Arpita Ghose

Measurement and determinants of public hospital efficiency in West Bengal, India

This article focuses on analysing the efficiency of secondary-level government-run hospitals in West Bengal, a medium performer state in terms of health indicators, in India. Two main objectives of this article are (1) to measure the technical efficiency of the same and (2) to identify the factors determining their inefficiency. For the first purpose, output-oriented data envelopment analysis (DEA) under variable returns to scale has been used. For the second purpose, we have used two-part regression models, first showing why some hospitals are efficient while others are not and, secondly, what are the factors that determine the relative efficiency of inefficient hospitals. We have used different forms of regression models for both types. The results show that the overall mean efficiency of all hospitals is 0.728, suggesting that on average the hospitals could produce at least 37 per cent more of output with same input volume if they had produced efficiently. The results also reveal that the highest contributor to slack is the group D staff, followed by doctors. It is found that increase in average length of stay, availability of free medicine from the hospital, ratio between doctor and non-doctor staff strength, outpatient bed day and share of emergency admission significantly decrease the efficiency of a hospital, while the ratio of nurses to non-nurses affects it positively. The article concludes with policy suggestions based on the analysis that decrease in average length of stay (ALOS) by better medical intervention and improved quality of care would definitely allow for more patients to be treated, while increase in nursing staff vis-à-vis other staff would also result in better care. Furthermore, as far as availability of medicines is concerned, the policy should not be to reduce access and coverage, but should rather centre round improving the quality of the drugs procured and distributed through the hospitals. The article concludes that the main source of inefficiency in a specialist hospital in a typical developing country is not just resource crunch, but huge gaps in planning and implementation by the central authorities as well as managerial inefficiency of the local hospital establishment. The determinants that play a vital role in increasing efficiency levels also indicate that most of the inefficiencies can be tackled either with long-term planning or by quick intercession by the hospital authority itself.

Government size and economic growth in emerging market economies: a panel co-integration approach

A significant positive influence of both government size and domestic investment on economic growth is found in the long run during 1970–2006 for a sample of 19 emerging market economies, employing panel co-integration testing and estimating the parameters using dynamic ordinary least square method, for all the indicators, excepting the case when one chooses general government final consumption expenditure as a percentage of GDP a measure of government size and gross capital formation as a percentage of GDP a measure of domestic investment, with per capita GDP a proxy for economic growth. The findings corroborate the argument that diverse results of the earlier studies are due to different measures adopted.

The Input Oriented Technical Efficiency and Its Determinants in Primary and Upper Primary Level of Education in India

This chapters estimates input-oriented technical-efficiency (INPTE) of primary, upper-primary education for General-Category-States (GCS), Special-Category-States (SCS) and Union-territories (UT) of India using non-parametric Data-Envelopment Analysis (DEA) creating two frontiers for GCS, SCSU number of schools per-lakh population (SPLP), teacher-pupil ratio (PTR), classroom-student ratio (CR), percentages of teachers with qualification graduate and above (TQ) are inputs; quality of both output and input is thus important. Most of the States/UT is technically inefficient; input can be contracted keeping output unchanged. INPTE of not all the States/UT has improved. Input-underutilization is highest for SPLP for three categories/levels and for TQ for one; is lowest for PTR for one category/level and TQ for three. The determinants vary across category/level, highlighting role of policy, infrastructure, social-indicator, state-specific variables and regional variability. The availability and utilization of central grant (AGM), ratio of girls to boys getting free text book, proportion of para-teachers with qualification graduate and above among the total number of teachers, state’s per-capita net-domestic-product-from-service-sector, density-of-population, percentage of school having drinking-water, students getting free text book, proportion of SC teacher to total teacher have a positive effect, while inequality in the distribution of income, proportion of school without building have negative effect on INPTE. AGM has indirect effect through other variables. For SCS&UT-primary there is an optimum-AGM beyond which negative-effect of AGM on INPTE operates.

An Overview of the Existing Literature and Its Linkages with the Present Book

This chapter provides an overview of the existing literature on the technical efficiency of education sector. The concept of output and input oriented measures of technical efficiency is illustrated. After describing the methodology of estimating technical efficiency using different approaches; the nonparametric data envelopment analysis (DEA, the deterministic frontier approach) and stochastic frontier production function, the chapter summarizes different studies of technical efficiency on education sector around the globe on school and higher education along with the relevant studies for the Indian economy. The connection between the existing literature on the technical efficiency of education sector and the book is highlighted.

The Summary and the Policy Suggestions

The summary results show most of the States/UT is technically inefficient considering both output-oriented technical-efficiency (OUTTE) and input-oriented technical-efficiency (INPTE). Also not all the States/UT depicts improved performance over the sample 2005–06 to 2010–11. Higher literacy-rate or educational-development-index does not imply better OUTTE. The extents of underutilization of inputs are estimated. The determinants of both OUTTE and INPTE vary between General-Category, Special-Category States and between primary and upper-primary level, highlighting importance of policy, infrastructure, State-specific and social-indicator variables. At policy level, both INPTE and OUTTE can be enhanced by increasing (i) the availability and utilization of central grant (AGM), (ii) the proportion of girls to boys getting free text book, para-teachers having qualification graduate and above, school with drinking water facility, SC teacher, (iii) State’s service sectors income, population-density and by reducing (i) without-building school, (ii) inequality of income-distribution. OUTTE can further be stimulated by increasing percentage of (i) schools getting school-development-grant, having common-toilet, (ii) SC-enrollment and by reducing proportion of (i) single-teacher-school, (ii) single-classroom-school, and (iii) below the poverty line population. INPTE can also be enhanced by increasing the proportion of students getting free text book. Effect of AGM on INPTE also operates through its joint interaction with other variables. For SCS&UT-primary effect of AGM on INPTE is positive up to a limit. Although employment of average input-bundle in SCS&UT-school produces less benefit as compared to GCS-school both for primary and upper primary, elasticity of OUTTE with respect to AGM is higher for SCS&UT-school.

The Background and the Motivation

The major departure of this book is its approach to estimating technical efficiency (TE) for primary and upper primary education which does not use a single frontier encompassing all the twenty-eight states and seven union territories (UT) over the period 2005–06 to 2010–11, as is done in the available literature. Rather, this method assumes that General Category State (GCS), Special Category States (SCS)U SCS&UT-primary and SCS&UT-upper primary highlighting some policy suggestions for improving efficiency. This chapter reports the basic motivation, objectives and the chapter composition of the book.

The Output Oriented Measures of Technical Efficiency and Its Determinants in Primary and Upper Primary Level of Education in India

Output-oriented technical-efficiency (OUTTE) of primary, upper-primary education for General-Category-States (GCS), Special-Category-States (SCS) and Union-territories (UT) of India using non-parametric Data-Envelopment Analysis (DEA) is estimated, creating two frontiers for GCS, SCSU number of schools per-lakh population, teacher-pupil ratio, classroom-student ratio, percentages of teachers with qualification graduate and above are inputs representing quality for both output-input. Most of the States/UT is technically inefficient; output can increase with same input-usage. OUTTE of not all the states/UT has shown improved performance. Higher literacy-rate or educational-development-index does not imply better OUTTE. Second-stage panel-regression show the determinants OUTTE vary between category and level and highlight importance of policy, infrastructure and state-specific variables. OUTTE having regional variability is determined positively by the availability and utilization of central grant (AGM), ratio of girls to boys getting free text book, proportion of para-teachers among the total teachers in school, para-teacher’s qualification; whether graduate and above, state’s per-capita net-domestic-product-from-service-sector, density of population, percentage of school having drinking-water, common-toilet, getting school-development-grant, proportion of SC-teachers and SC-enrollment. Proportion of without-building-school, single-teacher-school, single-class-room-school, proportion of people below the poverty line, inequality in the distribution of income of the State has negative effect on OUTTE Both primary and upper-primary GCS-school has high technology-closeness-ratio implying maximum output producible from an input-bundle by a GCS-school is high compared to SCS&UT-school. It shows less benefit of a input-bundle from SCS&UT-school having greater elasticity of OUTTE with respect to AGM.

Does Parental Education Have Any Role to Play on Female Child Disadvantage

In contrast to the existing studies that employ community level data to find out the discrimination against female child, the present chapter uses household level primary survey data from a small area of West Bengal, India, since the incidence of the discrimination against female child can properly be analysed using household level primary survey data. The existence of female child disadvantage (FCD) is verified by comparing female–male underweight level for each household following the World Health Organization’s (WHO’s) criterion. Nutritional deficiency is calculated using “WHO child growth standards” and “WHO reference 2007” tables for (i) children aged up to 5 years and (ii) children aged more than 5 and up to 6 years, respectively. The effect of an increase in the level of education of both father and mother of the child on the existence of FCD is tested separately along with family income, whether there is the custom of dowry, working status of the mother, the religion and cast of household as the other explanatory variables. It is found that 61.19 % of the sample households show bias against female children. An increase in education level of both mother and father reduces the probability of the existence of FCD, whereas the existence of the custom of dowry increases such probability. Thus, enhancing the education level of the parents and undertaking different measures for eradicating the dowry system such as making the existing law on dowry much more stringent and arranging different programmes to make people aware of the values of females are necessary for reducing the prevalence of FCD.

Trade and Distributional Impacts of Genetically Modified Crops in India: A CGE Analysis

Against the background of declining agricultural productivity and a large population, genetically modified (GM) crops could play a key role in India. The current article uses a modified GTAP model to study empirically the overall impacts of the adoption of GM cotton, soybean, maize and rice on various sectors of the Indian economy through computable general equilibrium analysis. The impacts of a compulsory labelling policy and positive and negative preference shifts towards GM rice by Indian consumers are also analysed along with the effects on income distribution. The results indicate that productivity improvements from GM technology adoption in India have a significant positive impact on India’s production, trade and welfare. Even a possible ban on the import of GM rice from India by European Union (EU) will not have any negative welfare impact on Indian consumers, though the export of Indian rice will be much lower. JEL Classification: C68, D33, D61, F17, O11

Role of monetary policy in a New Keynesian economy: a note from a laboratory experiment

This paper discusses an experimental study on the role of monetary policy within a New Keynesian macroeconomic framework. The novelty of this article is that each subject was asked to forecast both the inflation rate and output gap at the same time one period ahead, which is an improvement over the existing literature. We find that if both the expected inflation rate and expected output gap is incorporated in the monetary policy rule then inflation can be anchored and stabilized more efficiently.