are ethnic minority women significantly more likely to achieve appropriate care than their peers with equal resources?
One potential answer may lie in their choice of where to seek care. Vietnam has an extensive public health system that reaches to the community level. Though far from perfect, it has driven substantial improvements in health access and basic health indicators. With a rapidly developing economy, Vietnam also has a mushrooming private sector health care industry. With little regulation or oversight, the private sector has been found to deliver uneven care. Based on evidence that ethnic minority women are more likely to seek care in the public sector, and that seeking care in the public sector is associated with a greater likelihood of achieving appropriate care, Radin and her colleagues suggest that ethnic minorities may be more likely to be efficient because they are choosing to access care where it is more likely to be comprehensive.
This pilot suggests that analyzing demand side efficiency can be useful in two key ways: first, it begins to untangle whether the groups who systematically achieve better outcomes do so because they have more resources or because they are able to make more effective use of the resources they have; and second, by highlighting which groups are more likely to be efficient—and in turn how and why– it has the potential to inform policies that promote the drivers of efficiency.
