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Healthcare system efficiency and its determinants: A two-stage Data Envelopment Analysis (DEA) from MENA countries

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  • Iyad Dhaoui

    (Tunisian Institute of Competitiveness and Quantitative Studies)

Abstract

Efficiency is becoming one of the central preoccupations of health sector due to mounting pressures on health care resources since many years. However, assessing efficiency at cross-country level has not been often directly evaluated by given inputs or outputs. In the first stage of the two-stage performance analysis, this paper assesses the technical efficiency of 18 health systems in the Middle East and North Africa (MENA) region using Data Envelopment Analysis (DEA) method for the years 1997, 2005 and 2014. We used both an input and an output-oriented approaches to measure the technical efficiency of those systems and we conducted a cluster analysis in terms of health production efficiencies and health outcomes of various countries upon three sub-periods in order to make the division of health production patterns of these countries clearer. The paper also analyzes the allocative efficiency upon the two approaches. In the second stage, the paper analyzes the determinants of health efficiency using a Tobit regression. Descriptive analysis shows that life expectancy has increased since many years, although the important variations in terms of economic development among the considered sample. The DEA results indicated that the average efficiency scores for all health systems were, respectively for the years 1997, 2005 and 2014, 79% and 83.6% and 78.7%, under the input-oriented approach; and 98.2%, 98.5% and 97.9% according to the output-oriented approach. Results showed that efficient frontier includes countries with good health outcomes and those with modest health outcomes. In essence, the empirical evidence rejects some hypotheses, such as the low-income countries cannot be a reference in terms of health efficiency. Cluster analysis showed that both countries on efficiency frontier and countries far from this frontier are different from year to year. Analysis revealed also that some countries may learn from countries which are more economical in their allocation of health resources; and more spending is not necessary the best option. For the Tobit model, results upon the two approaches revealed that private expenditure as a percentage of GDP and control of corruption impact positively and significantly efficiency scores while public spending as a percentage of government expenditure has a negative effect. Adult literacy rate and population density have a positive and non-significant impact. Moreover, results showed no correlation between the efficiency of health system and the income group to which a country is belonging, and we cannot judge this efficiency through the gross national income per capita.

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  • Iyad Dhaoui, 2019. "Healthcare system efficiency and its determinants: A two-stage Data Envelopment Analysis (DEA) from MENA countries," Working Papers 1320, Economic Research Forum, revised 21 Aug 2019.
    • Handle: RePEc:erg:wpaper:1320
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    References listed on IDEAS

    as
    1. Alok Bhargava & Dean T. Jamison & Lawrence J. Lau & Christopher J. L. Murray, 2006. "Modeling the effects of health on economic growth," World Scientific Book Chapters, in: Econometrics, Statistics And Computational Approaches In Food And Health Sciences, chapter 20, pages 269-286, World Scientific Publishing Co. Pte. Ltd..
    2. João Medeiros & Christoph Schwierz, 2015. "Efficiency estimates of health care systems," European Economy - Economic Papers 2008 - 2015 549, Directorate General Economic and Financial Affairs (DG ECFIN), European Commission.
    3. ZHANG Ning & HU Angang & ZHENG Jinghai, 2007. "Using Data Envelopment Analysis approach to estimate the health production efficiencies in China," Frontiers of Economics in China-Selected Publications from Chinese Universities, Higher Education Press, vol. 2(1), pages 1-23, March.
    4. Afonso, Antonio & St. Aubyn, Miguel, 2005. "Non-Parametric Approaches to Education and Health Efficiency in OECD Countries," Journal of Applied Economics, Universidad del CEMA, vol. 8(2), pages 1-20, November.
    5. Cordero, José Manuel & Santín, Daniel & Sicilia, Gabriela, 2013. "Dealing with the Endogeneity Problem in Data Envelopment Analysis," MPRA Paper 47475, University Library of Munich, Germany.
    6. Sabatini, Fabio, 2014. "The relationship between happiness and health: Evidence from Italy," Social Science & Medicine, Elsevier, vol. 114(C), pages 178-187.
    7. 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.
    8. Afonso, Antonio & St. Aubyn, Miguel, 2006. "Cross-country efficiency of secondary education provision: A semi-parametric analysis with non-discretionary inputs," Economic Modelling, Elsevier, vol. 23(3), pages 476-491, May.
    9. Kaufmann, Daniel & Kraay, Aart & Mastruzzi, Massimo, 2007. "Governance Matters VI: Aggregate and Individual Governance Indicators, 1996-2006," Policy Research Working Paper Series 4280, The World Bank.
    10. World Bank, 2013. "Fairness and Accountability : Engaging in Health Systems in the Middle East and North Africa [Equité et redevabilité: S’engager en faveur des systèmes de santé au Moyen-Orient et en Afrique du Nord," World Bank Publications - Reports 16109, The World Bank Group.
    11. Asandului Laura & Popescu Cristian & Fătulescu Ionuț Puiu, 2015. "Identifying and Explaining the Efficiency of the Public Health Systems in European Countries," Scientific Annals of Economics and Business, Sciendo, vol. 62(3), pages 357-368, November.
    12. Jaume Puig-Junoy, 1998. "Measuring health production performance in the OECD," Applied Economics Letters, Taylor & Francis Journals, vol. 5(4), pages 255-259.
    13. Ruwan Jayasuriya & Quentin Wodon, 2003. "Efficiency in Reaching the Millennium Development Goals," World Bank Publications - Books, The World Bank Group, number 13884.
    14. Isabelle Joumard & Christophe André & Chantal Nicq, 2010. "Health Care Systems: Efficiency and Institutions," OECD Economics Department Working Papers 769, OECD Publishing.
    15. 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.
    16. 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.
    17. Elisabeta Jaba & Christiana Balan & Silvia Palaşcă, 2011. "Statistical Evaluation Of The Influence Of Determining Factors Of Life Expectancy," Analele Stiintifice ale Universitatii "Alexandru Ioan Cuza" din Iasi - Stiinte Economice (1954-2015), Alexandru Ioan Cuza University, Faculty of Economics and Business Administration, vol. 2011, pages 215-223, july.
    18. Herrera, Santiago & Pang, Gaobo, 2005. "Efficiency of public spending in developing countries : an efficiency frontier approach," Policy Research Working Paper Series 3645, The World Bank.
    19. Daniela BORISOV & Claudiu CICEA & Carmen TURLEA, 2012. "Dea Model For Assessing Efficiency In Providing Health Care And Management Decisions," Management Research and Practice, Research Centre in Public Administration and Public Services, Bucharest, Romania, vol. 4(1), pages 5-18, March.
    20. Norbert Hirschauer & Oliver Musshoff, 2014. "Non-metric data: a note on a neglected problem in DEA studies," European Journal of Law and Economics, Springer, vol. 37(3), pages 489-494, June.
    21. Omar Azfar & Tugrul Gurgur, 2008. "Does corruption affect health outcomes in the Philippines?," Economics of Governance, Springer, vol. 9(3), pages 197-244, July.
    22. 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.
    23. Samer Hamidi & Fevzi Akinci, 2016. "Measuring Efficiency of Health Systems of the Middle East and North Africa (MENA) Region Using Stochastic Frontier Analysis," Applied Health Economics and Health Policy, Springer, vol. 14(3), pages 337-347, June.
    24. Rajkumar, Andrew Sunil & Swaroop, Vinaya, 2008. "Public spending and outcomes: Does governance matter?," Journal of Development Economics, Elsevier, vol. 86(1), pages 96-111, April.
    25. Ruggiero, John, 2003. "Comment on estimating school efficiency," Economics of Education Review, Elsevier, vol. 22(6), pages 631-634, December.
    26. Wendelin Schnedler, 2005. "Likelihood Estimation for Censored Random Vectors," Econometric Reviews, Taylor & Francis Journals, vol. 24(2), pages 195-217.
    27. Yasar A. Ozcan, 2008. "Health Care Benchmarking and Performance Evaluation," International Series in Operations Research and Management Science, Springer, number 978-0-387-75448-2, April.
    28. Tudorel Andrei & Constantin Mitrut & Daniela L. Constantin & Bogdan Oancea, 2009. "The Impact of Decentralization on Public Health System’s Results. The Case of Romania," Theoretical and Applied Economics, Asociatia Generala a Economistilor din Romania / Editura Economica, vol. 10(10(539)), pages 17-22, October.
    29. Antonio Afonso & Ludger Schuknecht & Vito Tanzi, 2010. "Public sector efficiency: evidence for new EU member states and emerging markets," Applied Economics, Taylor & Francis Journals, vol. 42(17), pages 2147-2164.
    30. Tanzi,Vito & Schuknecht,Ludger, 2000. "Public Spending in the 20th Century," Cambridge Books, Cambridge University Press, number 9780521662918, September.
    31. Paul Marschall & Steffen Flessa, 2011. "Efficiency of primary care in rural Burkina Faso. A two-stage DEA analysis," Health Economics Review, Springer, vol. 1(1), pages 1-15, December.
    32. Michael Grossman, 1972. "The Demand for Health: A Theoretical and Empirical Investigation," NBER Books, National Bureau of Economic Research, Inc, number gros72-1.
    33. Daxin Sun & Haksoon Ahn & Tomas Lievens & Wu Zeng, 2017. "Evaluation of the performance of national health systems in 2004-2011: An analysis of 173 countries," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-13, March.
    34. Bifulco, Robert & Bretschneider, Stuart, 2001. "Estimating school efficiency: A comparison of methods using simulated data," Economics of Education Review, Elsevier, vol. 20(5), pages 417-429, October.
    35. Hauner, David & Kyobe, Annette, 2010. "Determinants of Government Efficiency," World Development, Elsevier, vol. 38(11), pages 1527-1542, November.
    36. Marwa Farag & A. Nandakumar & Stanley Wallack & Dominic Hodgkin & Gary Gaumer & Can Erbil, 2013. "Health expenditures, health outcomes and the role of good governance," International Journal of Health Economics and Management, Springer, vol. 13(1), pages 33-52, March.
    37. Unto Häkkinen & Isabelle Joumard, 2007. "Cross-Country Analysis of Efficiency in OECD Health Care Sectors: Options for Research," OECD Economics Department Working Papers 554, OECD Publishing.
    38. Gerdtham, Ulf-G. & Sogaard, Jes & Andersson, Fredrik & Jonsson, Bengt, 1992. "An econometric analysis of health care expenditure: A cross-section study of the OECD countries," Journal of Health Economics, Elsevier, vol. 11(1), pages 63-84, May.
    39. Gupta, Sanjeev & Verhoeven, Marijn, 2001. "The efficiency of government expenditure: experiences from Africa," Journal of Policy Modeling, Elsevier, vol. 23(4), pages 433-467, May.
    40. Bifulco, Robert & Bretschneider, Stuart, 2003. "Response to comment on estimating school efficiency," Economics of Education Review, Elsevier, vol. 22(6), pages 635-638, December.
    41. Filmer, Deon & Pritchett, Lant, 1999. "The impact of public spending on health: does money matter?," Social Science & Medicine, Elsevier, vol. 49(10), pages 1309-1323, November.
    42. Pablo Gottret & George Schieber, 2006. "Health Financing Revisited : A Practitioner's Guide," World Bank Publications - Books, The World Bank Group, number 7094.
    43. R. D. Banker & A. Charnes & W. W. Cooper, 1984. "Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis," Management Science, INFORMS, vol. 30(9), pages 1078-1092, September.
    44. repec:awi:wpaper:0417 is not listed on IDEAS
    45. Sabatini, Fabio, 2011. "The relationship between happiness and health: evidence from Italy," AICCON Working Papers 91-2011, Associazione Italiana per la Cultura della Cooperazione e del Non Profit.
    46. Chang, Hsi-Hui, 1998. "Determinants of Hospital Efficiency: the Case of Central Government-owned Hospitals in Taiwan," Omega, Elsevier, vol. 26(2), pages 307-317, April.
    47. Mr. Peter S. Heller, 2005. "Understanding Fiscal Space," IMF Policy Discussion Papers 2005/004, International Monetary Fund.
    48. Ruggiero, John, 2004. "Performance evaluation when non-discretionary factors correlate with technical efficiency," European Journal of Operational Research, Elsevier, vol. 159(1), pages 250-257, November.
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