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Three decades in healthcare service efficiency evaluation: a bootstrapping Data Envelopment Analysis (DEA) of Ministry of Health Malaysia

Author

Listed:
  • M Zulfakhar Zubir

    (Ministry of Health Malaysia
    Universiti Kebangsaan Malaysia)

  • Aizuddin A.N

    (Universiti Kebangsaan Malaysia)

  • Mohd Rizal Abdul Manaf

    (Universiti Kebangsaan Malaysia)

  • A Aziz Harith

    (Ministry of Health
    University of Otago Wellington)

  • M Ihsanuddin Abas

    (Universiti Sultan Zainal Abidin)

  • Maizatul Izyami Kayat

    (Ministry of Health Malaysia)

  • M Firdaus M Radi

    (Ministry of Health Malaysia)

  • Mas Norehan Merican

    (Ministry of Health Malaysia)

  • Nurcholisah Fitra

    (University of North Sumatra)

  • Affendi M Ali

    (Universiti Malaya Medical Centre)

  • Sharifah Ain Shameera Syed Rusli

    (Ministry of Health Malaysia)

Abstract

Background One of the most important ways to boost the health system’s performance and lower the rising cost of healthcare is to increase its efficiency. The objective of this study is to evaluate the efficiency of the MOH in providing public health services and to gauge the progress of health plans in Malaysia. Methods Three output variables (number of admissions, number of outpatient attendances, and number of maternal and child health attendances) and six input variables (budget allocation, number of doctors, dentists, pharmacists, nurses, and community nurses) were used in a Data Envelopment Analysis (DEA) Window Analysis. Eight input-output models’ bias-corrected efficiency scores were obtained using bootstrapping. Setting Ministry level in public health service. Participant 28 Decision making units (DMUs) from 1995 to 2022. Results Robust performance over the study period was shown by the mean bias-corrected efficiency score of 0.974 (95% CI: 0.907–0.989) under the Variable Returns to Scale (VRS) model. Lower Constant Returns to Scale (CRS) model scores, on the other hand, draw attention to scale-level inefficiencies. During the COVID-19 pandemic, efficiency decreased due to higher input demands and limited outputs. Conclusions Although MOH has attained a high level of technological efficiency, expanding operations and resolving inequalities in rural areas remain difficult. Targeted tactics including telemedicine adoption, resource redistribution, and a move towards preventive treatment are advised in order to improve fairness and resilience.

Suggested Citation

  • M Zulfakhar Zubir & Aizuddin A.N & Mohd Rizal Abdul Manaf & A Aziz Harith & M Ihsanuddin Abas & Maizatul Izyami Kayat & M Firdaus M Radi & Mas Norehan Merican & Nurcholisah Fitra & Affendi M Ali & Sha, 2025. "Three decades in healthcare service efficiency evaluation: a bootstrapping Data Envelopment Analysis (DEA) of Ministry of Health Malaysia," Health Economics Review, Springer, vol. 15(1), pages 1-14, December.
    • Handle: RePEc:spr:hecrev:v:15:y:2025:i:1:d:10.1186_s13561-025-00624-9
    DOI: 10.1186/s13561-025-00624-9
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    References listed on IDEAS

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    1. Gong, Byeong-Ho & Sickles, Robin C., 1992. "Finite sample evidence on the performance of stochastic frontiers and data envelopment analysis using panel data," Journal of Econometrics, Elsevier, vol. 51(1-2), pages 259-284.
    2. 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.
    3. Beata Gavurova & Kristina Kocisova & Jakub Sopko, 2021. "Health system efficiency in OECD countries: dynamic network DEA approach," Health Economics Review, Springer, vol. 11(1), pages 1-25, December.
    4. Timothy J. Coelli & D.S. Prasada Rao & Christopher J. O’Donnell & George E. Battese, 2005. "An Introduction to Efficiency and Productivity Analysis," Springer Books, Springer, edition 0, number 978-0-387-25895-9, March.
    5. Kok Fong See & Siew Hwa Yen, 2018. "Does happiness matter to health system efficiency? A performance analysis," Health Economics Review, Springer, vol. 8(1), pages 1-10, December.
    6. Aleksandra Kuzior & Mariia Kashcha & Olha Kuzmenko & Serhiy Lyeonov & Paulina Brożek, 2022. "Public Health System Economic Efficiency and COVID-19 Resilience: Frontier DEA Analysis," IJERPH, MDPI, vol. 19(22), pages 1-14, November.
    7. Bruce Hollingsworth & John Wildman, 2003. "The efficiency of health production: re‐estimating the WHO panel data using parametric and non‐parametric approaches to provide additional information," Health Economics, John Wiley & Sons, Ltd., vol. 12(6), pages 493-504, June.
    8. Panagiotis Mitropoulos & Kostas Kounetas & Ioannis Mitropoulos, 2016. "Factors affecting primary health care centers’ economic and production efficiency," Annals of Operations Research, Springer, vol. 247(2), pages 807-822, December.
    9. Yasar A. Ozcan, 2014. "Health Care Benchmarking and Performance Evaluation," International Series in Operations Research and Management Science, Springer, edition 2, number 978-1-4899-7472-3, June.
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