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No theory: an explanation of the lack of consistency in cross-country health care comparisons using non-parametric estimators

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  • Richard Gearhart

    (California State University)

Abstract

Since 2000 several papers have examined the efficiency of healthcare delivery systems worldwide. These papers have extended the literature using drastically different input and output combinations from one another, with little theoretical or empirical support backing these specifications. Issues arise that many of these inputs and outputs are available for a subset of OECD countries each year. Using a common estimator and the different specifications proposed leads to the result that efficiency rankings across papers can diverge quite significantly, with several countries being highly efficient in one specification and highly inefficient in another. Broad input-output measures that are collected annually provide consistent efficiency rankings across specifications, compared to specifications that utilize specific measures collected infrequently. This paper also finds that broad output measures that are not quality-adjusted, such as life expectancy, seem to be a suitable alternative for infrequently collected quality-adjusted output measures, such as disability adjusted life years.

Suggested Citation

  • Richard Gearhart, 2016. "No theory: an explanation of the lack of consistency in cross-country health care comparisons using non-parametric estimators," Health Economics Review, Springer, vol. 6(1), pages 1-12, December.
    • Handle: RePEc:spr:hecrev:v:6:y:2016:i:1:d:10.1186_s13561-016-0118-2
    DOI: 10.1186/s13561-016-0118-2
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    References listed on IDEAS

    as
    1. 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.
    2. Aragon, Y. & Daouia, A. & Thomas-Agnan, C., 2005. "Nonparametric Frontier Estimation: A Conditional Quantile-Based Approach," Econometric Theory, Cambridge University Press, vol. 21(2), pages 358-389, April.
    3. Jeff Richardson & John Wildman & Iain K. Robertson, 2003. "A critique of the World Health Organisation's evaluation of health system performance," Health Economics, John Wiley & Sons, Ltd., vol. 12(5), pages 355-366, May.
    4. S. Grosskopf & S. Self & O. Zaim, 2006. "Estimating the efficiency of the system of healthcare financing in achieving better health," Applied Economics, Taylor & Francis Journals, vol. 38(13), pages 1477-1488.
    5. 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.
    6. 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.
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    Cited by:

    1. Panagiotis Mitropoulos, 2021. "Production and quality performance of healthcare services in EU countries during the economic crisis," Operational Research, Springer, vol. 21(2), pages 857-873, June.
    2. Dino Rizzi & Michele Zanette, 2021. "Potential efficiency gains and expenditure savings in the Italian Regional Healthcare Systems," Politica economica, Società editrice il Mulino, issue 2, pages 187-214.

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    More about this item

    Keywords

    United States healthcare; Cross-country healthcare comparison; Production efficiency; Order- α; OECD;
    All these keywords.

    JEL classification:

    • C14 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Semiparametric and Nonparametric Methods: General
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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