Risk management strategies and practices in budget allocation of public hospitals in Manabí, Ecuador
Keywords:
Strategies, Risk Management, Public Hospitals, Budget AllocationAbstract
Introduction: This research aimed to analyze the most effective risk management strategies and practices in budget allocation for public hospitals in Manabí, Ecuador, during the period 2019-2024. Additionally, it sought to evaluate how these strategies have impacted the efficiency and quality of health services to draw lessons applicable to similar contexts. Materials and methods: A systematic review was carried out following PRISMA guidelines, using academic databases such as Scopus, Web of Science, PubMed, LILACS, and SciELO. Inclusion criteria were applied to select studies published between 2019 and 2024, focused on financial risk management in public hospitals. The quality of the studies was assessed using the AMSTAR 2 tool, and a narrative synthesis of the findings was performed. Of the 1,254 articles initially identified, 87 met the inclusion criteria. Results: The findings indicate that rigorous budget planning and evaluation, combined with strict control of revenues and expenditures, are essential to avoid resource underutilization and maintain financial sustainability. Discussion: Furthermore, disaster preparedness and the implementation of savings and efficiency strategies emerge as key components for improving the resilience of public hospitals. The strategies identified in this review have important implications for public policy in Ecuador and other similar contexts. Conclusions: The adoption of advanced financial management systems and investment in staff training are essential to ensure the efficiency and quality of health services.
References
Almeida-Santos, P. S., Mendes, N. C. F., & Matias-Pereira, J. (2024). Impactos de ações rent-seeking sobre o orçamento público: o efeito do caso “Máfia das Ambulâncias” nos municípios mato-grossenses. Revista Brasileira de Ciência Política, 43. https://doi.org/https://doi.org/10.1590/0103-3352.2024.43.275921
Anderson, I., Maliqi, B., Axelson, H., & Ostergren, M. (2016). How can health ministries present persuasive investment plans for women’s, children’s and adolescents’ health? | Comment les ministères de la Santé peuvent-ils présenter des plans d’investissements persuasifs en matière de santé de la femme, de l’enfant e. Bulletin of the World Health Organization, 94(6), 468–474. https://doi.org/10.2471/BLT.15.168419
Barasa, E. W., Molyneux, S., English, M., & Cleary, S. (2017). Hospitals as complex adaptive systems: A case study of factors influencing priority setting practices at the hospital level in Kenya. Social Science and Medicine, 174, 104–112. https://doi.org/10.1016/j.socscimed.2016.12.026
Barroy, H., Kutzin, J., Coulibaly, S., Bigeard, A., Yaméogo, S. P., Caremel, J.-F., & Korachais, C. (2022). Public Financial Management as an Enabler for Health Financing Reform: Evidence from Free Health Care Policies Implemented in Burkina Faso, Burundi, and Niger. Health Systems and Reform, 8(1). https://doi.org/10.1080/23288604.2022.2064731
Baumeister, R. F., Leary, M. R., & Berntson, G. G. (2019). The use of mixed methods in health psychology. Journal of Health Psychology, 24(3), 347–355. https://doi.org/10.1177/1359105317746904
Behera, D. K., & Dash, U. (2019). Impact of macro-fiscal determinants on health financing: empirical evidence from low-and middle-income countries. Global Health Research and Policy, 4(1). https://doi.org/10.1186/s41256-019-0112-4
Berger, M., Sommersguter-Reichmann, M., & Czypionka, T. (2020). Determinants of soft budget constraints: How public debt affects hospital performance in Austria. Social Science and Medicine, 249. https://doi.org/10.1016/j.socscimed.2020.112855
Chi, J., & Hu, S. (2021). Research on the Application of HRP-based Budget Management System in Hospitals. ACM International Conference Proceeding Series, 278–282. https://doi.org/10.1145/3510858.3510947
Falagas, M. E., Pitsouni, E. I., Malietzis, G. A., & Pappas, G. (2008). Comparison of PubMed, Scopus, Web of Science, and Google Scholar: strengths and weaknesses. The FASEB Journal, 22(2), 338–342. https://doi.org/10.1096/fj.07-9492LSF
Friesner, D., McPherson, M. Q., & Haugen, K. (2019). Assessing the Impact of Medical Laboratory Resource Allocations on Hospital Finances. Hospital Topics, 97(4), 119–132. https://doi.org/10.1080/00185868.2019.1631724
Gajadien, C., Dohmen, P., Eijkenaar, F., Schut, F., van Raaij, E., & Heijink, R. (2023). Financial risk allocation and provider incentives in hospital–insurer contracts in The Netherlands. European Journal of Health Economics, 24(1), 125–138. https://doi.org/10.1007/s10198-022-01459-5
Haddaway, N. R., Collins, A. M., Coughlin, D., & Kirk, S. (2015). The role of Google Scholar in evidence reviews and its applicability to grey literature searching. PLOS ONE, 10(9), e0138237. https://doi.org/10.1371/journal.pone.0138237
Higgins, J., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M., Welch, V. (editors) (2019). Cochrane Handbook for Systematic Reviews of Interventions. 2nd Edition. Chichester (UK): John Wiley & Sons. www.training.cochrane.org/handbook.
Hu, X., Jin, W., Yang, A., & Hu, Z. (2022). Management of capital liquidity in public hospitals under the epidemic situation of COVID-19. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.977221
James, C. D., Peabody, J., Hanson, K., & Solon, O. (2015). Public hospital care: Equal for all or equal for some? Evidence from the Philippines. Asia-Pacific Journal of Public Health, 27(2), NP1026–NP1038. https://doi.org/10.1177/1010539511422740
Kruse, F. M., & Jeurissen, P. P. T. (2020). For-profit hospitals out of business? Financial sustainability during the COVID-19 epidemic emergency response. International Journal of Health Policy and Management, 9(10), 423–428. https://doi.org/10.34172/ijhpm.2020.67
Lee, C.-L., Shih, Y.-N., & Hsiao, C.-F. (2015). The relationship among physicians’ professionalism, management accounting system and budget control behavior under global budget system. NTU Management Review, 25(2), 119–148. https://doi.org/10.6226/NTUMR.2015.Jun.R.11029
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Medicine, 6(7), e1000097. https://doi.org/10.1371/journal.pmed.1000097
Munn, Z., Moola, S., Lisy, K., Riitano, D., & Tufanaru, C. (2015). Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int J Evid Based Healthc. 13(3):147-53. https://doi.org/10.1097/XEB.0000000000000054
Novick, G. E. (2017). Health Care Organization and Delivery in Argentina: A Case of Fragmentation, Inefficiency and Inequality. Global Policy, 8, 93–96. https://doi.org/10.1111/1758-5899.12267
Noyes, J., Booth, A., Moore, G., Flemming, K., Tuncalp, O., & Shakibazadeh, E. (2019). Synthesising quantitative and qualitative evidence to inform guidelines on complex interventions: clarifying the purposes, designs and outlining some methods. BMJ Global Health, 4(1), e000893. https://gh.bmj.com/content/4/Suppl_1/e000893
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., & Moher, D. (2021). Declaración PRISMA 2020: una guía actualizada para la publicación de revisiones sistemáticas. Revista Española de Cardiología, 74(9), pp. 790-799. ISSN 0300-8932. https://doi.org/10.1016/j.recesp.2021.06.016
Pavlatos, O., & Kostakis, H. (2023). Moderating Role of Cost Accounting Information Quality on the Relationship Between the COVID-19 Pandemic and Budgeting in Public Hospitals. Australian Accounting Review, 33(1), 14–30. https://doi.org/10.1111/auar.12393
Pereira de Campos, C. M., Rodrigues, L. L., & Jorge, S. M. F. (2016). The Role of Management Accounting Systems in Public Hospitals and the Construction of Budgets. Public Health and Welfare. IGI Global. http://doi.org/10.4018/978-1-5225-1674-3.ch014
Popay, J., Roberts, H., Sowden, A., Petticrew, M., Arai, L., Rodgers, M., & Duffy, S. (2006). Guidance on the conduct of narrative synthesis in systematic reviews. https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=ed8b23836338f6fdea0cc55e161b0fc5805f9e27
Ramamonjiarivelo, Z., Weech-Maldonado, R., Hearid, L., & Pradhan, R. (2015). Public hospitals in Peril: Factors associated with financial distress. Journal of Health Care Finance, 40(3), 14–30. https://pubmed.ncbi.nlm.nih.gov/25223157/
Ramamonjiarivelo, Z., Weech-Maldonado, R., Hearld, L., Menachemi, N., Epané, J. P., & O’Connor, S. (2015). Public hospitals in financial distress: Is privatization a strategic choice? Health Care Management Review, 40(4), 337–347. https://doi.org/10.1097/HMR.0000000000000032
Senna, P., Reis, A. D. C., Leão Santos, I., & Dias, A. C. (2022). Healthcare supply chain risk management in Rio de Janeiro, Brazil: What is the current situation? Work, 72(2), 511–527. https://doi.org/10.3233/WOR-205216
Shea, B. J., Reeves, B. C., Wells, G., Thuku, M., Hamel, C., Moran, J., & Henry, D. A. (2017). AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 358, j4008. https://doi.org/10.1136/bmj.j4008
Tavera Cortés, M. E., Torres Sandoval, A. J., & Sandoval Gómez, R. J. (2024). Asignación eficiente del presupuesto en México. RIDE Revista Iberoamericana Para La Investigación y El Desarrollo Educativo, 14(28). https://www.ride.org.mx/index.php/RIDE/article/view/1764
Thomas, J., Harden, A., & Newman, M. (2012). Synthesis: combining results systematically and appropriately. In D. Gough, S. Oliver, & J. Thomas (Eds.), An introduction to systematic reviews (pp. 179–226). SAGE Publications. https://www.scienceopen.com/document?vid=c99ba2c7-0a74-4909-9404-faf4f7eb8d40
Wright, D. J. (2016). Soft Budget Constraints in Public Hospitals. Health Economics (United Kingdom), 25(5), 578–590. https://ideas.repec.org/p/syd/wpaper/2015-03.html
Published
Issue
Section
License
Copyright (c) 2025 Diana Elizabeth Calle Arcentales, Nataly Roció López Mite, Gladys Lola Luján Johnson
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
CC Reconocimiento-NoComercial-SinObrasDerivadas 4.0
.jpg)
_de_logo.jpg){kind=logo}
![](https://clustrmaps.com/site/1bhn8" title="Visit tracker"><img src="//www.clustrmaps.com/map_v2.png?d=2WTJsN7QOuRFRD2DOJOZtvZ6v94bxB6RU96I-iXx-_s&cl=ffffff"></a>)
