Has the efficiency and productivity of the health system in India improved during post-policy period? Application of the bootstrap data envelopment analysis and Malmquist productivity index

The efficiency and productivity of the health system are assessed using bootstrap data envelopment analysis and the bootstrap Malmquist productivity index across 21 states of India against the backdrop of the National Health Policy (NHP-2017). We took two child outcomes and three maternal outcomes as outputs and four inputs. A technical efficiency score of 0.760 suggests that the outputs could be increased by 24% without any additional inputs in the health system. A productivity of 0.993 indicates a decline at an average rate of 0.7% per year attributable to technological regress. Deducing from the statistical tests conducted, a significant change in the efficiency of the health system over the years was observed, particularly between the pre- and post-policy periods. In contrast, no significant change in productivity was observed. Despite having relatively better outcomes, Tamil Nadu lies farther away from the frontier, which indicates the inefficient utilization of public health resources. In contrast, Bihar, which has poor health outcomes, has better efficiency and witnessed significant productivity growth, indicating the efficient utilization of limited resources.