Using data envelopment analysis, we examine the efficiency of Canada's universal health care system by considering a set of labour (physicians) and capital (beds) inputs, which produce a level of care (measured in terms of health quality and quantity) in a given region. Data from 2013–2015 were collected from the Canadian Institute for Health Information regarding inputs and from the Canadian Community Health Survey and Statistics Canada regarding our output variables, health utility (quality) and life expectancy (quantity). We posit that variation in efficiency scores across Canada is the result of regional heterogeneity regarding socioeconomic and demographic disparities. Regressing efficiency scores on such covariates suggests that regional unemployment and an older population are quite impactful and associated with less efficient health care production. Moreover, regional variation indicates the Atlantic provinces (Newfoundland, Prince Edward Island, Nova Scotia, New Brunswick) are quite inefficient, have poorer economic prospects, and tend to have an older population than the rest of Canada. Oaxaca-Blinder decompositions suggest that the latter two factors explain about one-third of this efficiency gap. Based on our two-stage semi-parametric analysis, we recommend Canada adjust their transfer payments to reflect these disparities, thereby potentially reducing inequality in regional efficiency.

Given change in the universal developmental agenda and the quality of governance in the last two decades, this paper re-examines the relationship between governance, health expenditure and maternal mortality using panel data for 184 countries from 1996 to 2019. By employing the ‘dynamic panel data regression model’, the study reveals that a one-point improvement in the governance index decreases maternal mortality by 10–21%. We also find that good governance can better translate health expenditure into improved maternal health outcomes through effective allocation and equitable distribution of available resources. These results are robust to alternative instruments, alternative dependent variables (such as infant mortality rate and life expectancy), estimation by different governance dimensions and at the sub-national level. Additional findings using ‘Quantile regression’ estimates show that the quality of governance matters more than the health expenditure in countries with a higher level of maternal mortality. While the ‘Path regression’ analysis exhibits the specific direct and indirect mechanisms through which the causal inference operates between governance and maternal mortality.

Sri Lanka has a history of successfully managing communicable diseases by utilising its extensive public healthcare network of community clinics and public hospitals. This article makes use of Job Demands-Resources theory (JD-R) to examine the impact of COVID-19 on nurses’ working conditions in public and private hospitals in Sri Lanka. Prior to the COVID-19 pandemic, nurses’ job demands on public hospital wards included long working hours, limited workplace autonomy, minimal medical resources and high workloads caused by understaffing. Private hospital nurses experienced pressure from patients and their families to provide them with discounts on medical bills. Nurses allocated to work on COVID-19 wards experienced additional physical job demands from wearing personal protective equipment (PPE) for lengthy periods on hospital wards in a humid climate. Nurses on COVID-19 wards also experienced increased anxiety that they could transmit the disease to family members. While nurses experienced job resources such as social support from nursing supervisors and other nurses, they reported receiving minimal training in the provision of healthcare to COVID-19 patients. This combination of high job demands and low job resources increased the levels of exhaustion and mental distress experienced by many nurses working on COVID-19 hospital wards.

How has public healthcare spending prepared countries for tackling the COVID-19 pandemic? Arguably, spending is the primary policy tool of governments for providing effective health. We argue that the effectiveness of spending for reducing COVID deaths is conditional on the existence of healthcare equity and lower political corruption because the health sector is particularly susceptible to political spending. Our results, obtained using ordinary least squares and two-stage least squares estimations, suggest that higher spending targeted at reducing inequitable access to health has reduced COVID deaths. Consistent with the findings of others, our results indirectly suggest that health spending is necessary, but not sufficient unless accompanied by good governance and equitable access. Equitable health systems ease the effects of COVID presumably because they allow states to reach and treat people more effectively. Spending aimed at increasing health system capacity by increasing access thus seems a sound strategy for fighting the spread of disease, ultimately benefiting us all.

Measured health output in the UK declined sharply during the Covid-19 pandemic, despite the evident large increase in some National Health Service (NHS) activities such as critical care, and the new test and trace and vaccination programmes. We explain the measurement methods applied to public services that produced the published decline, in the context of the inherent difficulties of defining and measuring health output and productivity; and describe the changes in practice that had to take place in NHS hospitals. We also discuss, on the basis of these changes including increased use of technology, the likely outlook for healthcare productivity. We conclude that within NHS England capacity, constraints have contributed to substantial falls in non-Covid-19 healthcare output and argue that increased capacity in the social infrastructure of the health service is essential to enable higher productivity in an uncertain environment.

Most hospital payment systems based on diagnosis-related groups (DRGs) provide payments for newly approved technologies. In Germany, they are negotiated between individual hospitals and health insurances. The aim of our study is to assess the functioning of temporary reimbursement mechanisms. We used multilevel logistic regression to examine factors at the hospital and state levels that are associated with agreeing innovation payments. Dependent variable was whether or not a hospital had successfully negotiated innovation payments in 2013 (n = 1532). Using agreement data of the yearly budget negotiations between each German hospital and representatives of the health insurances, the study comprises all German acute hospitals and innovation payments on all diagnoses. In total, 32.9% of the hospitals successfully negotiated innovation payments in 2013. We found that the chance of receiving innovation payments increased if the hospital was located in areas with a high degree of competition and if they were large, had university status and were private for-profit entities. Our study shows an implicit self-controlled selection of hospitals receiving innovation payments. While implicitly encouraging safety of patient care, policy makers should favour a more direct and transparent process of distributing innovation payments in prospective payment systems.

In this paper we explain some of the difficulties of providing forecasts of the financial benefits of early intervention programmes, focussing on those delivered during the early childhood period. We highlight the diversity of early intervention, and the complexity and multiplicity of outcomes. We summarise recent work at the Early Intervention Foundation to assess the evidence on the impacts of early intervention, recognising the diversity of approaches to delivery and the importance of innovation and local practice as well as of rigorous approaches to evaluating causal effects. We also describe new ways of assessing accurately the local fiscal costs of late intervention and consider the implications of this for addressing the well-established barriers to investment in prevention. Our analysis brings to the fore gaps in the evidence from which even the most rigorous ‘gold-standard’ research is not immune. These limitations prevent the production of an accurate and realistic cost-benefit ratio or net present value for the majority of programmes as delivered in practice. We suggest some paths towards a firmer foundation of evidence and a better alignment of evidence and policy.