ارزیابی کارایی بودجه در بخش دولتی سلامت برای مراقبت‌های سرپایی و بستری در مدل بودجه عملیاتی بر اساس کارکردها

Background and Objective: Expressing relationship between financial payments and performances’ results in health system could be explained by performance-based financing presentation. This study aimed to indicate differences in budget efficiencies amongst the Iranian provinces by comparative means, using performances data on public health sector in the provinces, and results of computing provinces’ relative budget efficiencies. Materials and Methods: in this study, statistical-descriptive analysis method was used and operational or performance-based budget efficiency indicators in the Iranian provinces using record data from the Health Ministry and the Iranian Health Insurance Organization were used. Presenting a simple picture of performance-based budgeting, by health expenditure, manpower and physical resources for outpatient and inpatient performances in the provinces, the comparative indicators of efficiencies were computed, using Data Envelopment Analysis (DEA) method. Results: The country average of budget efficiencies for performances maximization in 2011 and 2013 were 0.55 and 0.58 for outpatient services, respectively, and 0.82 and 0.86 for inpatient services, respectively. The efficiency indicators in the public sector showed provinces, despite having the same conditions on revenue collecting and performance regulating, are classified with considerable differences in service maximization and expenditure or budget minimization Conclusion: This study is the first research, introducing efficiency indicators in operational or performance-based budgeting scheme in the public health sector. Efficiency differences amongst provinces, and declining efficiency in some provinces in the second year could be considered sources of efficiency unsustainability and inequalities and limiting access to health sector goals.