IDEAS home Printed from https://ideas.repec.org/a/eee/soceps/v101y2025ics0038012125001065.html

Determinants of primary healthcare efficiency in the Brazilian Legal Amazon: A hybrid approach using Data Envelopment Analysis and Tobit regression

Author

Listed:
  • de Oliveira, Luís Filipe Azevedo
  • Baião, Fernanda Araujo
  • Oliveira, Fernando Luiz Cyrino
  • Peres, Igor Tona

Abstract

•Efficiency was evaluated using bootstrapped DEA with 1000 replications.•Productive, technical, and scale efficiency were assessed for 2019 and 2022.•Tobit regression models explained inefficiency based on Lasso-selected variables.•Urban infrastructure and proximity to capitals shaped municipal inefficiency.•The study provides robust insights for health policy in remote Amazonian areas.

Suggested Citation

  • de Oliveira, Luís Filipe Azevedo & Baião, Fernanda Araujo & Oliveira, Fernando Luiz Cyrino & Peres, Igor Tona, 2025. "Determinants of primary healthcare efficiency in the Brazilian Legal Amazon: A hybrid approach using Data Envelopment Analysis and Tobit regression," Socio-Economic Planning Sciences, Elsevier, vol. 101(C).
    • Handle: RePEc:eee:soceps:v:101:y:2025:i:c:s0038012125001065
    DOI: 10.1016/j.seps.2025.102257
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0038012125001065
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.seps.2025.102257?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to

    for a different version of it.

    References listed on IDEAS

    as
    1. Amemiya, Takeshi, 1973. "Regression Analysis when the Dependent Variable is Truncated Normal," Econometrica, Econometric Society, vol. 41(6), pages 997-1016, November.
    2. Tais Freire Galvao & Gustavo Magno Baldin Tiguman & Mónica Caicedo Roa & Marcus Tolentino Silva, 2019. "Inequity in utilizing health services in the Brazilian Amazon: A population‐based survey, 2015," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1846-1853, October.
    3. Sebastian Kohl & Jan Schoenfelder & Andreas Fügener & Jens O. Brunner, 2019. "The use of Data Envelopment Analysis (DEA) in healthcare with a focus on hospitals," Health Care Management Science, Springer, vol. 22(2), pages 245-286, June.
    4. Charnes, A. & Cooper, W. W. & Rhodes, E., 1978. "Measuring the efficiency of decision making units," European Journal of Operational Research, Elsevier, vol. 2(6), pages 429-444, November.
    5. Margherita Neri & Patricia Cubi-Molla & Graham Cookson, 2022. "Approaches to Measure Efficiency in Primary Care: A Systematic Literature Review," Applied Health Economics and Health Policy, Springer, vol. 20(1), pages 19-33, January.
    6. Léopold Simar & Paul W. Wilson, 1998. "Sensitivity Analysis of Efficiency Scores: How to Bootstrap in Nonparametric Frontier Models," Management Science, INFORMS, vol. 44(1), pages 49-61, January.
    7. Jeffrey M Wooldridge, 2010. "Econometric Analysis of Cross Section and Panel Data," MIT Press Books, The MIT Press, edition 2, volume 1, number 0262232588, December.
    8. El Mehdi, Rachida & Hafner, Christian M., 2014. "Inference in stochastic frontier analysis with dependent error terms," Mathematics and Computers in Simulation (MATCOM), Elsevier, vol. 102(C), pages 104-116.
    9. Simar, Leopold & Wilson, Paul W., 2007. "Estimation and inference in two-stage, semi-parametric models of production processes," Journal of Econometrics, Elsevier, vol. 136(1), pages 31-64, January.
    10. Meeusen, Wim & van den Broeck, Julien, 1977. "Efficiency Estimation from Cobb-Douglas Production Functions with Composed Error," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 18(2), pages 435-444, June.
    11. Vinod, H. D., 1976. "Canonical ridge and econometrics of joint production," Journal of Econometrics, Elsevier, vol. 4(2), pages 147-166, May.
    12. Bruce Hollingsworth, 2008. "The measurement of efficiency and productivity of health care delivery," Health Economics, John Wiley & Sons, Ltd., vol. 17(10), pages 1107-1128, October.
    13. Shujuan Chen & Yue Li & Yi Zheng & Binglun Wu & Ronita Bardhan & Liqun Wu, 2023. "Technical Efficiency Evaluation of Primary Health Care Institutions in Shenzhen, China, and Its Policy Implications under the COVID-19 Pandemic," IJERPH, MDPI, vol. 20(5), pages 1-21, March.
    14. Seiford, Lawrence M. & Zhu, Joe, 2002. "Modeling undesirable factors in efficiency evaluation," European Journal of Operational Research, Elsevier, vol. 142(1), pages 16-20, October.
    15. Aigner, Dennis & Lovell, C. A. Knox & Schmidt, Peter, 1977. "Formulation and estimation of stochastic frontier production function models," Journal of Econometrics, Elsevier, vol. 6(1), pages 21-37, July.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Kaffash, Sepideh & Azizi, Roza & Huang, Ying & Zhu, Joe, 2020. "A survey of data envelopment analysis applications in the insurance industry 1993–2018," European Journal of Operational Research, Elsevier, vol. 284(3), pages 801-813.
    2. Varabyova, Yauheniya & Schreyögg, Jonas, 2013. "International comparisons of the technical efficiency of the hospital sector: Panel data analysis of OECD countries using parametric and non-parametric approaches," Health Policy, Elsevier, vol. 112(1), pages 70-79.
    3. Mergoni, Anna & Emrouznejad, Ali & De Witte, Kristof, 2025. "Fifty years of Data Envelopment Analysis," European Journal of Operational Research, Elsevier, vol. 326(3), pages 389-412.
    4. Bao Hoang Nguyen & Valentin Zelenyuk, 2021. "Aggregation of Outputs and Inputs for DEA Analysis of Hospital Efficiency: Economics, Operations Research and Data Science Perspectives," International Series in Operations Research & Management Science, in: Joe Zhu & Vincent Charles (ed.), Data-Enabled Analytics, pages 123-158, Springer.
    5. Lampe, Hannes W. & Hilgers, Dennis, 2015. "Trajectories of efficiency measurement: A bibliometric analysis of DEA and SFA," European Journal of Operational Research, Elsevier, vol. 240(1), pages 1-21.
    6. Iparraguirre, José Luis & Ma, Ruosi, 2015. "Efficiency in the provision of social care for older people. A three-stage Data Envelopment Analysis using self-reported quality of life," Socio-Economic Planning Sciences, Elsevier, vol. 49(C), pages 33-46.
    7. Galina Besstremyannaya, 2013. "The impact of Japanese hospital financing reform on hospital efficiency: A difference-in-difference approach," The Japanese Economic Review, Japanese Economic Association, vol. 64(3), pages 337-362, September.
    8. Vittadini, Giorgio & Sturaro, Caterina & Folloni, Giuseppe, 2022. "Non-Cognitive Skills and Cognitive Skills to measure school efficiency," Socio-Economic Planning Sciences, Elsevier, vol. 81(C).
    9. Thanh Ngo & Kan Wai Hong Tsui, 2022. "Estimating the confidence intervals for DEA efficiency scores of Asia-Pacific airlines," Operational Research, Springer, vol. 22(4), pages 3411-3434, September.
    10. Sickles, Robin C. & Song, Wonho & Zelenyuk, Valentin, 2018. "Econometric Analysis of Productivity: Theory and Implementation in R," Working Papers 18-008, Rice University, Department of Economics.
    11. Carlos Pestana Barros & Gaël Bertrand & Laurent Botti & Scott Tainsky, 2014. "Cost efficiency of French rugby clubs," Applied Economics, Taylor & Francis Journals, vol. 46(23), pages 2721-2732, August.
    12. Abu Daud Pathan, 2025. "Technical Efficiency and its Determinants of Cane and Bamboo Enterprise in Assam: A Conventional DEA, Double Bootstrap DEA, and SFA Approach," SN Operations Research Forum, Springer, vol. 6(3), pages 1-27, September.
    13. Léopold Simar & Paul W. Wilson, 2015. "Statistical Approaches for Non-parametric Frontier Models: A Guided Tour," International Statistical Review, International Statistical Institute, vol. 83(1), pages 77-110, April.
    14. Emrouznejad, Ali & De Witte, Kristof, 2010. "COOPER-framework: A unified process for non-parametric projects," European Journal of Operational Research, Elsevier, vol. 207(3), pages 1573-1586, December.
    15. Calogero Guccio & Marco Ferdinando Martorana & Luisa Monaco, 2016. "Evaluating the impact of the Bologna Process on the efficiency convergence of Italian universities: a non-parametric frontier approach," Journal of Productivity Analysis, Springer, vol. 45(3), pages 275-298, June.
    16. Bao Hoang Nguyen & Valentin Zelenyuk, 2020. "Robust efficiency analysis of public hospitals in Queensland, Australia," CEPA Working Papers Series WP052020, School of Economics, University of Queensland, Australia.
    17. Massimo Finocchiaro Castro & Calogero Guccio & Ilde Rizzo, 2014. "An assessment of the waste effects of corruption on infrastructure provision," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 21(4), pages 813-843, August.
    18. Isabel Narbón-Perpiñá & Kristof De Witte, 2016. "Local governments’ efficiency: A systematic literature review – Part II," Working Papers 2016/21, Economics Department, Universitat Jaume I, Castellón (Spain).
    19. Quaranta, Anna Grazia & Raffoni, Anna & Visani, Franco, 2018. "A multidimensional approach to measuring bank branch efficiency," European Journal of Operational Research, Elsevier, vol. 266(2), pages 746-760.
    20. Shiovan Ni Luasa & Declan Dineen & Marta Zieba, 2018. "Technical and scale efficiency in public and private Irish nursing homes – a bootstrap DEA approach," Health Care Management Science, Springer, vol. 21(3), pages 326-347, September.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:soceps:v:101:y:2025:i:c:s0038012125001065. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/locate/seps .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.