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Relative Efficiency of Health Provision: a DEA Approach with Non-discretionary Inputs

Author

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  • António Afonso
  • Miguel St. Aubyn

Abstract

We estimate a semi-parametric model of health production process using a two-stage approach for OECD countries. By regressing data envelopment analysis output efficiency scores on non-discretionary variables, both using Tobit analysis and a single and double bootstrap procedure, we show that inefficiency is strongly related to GDP per head, the education level, and health behaviour such as obesity and smoking habits. The used bootstrapping procedure corrects likely biased DEA output scores taking into account that environmental variables are correlated to output and input variables.

Suggested Citation

  • 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.
  • Handle: RePEc:ise:isegwp:wp332006
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    File URL: http://pascal.iseg.utl.pt/~depeco/wp/wp332006.pdf
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    References listed on IDEAS

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    1. Leopold Simar & Paul Wilson, 2000. "A general methodology for bootstrapping in non-parametric frontier models," Journal of Applied Statistics, Taylor & Francis Journals, vol. 27(6), pages 779-802.
    2. António Afonso & Miguel St. Aubyn, 2005. "Non-parametric approaches to education and health efficiency in OECD countries," Journal of Applied Economics, Universidad del CEMA, vol. 8, pages 227-246, November.
    3. Adler, Nicole & Golany, Boaz, 2001. "Evaluation of deregulated airline networks using data envelopment analysis combined with principal component analysis with an application to Western Europe," European Journal of Operational Research, Elsevier, vol. 132(2), pages 260-273, July.
    4. 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.
    5. 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.
    6. 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.
    7. 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.
    8. António Afonso & Ludger Schuknecht & Vito Tanzi, 2005. "Public sector efficiency: An international comparison," Public Choice, Springer, vol. 123(3), pages 321-347, June.
    9. 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.
    10. 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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    Citations

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    Cited by:

    1. Ana Poças & Elias Soukiazis, 2010. "Health Status Determinants in the OECD Countries. A Panel Data Approach with Endogenous Regressors," GEMF Working Papers 2010-04, GEMF, Faculty of Economics, University of Coimbra.
    2. 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.
    3. Francesco Porcelli, 2014. "Electoral accountability and local government efficiency: quasi-experimental evidence from the Italian health care sector reforms," Economics of Governance, Springer, vol. 15(3), pages 221-251, August.
    4. António Afonso & Ludger Schuknecht & Vito Tanzi, 2010. "Income distribution determinants and public spending efficiency," The Journal of Economic Inequality, Springer;Society for the Study of Economic Inequality, vol. 8(3), pages 367-389, September.
    5. Aristovnik, Aleksander & Obadić, Alka, 2014. "Measuring relative efficiency of secondary education in selected EU and OECD countries: the case of Slovenia and Croatia," MPRA Paper 63936, University Library of Munich, Germany.
    6. Aristovnik, Aleksander, 2012. "The impact of ICT on educational performance and its efficiency in selected EU and OECD countries: a non-parametric analysis," MPRA Paper 39805, University Library of Munich, Germany.
    7. Bruno Eugène, 2008. "The efficiency frontier as a method for gauging the performance of public expenditure : a Belgian case study," Working Paper Research 138, National Bank of Belgium.
    8. Francesco Porcelli, 2009. "Effects of fiscal decentralisation and electoral accountability efficiency evidence from the Italian health care sector," Working Papers 2009/29, Institut d'Economia de Barcelona (IEB).
    9. Eric Nauenberg, 2014. "Changing healthcare capital-to-labor ratios: evidence and implications for bending the cost curve in Canada and beyond," International Journal of Health Economics and Management, Springer, vol. 14(4), pages 339-353, December.
    10. Eric Nauenberg, 2014. "Changing Healthcare Capital-To-Labor Ratios: Evidence and Implications for Bending the Cost Curve in Canada and Beyond," Working Papers 140002, Canadian Centre for Health Economics, revised Jul 2014.
    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, De Gruyter Open, vol. 62(3), pages 357-368, November.
    12. Mihai Mutascu & Marius Milos, 2009. "Optimal Size Of Government Spending. The Case Of European Union Member States," Annales Universitatis Apulensis Series Oeconomica, Faculty of Sciences, "1 Decembrie 1918" University, Alba Iulia, vol. 1(11), pages 1-45.
    13. repec:wfo:monber:y:2017:i:9:p:677-699 is not listed on IDEAS
    14. Aleksander Aristovnik, 2013. "Relative Efficiency of Education Expenditures in Eastern Europe: A Non-parametric Approach," Journal of Knowledge Management, Economics and Information Technology, ScientificPapers.org, vol. 3(3), pages 1-4, June.
    15. Brijesh C. Purohit, 2015. "Efficiency in Elementary Education in Urban India: An exploratory Analysis using DEA," Working Papers 2015-113, Madras School of Economics,Chennai,India.
    16. Bergantino, Angela Stefania & Capozza, Claudia & Porcelli, Francesco, 2015. "Hotelling competition and teaching efficiency of Italian university faculties. A semi-parametric analysis," MPRA Paper 62927, University Library of Munich, Germany.
    17. Péter Halmai & Viktória Vásáry, 2012. "Convergence crisis: economic crisis and convergence in the European Union," International Economics and Economic Policy, Springer, vol. 9(3), pages 297-322, September.

    More about this item

    Keywords

    technical efficiency; health; DEA; bootstrap; semi-parametric.;

    JEL classification:

    • C14 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Semiparametric and Nonparametric Methods: General
    • C61 - Mathematical and Quantitative Methods - - Mathematical Methods; Programming Models; Mathematical and Simulation Modeling - - - Optimization Techniques; Programming Models; Dynamic Analysis
    • H52 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Education
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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