IDEAS home Printed from https://ideas.repec.org/a/spr/eurase/v13y2023i2d10.1007_s40822-023-00233-z.html
   My bibliography  Save this article

Health care financing and productivity of health care in OECD countries: a stochastic frontier analysis

Author

Listed:
  • Constantin Ogloblin

    (Georgia Southern University)

Abstract

The effects of health-care expenditure on health outcomes and the efficiency of health-care financing schemes in the OECD are estimated with a panel of 30 countries over 1995–2019. The survival rate constructed from the data on age-standardized health-related mortality is used as the health outcome variable. The stochastic frontier model used in the study accommodates nonmonotonic relationships between the factors of interest and the outcome, allowing us to find the optimal levels of the factors. The marginal effect of per capita health-care expenditure on the maximum achievable survival rate diminishes as the level of spending increases and is no longer statistically positive after health-care spending reaches $4811 (2015 PPP). The optimal share of compulsory financing in health expenditure is between 55 and 65%, and health care systems where it exceeds 90% are significantly less efficient. Health-care systems where the percentage of private financing in health expenditure is below 18% are significantly less efficient than those where it is close to the optimal level of about 62%. Further research is needed to examine the effects on health-care efficiency of more specific characteristics of health-care systems taking into account their complex interactions.

Suggested Citation

  • Constantin Ogloblin, 2023. "Health care financing and productivity of health care in OECD countries: a stochastic frontier analysis," Eurasian Economic Review, Springer;Eurasia Business and Economics Society, vol. 13(2), pages 259-283, June.
  • Handle: RePEc:spr:eurase:v:13:y:2023:i:2:d:10.1007_s40822-023-00233-z
    DOI: 10.1007/s40822-023-00233-z
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s40822-023-00233-z
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.

    File URL: https://libkey.io/10.1007/s40822-023-00233-z?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 search for a different version of it.

    References listed on IDEAS

    as
    1. Sharon Hadad & Yossi Hadad & Tzahit Simon-Tuval, 2013. "Determinants of healthcare system’s efficiency in OECD countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(2), pages 253-265, April.
    2. Pablo Cos & Enrique Moral-Benito, 2014. "Determinants of health-system efficiency: evidence from OECD countries," International Journal of Health Economics and Management, Springer, vol. 14(1), pages 69-93, March.
    3. Sharmistha Self & Richard Grabowski, 2003. "How effective is public health expenditure in improving overall health? A cross-country analysis," Applied Economics, Taylor & Francis Journals, vol. 35(7), pages 835-845.
    4. Christensen, Laurits R & Jorgenson, Dale W & Lau, Lawrence J, 1973. "Transcendental Logarithmic Production Frontiers," The Review of Economics and Statistics, MIT Press, vol. 55(1), pages 28-45, February.
    5. 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.
    6. Willam Greene, 2005. "Fixed and Random Effects in Stochastic Frontier Models," Journal of Productivity Analysis, Springer, vol. 23(1), pages 7-32, January.
    7. OGLOBLIN, Constantin, 2011. "Health Care Efficiency Across Countries: A Stochastic Frontier Analysis," Applied Econometrics and International Development, Euro-American Association of Economic Development, vol. 11(1).
    8. Isabelle Joumard & Christophe André & Chantal Nicq, 2010. "Health Care Systems: Efficiency and Institutions," OECD Economics Department Working Papers 769, OECD Publishing.
    9. S. Grosskopf & S. Self & O. Zaim, 2006. "Estimating the efficiency of the system of healthcare financing in achieving better health," Applied Economics, Taylor & Francis Journals, vol. 38(13), pages 1477-1488.
    10. Sherry A. Glied, 2008. "Health Care Financing, Efficiency, and Equity," NBER Working Papers 13881, National Bureau of Economic Research, Inc.
    11. Shao-Hsun Keng & Yang Li, 2010. "Decomposition of total factor productivity in world health production: a stochastic frontier approach," Applied Economics, Taylor & Francis Journals, vol. 42(23), pages 3011-3021.
    12. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-255, March-Apr.
    13. António Afonso & Miguel St. Aubyn, 2006. "Relative Efficiency of Health Provision: a DEA Approach with Non-discretionary Inputs," Working Papers Department of Economics 2006/33, ISEG - Lisbon School of Economics and Management, Department of Economics, Universidade de Lisboa.
    14. Vasanthakumar Bhat, 2005. "Institutional arrangements and efficiency of health care delivery systems," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 6(3), pages 215-222, September.
    15. Richard Auster & Irving Leveson & Deborah Sarachek, 1969. "The Production of Health, an Exploratory Study," Journal of Human Resources, University of Wisconsin Press, vol. 4(4), pages 411-436.
    16. Jondrow, James & Knox Lovell, C. A. & Materov, Ivan S. & Schmidt, Peter, 1982. "On the estimation of technical inefficiency in the stochastic frontier production function model," Journal of Econometrics, Elsevier, vol. 19(2-3), pages 233-238, August.
    17. Pierre‐Yves Crémieux & Pierre Ouellette & Caroline Pilon, 1999. "Health care spending as determinants of health outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 8(7), pages 627-639, November.
    18. Mark Berger & Jodi Messer, 2002. "Public financing of health expenditures, insurance, and health outcomes," Applied Economics, Taylor & Francis Journals, vol. 34(17), pages 2105-2113.
    19. Lovell, C. A. Knox, 1995. "Econometric efficiency analysis: A policy-oriented review," European Journal of Operational Research, Elsevier, vol. 80(3), pages 452-461, February.
    20. William Greene, 2004. "Distinguishing between heterogeneity and inefficiency: stochastic frontier analysis of the World Health Organization's panel data on national health care systems," Health Economics, John Wiley & Sons, Ltd., vol. 13(10), pages 959-980, October.
    21. Mark C. Berger & J. Paul Leigh, 1989. "Schooling, Self-Selection, and Health," Journal of Human Resources, University of Wisconsin Press, vol. 24(3), pages 433-455.
    22. Wagstaff, Adam & van Doorslaer, Eddy, 2000. "Chapter 34 Equity in health care finance and delivery," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 34, pages 1803-1862, Elsevier.
    23. John Nixon & Philippe Ulmann, 2006. "The relationship between health care expenditure and health outcomes," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 7(1), pages 7-18, March.
    24. Sherwin Rosen & Paul Taubman, 1982. "Changes in Life-Cycle Earnings: What Do Social Security Data Show?," Journal of Human Resources, University of Wisconsin Press, vol. 17(3), pages 321-338.
    25. Lant Pritchett & Lawrence H. Summers, 1996. "Wealthier is Healthier," Journal of Human Resources, University of Wisconsin Press, vol. 31(4), pages 841-868.
    26. Joseph P. Newhouse & Lindy J. Friedlander, 1980. "The Relationship between Medical Resources and Measures of Health: Some Additional Evidence," Journal of Human Resources, University of Wisconsin Press, vol. 15(2), pages 200-218.
    27. Jeff Richardson & John Wildman & Iain K. Robertson, 2003. "A critique of the World Health Organisation's evaluation of health system performance," Health Economics, John Wiley & Sons, Ltd., vol. 12(5), pages 355-366, May.
    28. Amitabh Chandra & Amy Finkelstein & Adam Sacarny & Chad Syverson, 2013. "Healthcare Exceptionalism? Productivity and Allocation in the U.S. Healthcare Sector," NBER Working Papers 19200, National Bureau of Economic Research, Inc.
    29. Wranik, Dominika, 2012. "Healthcare policy tools as determinants of health-system efficiency: evidence from the OECD," Health Economics, Policy and Law, Cambridge University Press, vol. 7(2), pages 197-226, April.
    30. Schmidt, Peter & Sickles, Robin C, 1984. "Production Frontiers and Panel Data," Journal of Business & Economic Statistics, American Statistical Association, vol. 2(4), pages 367-374, October.
    31. Kumbhakar,Subal C. & Wang,Hung-Jen & Horncastle,Alan P., 2015. "A Practitioner's Guide to Stochastic Frontier Analysis Using Stata," Cambridge Books, Cambridge University Press, number 9781107029514.
    32. Ulf-G. Gerdtham & Mickael Lothgren, 2001. "Health system effects on cost efficiency in the OECD countries," Applied Economics, Taylor & Francis Journals, vol. 33(5), pages 643-647.
    33. John Wildman & Hugh Gravelle & Matthew Sutton, 2003. "Health and income inequality: attempting to avoid the aggregation problem," Applied Economics, Taylor & Francis Journals, vol. 35(9), pages 999-1004.
    34. Isabelle Joumard & Christophe André & Chantal Nicq & Olivier Chatal, 2008. "Health Status Determinants: Lifestyle, Environment, Health Care Resources and Efficiency," OECD Economics Department Working Papers 627, OECD Publishing.
    35. Hung-Jen Wang, 2002. "Heteroscedasticity and Non-Monotonic Efficiency Effects of a Stochastic Frontier Model," Journal of Productivity Analysis, Springer, vol. 18(3), pages 241-253, November.
    36. Paula K. Lorgelly & Joanne Lindley, 2008. "What is the relationship between income inequality and health? Evidence from the BHPS," Health Economics, John Wiley & Sons, Ltd., vol. 17(2), pages 249-265, February.
    37. Retzlaff-Roberts, Donna & Chang, Cyril F. & Rubin, Rose M., 2004. "Technical efficiency in the use of health care resources: a comparison of OECD countries," Health Policy, Elsevier, vol. 69(1), pages 55-72, July.
    38. Valérie Paris & Marion Devaux & Lihan Wei, 2010. "Health Systems Institutional Characteristics: A Survey of 29 OECD Countries," OECD Health Working Papers 50, OECD Publishing.
    39. Kutzin, Joseph, 2001. "A descriptive framework for country-level analysis of health care financing arrangements," Health Policy, Elsevier, vol. 56(3), pages 171-204, June.
    40. Jean Spinks & Bruce Hollingsworth, 2009. "Cross-country comparisons of technical efficiency of health production: a demonstration of pitfalls," Applied Economics, Taylor & Francis Journals, vol. 41(4), pages 417-427.
    41. Cornwell, Christopher & Schmidt, Peter & Sickles, Robin C., 1990. "Production frontiers with cross-sectional and time-series variation in efficiency levels," Journal of Econometrics, Elsevier, vol. 46(1-2), pages 185-200.
    42. Subal Kumbhakar, 2010. "Efficiency and productivity of world health systems: where does your country stand?," Applied Economics, Taylor & Francis Journals, vol. 42(13), pages 1641-1659.
    43. Antonio Afonso & Miguel St. Aubyn, 2011. "Assessing health efficiency across countries with a two-step and bootstrap analysis," Applied Economics Letters, Taylor & Francis Journals, vol. 18(15), pages 1427-1430.
    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. Erika Laranjeira & Helena Szrek, 2016. "Going beyond life expectancy in assessments of health systems’ performance: life expectancy adjusted by perceived health status," International Journal of Health Economics and Management, Springer, vol. 16(2), pages 133-161, June.
    2. Angelo Castaldo & Maria Alessandra Antonelli & Valeria De Bonis & Giorgia Marini, 2020. "Determinants of health sector efficiency: evidence from a two-step analysis on 30 OECD countries," Economics Bulletin, AccessEcon, vol. 40(2), pages 1651-1666.
    3. Varabyova, Yauheniya & Müller, Julia-Maria, 2016. "The efficiency of health care production in OECD countries: A systematic review and meta-analysis of cross-country comparisons," Health Policy, Elsevier, vol. 120(3), pages 252-263.
    4. Ozbugday, Fatih Cemil & Tirgil, Abdullah & Kose, Elif Gul, 2020. "Efficiency changes in long-term care in OECD countries: A non-parametric Malmquist Index approach," Socio-Economic Planning Sciences, Elsevier, vol. 70(C).
    5. Gearhart Richard, 2019. "The Impact of Secondary Environmental Variables on OECD Healthcare Efficiency: A Robust Conditional Approach," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 19(2), pages 1-16, April.
    6. Pınar Kaya Samut & Reyhan Cafrı, 2016. "Analysis of the Efficiency Determinants of Health Systems in OECD Countries by DEA and Panel Tobit," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 129(1), pages 113-132, October.
    7. Dino Rizzi & Michele Zanette, 2021. "Potential efficiency gains and expenditure savings in the Italian Regional Healthcare Systems," Politica economica, Società editrice il Mulino, issue 2, pages 187-214.
    8. Puertas, Rosa & Marti, Luisa & Guaita-Martinez, José M., 2020. "Innovation, lifestyle, policy and socioeconomic factors: An analysis of European quality of life," Technological Forecasting and Social Change, Elsevier, vol. 160(C).
    9. Marianela Carrillo & Jesús M. Jorge, 2017. "DEA-Like Efficiency Ranking of Regional Health Systems in Spain," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 133(3), pages 1133-1149, September.
    10. Ali M. Oumer & Amin Mugera & Michael Burton & Atakelty Hailu, 2022. "Technical efficiency and firm heterogeneity in stochastic frontier models: application to smallholder maize farms in Ethiopia," Journal of Productivity Analysis, Springer, vol. 57(2), pages 213-241, April.
    11. Pablo Cos & Enrique Moral-Benito, 2014. "Determinants of health-system efficiency: evidence from OECD countries," International Journal of Health Economics and Management, Springer, vol. 14(1), pages 69-93, March.
    12. Valentin Zelenyuk & Zhichao Wang, 2023. "Random vs. Explained Inefficiency in Stochastic Frontier Analysis: The Case of Queensland Hospitals," CEPA Working Papers Series WP052023, School of Economics, University of Queensland, Australia.
    13. Anton Sorin Gabriel, 2013. "Technical Efficiency in the Use of Health Care Resources: A Cross-Country Analysis," Scientific Annals of Economics and Business, Sciendo, vol. 60(1), pages 1-12, July.
    14. Subal C. Kumbhakar & Christopher F. Parmeter & Valentin Zelenyuk, 2022. "Stochastic Frontier Analysis: Foundations and Advances I," Springer Books, in: Subhash C. Ray & Robert G. Chambers & Subal C. Kumbhakar (ed.), Handbook of Production Economics, chapter 8, pages 331-370, Springer.
    15. Farsi, Mehdi & Filippini, Massimo, 2009. "An analysis of cost efficiency in Swiss multi-utilities," Energy Economics, Elsevier, vol. 31(2), pages 306-315, March.
    16. Keller, Michael, 2020. "Wasted windfalls: Inefficiencies in health care spending in oil rich countries," Resources Policy, Elsevier, vol. 66(C).
    17. Sepideh Abolghasem & Mehdi Toloo & Santiago Amézquita, 2019. "Cross-efficiency evaluation in the presence of flexible measures with an application to healthcare systems," Health Care Management Science, Springer, vol. 22(3), pages 512-533, September.
    18. Asiskovitch, Sharon, 2010. "Gender and health outcomes: The impact of healthcare systems and their financing on life expectancies of women and men," Social Science & Medicine, Elsevier, vol. 70(6), pages 886-895, March.
    19. 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.
    20. Tomoki Fujii, 2018. "Sources of health financing and health outcomes: A panel data analysis," Health Economics, John Wiley & Sons, Ltd., vol. 27(12), pages 1996-2015, December.

    More about this item

    Keywords

    Health expenditure; Health care; Efficiency; Stochastic frontier; OECD;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I19 - Health, Education, and Welfare - - Health - - - Other

    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:spr:eurase:v:13:y:2023:i:2:d:10.1007_s40822-023-00233-z. 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: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    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.