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Health System Efficiency in European Countries: Network Data Envelopment Analysis Approach

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  • Justyna Kujawska

Abstract

Purpose: The article's main aim is to investigate the effectiveness of health systems in European countries based on EUROSTAT data. A comparative analysis of the health systems' effectiveness in different countries is based on their improvement (reform), using the best practices approach. Design/Methodology/Approach: The network DEA model and a slack-based model (NDEA – SBM) are used. A non-oriented model is used. The research sample covers 30 countries (28 EU plus Norway and Island). The health system considers two factors: lifestyle (LF) and primary medical care resources (MC). Lifestyle factors included, alcohol consumption, smoking, and being overweight. The primary resources of medical care are medical personnel, hospital beds, and finances. The subjective assessment of health status and healthy life expectancy is taken as direct outputs. As an intermediate product (link), the expenditure on prevention is assumed as a percentage of GDP. Findings: Health systems in five countries are identified as fully efficient. These countries have also achieved total efficiency for both divisions, lifestyle factors and medical care. The average efficiency of health systems for all countries is low and amounts to 0.619, and the average efficiency for the LF division is 0.580, with huge variations between countries. In the MC division, the average efficiency for all countries is 0.72. However, the difference between countries is more minor. For inefficient countries, the projection of necessary changes to achieve total efficiency has been calculated. Practical Implications: The network DEA model allows a better understanding of the functioning of the complex health care system by analyzing the effectiveness of two separate areas (lifestyle and health care). The values of the forecasted variables are also determined, inputs, outputs, and the linking variable that may help determine priority actions in the field of improving the efficiency of health systems. Originality/value: This paper contributes to the literature by applying the network model to assess the effectiveness of health systems. It enables simultaneous research of various areas related to health. Few publications have attempted to use the network model in the area of health protection.

Suggested Citation

  • Justyna Kujawska, 2021. "Health System Efficiency in European Countries: Network Data Envelopment Analysis Approach," European Research Studies Journal, European Research Studies Journal, vol. 0(2), pages 1095-1117.
    • Handle: RePEc:ers:journl:v:xxiv:y:2021:i:2:p:1095-1117
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    1. Cheng, Gang & Zervopoulos, Panagiotis D., 2014. "Estimating the technical efficiency of health care systems: A cross-country comparison using the directional distance function," European Journal of Operational Research, Elsevier, vol. 238(3), pages 899-910.
    2. William W. Cooper & Lawrence M. Seiford & Joe Zhu (ed.), 2011. "Handbook on Data Envelopment Analysis," International Series in Operations Research and Management Science, Springer, number 978-1-4419-6151-8, January.
    3. Rolf Färe & Shawna Grosskopf & Gerald Whittaker, 2014. "Network DEA II," International Series in Operations Research & Management Science, in: Wade D. Cook & Joe Zhu (ed.), Data Envelopment Analysis, edition 127, chapter 0, pages 307-327, Springer.
    4. Lu, Wen-Min & Kweh, Qian Long & Nourani, Mohammad & Huang, Feng-Wen, 2016. "Evaluating the efficiency of dual-use technology development programs from the R&D and socio-economic perspectives," Omega, Elsevier, vol. 62(C), pages 82-92.
    5. 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.
    6. 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.
    7. Golany, B & Roll, Y, 1989. "An application procedure for DEA," Omega, Elsevier, vol. 17(3), pages 237-250.
    8. 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.
    9. 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.
    10. Jaume Puig-Junoy, 1998. "Measuring health production performance in the OECD," Applied Economics Letters, Taylor & Francis Journals, vol. 5(4), pages 255-259.
    11. Bruce Hollingsworth, 2012. "Revolution, evolution, or status quo? Guidelines for efficiency measurement in health care," Journal of Productivity Analysis, Springer, vol. 37(1), pages 1-5, February.
    12. Naci Mocan & Duha Altindag, 2014. "Education, cognition, health knowledge, and health behavior," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(3), pages 265-279, April.
    13. 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.
    14. Chiang Kao, 2014. "Efficiency Decomposition in Network Data Envelopment Analysis," International Series in Operations Research & Management Science, in: Wade D. Cook & Joe Zhu (ed.), Data Envelopment Analysis, edition 127, chapter 0, pages 55-77, Springer.
    15. Tone, Kaoru & Tsutsui, Miki, 2009. "Network DEA: A slacks-based measure approach," European Journal of Operational Research, Elsevier, vol. 197(1), pages 243-252, August.
    16. Andrew Rettenmaier & Zijun Wang, 2013. "What determines health: a causal analysis using county level data," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(5), pages 821-834, October.
    17. Luis Murillo-Zamorano & Carmelo Petraglia, 2011. "Technical efficiency in primary health care: does quality matter?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(2), pages 115-125, April.
    18. 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.
    19. Cawley, John & Ruhm, Christopher J., 2011. "The Economics of Risky Health Behaviors," Handbook of Health Economics, in: Mark V. Pauly & Thomas G. Mcguire & Pedro P. Barros (ed.), Handbook of Health Economics, volume 2, chapter 0, pages 95-199, Elsevier.
    20. Joe Zhu, 2014. "Data Envelopment Analysis," International Series in Operations Research & Management Science, in: Quantitative Models for Performance Evaluation and Benchmarking, edition 3, chapter 1, pages 1-9, Springer.
    21. Panayiotis G. Curtis & Michael Hanias & Eleftherios Kourtis & Mixalis Kourtis, 2020. "Data Envelopment Analysis (DEA) and Financial Ratios: Α Pro-Stakeholders’ View of Performance Measurement for Sustainable Value Creation of the Wind Energy," International Journal of Economics & Business Administration (IJEBA), International Journal of Economics & Business Administration (IJEBA), vol. 0(2), pages 326-350.
    22. Government of India, 2017. "National Health Policy 2017," Working Papers id:11664, eSocialSciences.
    23. Kao, Chiang, 2014. "Network data envelopment analysis: A review," European Journal of Operational Research, Elsevier, vol. 239(1), pages 1-16.
    24. Cook, Wade D. & Tone, Kaoru & Zhu, Joe, 2014. "Data envelopment analysis: Prior to choosing a model," Omega, Elsevier, vol. 44(C), pages 1-4.
    25. Yasar A. Ozcan & Jaya Khushalani, 2017. "Assessing efficiency of public health and medical care provision in OECD countries after a decade of reform," Central European Journal of Operations Research, Springer;Slovak Society for Operations Research;Hungarian Operational Research Society;Czech Society for Operations Research;Österr. Gesellschaft für Operations Research (ÖGOR);Slovenian Society Informatika - Section for Operational Research;Croatian Operational Research Society, vol. 25(2), pages 325-343, June.
    26. Dosi, Giovanni & Llerena, Patrick & Labini, Mauro Sylos, 2006. "The relationships between science, technologies and their industrial exploitation: An illustration through the myths and realities of the so-called `European Paradox'," Research Policy, Elsevier, vol. 35(10), pages 1450-1464, December.
    27. Bruce Hollingsworth & Andrew Street, 2006. "The market for efficiency analysis of health care organisations," Health Economics, John Wiley & Sons, Ltd., vol. 15(10), pages 1055-1059, October.
    28. Mark V. Pauly & Thomas G. Mcguire & Pedro P. Barros (ed.), 2011. "Handbook of Health Economics," Handbook of Health Economics, Elsevier, volume 2, number 2.
    29. 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.
    30. Dyson, R. G. & Allen, R. & Camanho, A. S. & Podinovski, V. V. & Sarrico, C. S. & Shale, E. A., 2001. "Pitfalls and protocols in DEA," European Journal of Operational Research, Elsevier, vol. 132(2), pages 245-259, July.
    31. Necmi K. Avkiran, 2011. "Applications of Data Envelopment Analysis in the Service Sector," International Series in Operations Research & Management Science, in: William W. Cooper & Lawrence M. Seiford & Joe Zhu (ed.), Handbook on Data Envelopment Analysis, chapter 0, pages 403-443, Springer.
    32. 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.
    33. 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.
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    More about this item

    Keywords

    Health system; lifestyle factors; efficiency; network data envelopment analysis.;
    All these keywords.

    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
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

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