IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0147261.html
   My bibliography  Save this article

Efficiency of Health Care Production in Low-Resource Settings: A Monte-Carlo Simulation to Compare the Performance of Data Envelopment Analysis, Stochastic Distance Functions, and an Ensemble Model

Author

Listed:
  • Laura Di Giorgio
  • Abraham D Flaxman
  • Mark W Moses
  • Nancy Fullman
  • Michael Hanlon
  • Ruben O Conner
  • Alexandra Wollum
  • Christopher J L Murray

Abstract

Low-resource countries can greatly benefit from even small increases in efficiency of health service provision, supporting a strong case to measure and pursue efficiency improvement in low- and middle-income countries (LMICs). However, the knowledge base concerning efficiency measurement remains scarce for these contexts. This study shows that current estimation approaches may not be well suited to measure technical efficiency in LMICs and offers an alternative approach for efficiency measurement in these settings. We developed a simulation environment which reproduces the characteristics of health service production in LMICs, and evaluated the performance of Data Envelopment Analysis (DEA) and Stochastic Distance Function (SDF) for assessing efficiency. We found that an ensemble approach (ENS) combining efficiency estimates from a restricted version of DEA (rDEA) and restricted SDF (rSDF) is the preferable method across a range of scenarios. This is the first study to analyze efficiency measurement in a simulation setting for LMICs. Our findings aim to heighten the validity and reliability of efficiency analyses in LMICs, and thus inform policy dialogues about improving the efficiency of health service production in these settings.

Suggested Citation

  • Laura Di Giorgio & Abraham D Flaxman & Mark W Moses & Nancy Fullman & Michael Hanlon & Ruben O Conner & Alexandra Wollum & Christopher J L Murray, 2016. "Efficiency of Health Care Production in Low-Resource Settings: A Monte-Carlo Simulation to Compare the Performance of Data Envelopment Analysis, Stochastic Distance Functions, and an Ensemble Model," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-20, January.
    • Handle: RePEc:plo:pone00:0147261
    DOI: 10.1371/journal.pone.0147261
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0147261
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0147261&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0147261?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
    ---><---

    References listed on IDEAS

    as
    1. 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, April.
    2. Kneip, Alois & Simar, Léopold & Wilson, Paul W., 2008. "Asymptotics And Consistent Bootstraps For Dea Estimators In Nonparametric Frontier Models," Econometric Theory, Cambridge University Press, vol. 24(6), pages 1663-1697, December.
    3. Mehdi Farsi & Massimo Filippini, 2006. "An Analysis of Efficiency and Productivity in Swiss Hospitals," Swiss Journal of Economics and Statistics (SJES), Swiss Society of Economics and Statistics (SSES), vol. 142(I), pages 1-37, March.
    4. Mark Andor & Frederik Hesse, "undated". "The StoNED age: The Departure Into a New Era of Efficiency Analysis? An MC study Comparing StoNED and the "Oldies" (SFA and DEA)," Working Papers 201285, Institute of Spatial and Housing Economics, Munster Universitary.
    5. repec:zbw:rwirep:0394 is not listed on IDEAS
    6. Till Barnighausen & David E. Bloom & David Canning, 2010. "Universal antiretroviral treatment: the challenge of human resources," PGDA Working Papers 5510, Program on the Global Demography of Aging.
    7. Nyman, John A & Bricker, Dennis L, 1989. "Profit Incentives and Technical Efficiency in the Production of Nursing Home Care," The Review of Economics and Statistics, MIT Press, vol. 71(4), pages 586-594, November.
    8. Jim Griffin & Mark Steel, 2007. "Bayesian stochastic frontier analysis using WinBUGS," Journal of Productivity Analysis, Springer, vol. 27(3), pages 163-176, June.
    9. Mark Andor & Frederik Hesse, 2014. "The StoNED age: the departure into a new era of efficiency analysis? A monte carlo comparison of StoNED and the “oldies” (SFA and DEA)," Journal of Productivity Analysis, Springer, vol. 41(1), pages 85-109, February.
    10. Dias, Carlos Tadeu dos Santos & Samaranayaka, Ari & Manly, Bryan, 2008. "On the use of correlated beta random variables with animal population modelling," Ecological Modelling, Elsevier, vol. 215(4), pages 293-300.
    11. Mark Andor & Frederik Hesse, "undated". "A Monte Carlo Simulation comparing DEA, SFA and two simple approaches to combine efficiency estimates," Working Papers 201177, Institute of Spatial and Housing Economics, Munster Universitary.
    12. Resti, Andrea, 2000. "Efficiency measurement for multi-product industries: A comparison of classic and recent techniques based on simulated data," European Journal of Operational Research, Elsevier, vol. 121(3), pages 559-578, March.
    13. Grosskopf, S. & Valdmanis, V., 1987. "Measuring hospital performance : A non-parametric approach," Journal of Health Economics, Elsevier, vol. 6(2), pages 89-107, June.
    14. Ruggiero, John, 1998. "A new approach for technical efficiency estimation in multiple output production," European Journal of Operational Research, Elsevier, vol. 111(2), pages 369-380, December.
    15. Banker, Rajiv D. & Chang, Hsihui & Cooper, William W., 2004. "A simulation study of DEA and parametric frontier models in the presence of heteroscedasticity," European Journal of Operational Research, Elsevier, vol. 153(3), pages 624-640, March.
    16. Maria Portela & Emmanuel Thanassoulis, 2006. "Zero weights and non-zero slacks: Different solutions to the same problem," Annals of Operations Research, Springer, vol. 145(1), pages 129-147, July.
    17. Yu, Chunyan, 1998. "The effects of exogenous variables in efficiency measurement--A monte carlo study," European Journal of Operational Research, Elsevier, vol. 105(3), pages 569-580, March.
    18. 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.
    19. Ruggiero, John, 1999. "Efficiency estimation and error decomposition in the stochastic frontier model: A Monte Carlo analysis," European Journal of Operational Research, Elsevier, vol. 115(3), pages 555-563, June.
    20. Coelli, Tim & Perelman, Sergio, 1999. "A comparison of parametric and non-parametric distance functions: With application to European railways," European Journal of Operational Research, Elsevier, vol. 117(2), pages 326-339, September.
    21. Kneller, Richard & Andrew Stevens, Philip, 2003. "The specification of the aggregate production function in the presence of inefficiency," Economics Letters, Elsevier, vol. 81(2), pages 223-226, November.
    22. Sergio Perelman & Daniel Santin, 2011. "Measuring educational efficiency at student level with parametric stochastic distance functions: an application to Spanish PISA results," Education Economics, Taylor & Francis Journals, vol. 19(1), pages 29-49.
    23. 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.
    24. Banker, Rajiv D. & Gadh, Vandana M. & Gorr, Wilpen L., 1993. "A Monte Carlo comparison of two production frontier estimation methods: Corrected ordinary least squares and data envelopment analysis," European Journal of Operational Research, Elsevier, vol. 67(3), pages 332-343, June.
    25. Jacobs,Rowena & Smith,Peter C. & Street,Andrew, 2006. "Measuring Efficiency in Health Care," Cambridge Books, Cambridge University Press, number 9780521851442, October.
    26. Stevenson, Rodney E., 1980. "Likelihood functions for generalized stochastic frontier estimation," Journal of Econometrics, Elsevier, vol. 13(1), pages 57-66, May.
    27. 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.
    28. Greene, William H., 1990. "A Gamma-distributed stochastic frontier model," Journal of Econometrics, Elsevier, vol. 46(1-2), pages 141-163.
    29. Xavier Irz & Colin Thirtle, 2004. "Dual Technological Development in Botswana Agriculture: A Stochastic Input Distance Function Approach," Journal of Agricultural Economics, Wiley Blackwell, vol. 55(3), pages 455-478, November.
    30. Collier, Trevor & Johnson, Andrew L. & Ruggiero, John, 2011. "Technical efficiency estimation with multiple inputs and multiple outputs using regression analysis," European Journal of Operational Research, Elsevier, vol. 208(2), pages 153-160, January.
    31. Sara Bennett & Sachiko Ozawa & Krishna D Rao, 2010. "Which Path to Universal Health Coverage? Perspectives on the World Health Report 2010," PLOS Medicine, Public Library of Science, vol. 7(11), pages 1-3, November.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Ahn, Heinz & Clermont, Marcel & Langner, Julia, 2023. "Comparative performance analysis of frontier-based efficiency measurement methods – A Monte Carlo simulation," European Journal of Operational Research, Elsevier, vol. 307(1), pages 294-312.
    2. Nicolas A. Menzies & Christian Suharlim & Stephen C. Resch & Logan Brenzel, 2020. "The efficiency of routine infant immunization services in six countries: a comparison of methods," Health Economics Review, Springer, vol. 10(1), pages 1-11, December.

    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. Andor, Mark A. & Parmeter, Christopher & Sommer, Stephan, 2019. "Combining uncertainty with uncertainty to get certainty? Efficiency analysis for regulation purposes," European Journal of Operational Research, Elsevier, vol. 274(1), pages 240-252.
    2. Andor, Mark A. & Parmeter, Christopher & Sommer, Stephan, 2019. "Combining uncertainty with uncertainty to get certainty? Efficiency analysis for regulation purposes," European Journal of Operational Research, Elsevier, vol. 274(1), pages 240-252.
    3. Ahn, Heinz & Clermont, Marcel & Langner, Julia, 2023. "Comparative performance analysis of frontier-based efficiency measurement methods – A Monte Carlo simulation," European Journal of Operational Research, Elsevier, vol. 307(1), pages 294-312.
    4. Mark Andor & Frederik Hesse, 2014. "The StoNED age: the departure into a new era of efficiency analysis? A monte carlo comparison of StoNED and the “oldies” (SFA and DEA)," Journal of Productivity Analysis, Springer, vol. 41(1), pages 85-109, February.
    5. Mark Andor & Frederik Hesse, "undated". "The StoNED age: The Departure Into a New Era of Efficiency Analysis? An MC study Comparing StoNED and the "Oldies" (SFA and DEA)," Working Papers 201285, Institute of Spatial and Housing Economics, Munster Universitary.
    6. Sakouvogui Kekoura & Shaik Saleem & Doetkott Curt & Magel Rhonda, 2021. "Sensitivity analysis of stochastic frontier analysis models," Monte Carlo Methods and Applications, De Gruyter, vol. 27(1), pages 71-90, March.
    7. Isabel Narbón-Perpiñá & Maria Teresa Balaguer-Coll & Marko Petrović & Emili Tortosa-Ausina, 2020. "Which estimator to measure local governments’ cost efficiency? The case of Spanish municipalities," SERIEs: Journal of the Spanish Economic Association, Springer;Spanish Economic Association, vol. 11(1), pages 51-82, March.
    8. Julia Schaefer & Marcel Clermont, 2018. "Stochastic non-smooth envelopment of data for multi-dimensional output," Journal of Productivity Analysis, Springer, vol. 50(3), pages 139-154, December.
    9. Bao Hoang Nguyen & Robin C. Sickles & Valentin Zelenyuk, 2021. "What do we know from the vast literature on efficiency and productivity in healthcare? A Systematic Review and Bibliometric Analysis," CEPA Working Papers Series WP092021, School of Economics, University of Queensland, Australia.
    10. Léopold Simar & Valentin Zelenyuk, 2011. "Stochastic FDH/DEA estimators for frontier analysis," Journal of Productivity Analysis, Springer, vol. 36(1), pages 1-20, August.
    11. Sickles, Robin C. & Song, Wonho & Zelenyuk, Valentin, 2018. "Econometric Analysis of Productivity: Theory and Implementation in R," Working Papers 18-008, Rice University, Department of Economics.
    12. Krüger, Jens J., 2012. "A Monte Carlo study of old and new frontier methods for efficiency measurement," European Journal of Operational Research, Elsevier, vol. 222(1), pages 137-148.
    13. Ruggiero, John, 2003. "Comment on estimating school efficiency," Economics of Education Review, Elsevier, vol. 22(6), pages 631-634, December.
    14. George Fragkiadakis & Michael Doumpos & Constantin Zopounidis & Christophe Germain, 2016. "Operational and economic efficiency analysis of public hospitals in Greece," Annals of Operations Research, Springer, vol. 247(2), pages 787-806, December.
    15. Collier, Trevor & Johnson, Andrew L. & Ruggiero, John, 2011. "Technical efficiency estimation with multiple inputs and multiple outputs using regression analysis," European Journal of Operational Research, Elsevier, vol. 208(2), pages 153-160, January.
    16. Zangin Zeebari & Kristofer Månsson & Pär Sjölander & Magnus Söderberg, 2023. "Regularized conditional estimators of unit inefficiency in stochastic frontier analysis, with application to electricity distribution market," Journal of Productivity Analysis, Springer, vol. 59(1), pages 79-97, February.
    17. Das, Arabinda, 2013. "Estimation of Inefficiency using a Firm-specific Frontier Model," MPRA Paper 46168, University Library of Munich, Germany.
    18. Chunping Liu & Audrey Laporte & Brian S. Ferguson, 2008. "The quantile regression approach to efficiency measurement: insights from Monte Carlo simulations," Health Economics, John Wiley & Sons, Ltd., vol. 17(9), pages 1073-1087, September.
    19. Daraio, Cinzia & Simar, Léopold, 2022. "Approximations and Inference for Nonparametric Production Frontiers," LIDAM Discussion Papers ISBA 2022017, Université catholique de Louvain, Institute of Statistics, Biostatistics and Actuarial Sciences (ISBA).
    20. Michael Danquah & Kunal Sen, 2022. "Informal institutions, transaction risk, and firm productivity in Myanmar," Small Business Economics, Springer, vol. 58(3), pages 1721-1737, March.

    More about this item

    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:plo:pone00:0147261. 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: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    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.