The Robustness of Cross-Country Healthcare Rankings Among Homogeneous Oecd Countries

This paper re-examines analyses of cross-country healthcare efficiency using modern, non-parametric estimators and Malmquist indices to determine productivity changes over the panel. This paper finds that cross-country heterogeneity leads to different efficiency rankings than previously thought, and that the hyperbolic order-α estimator leads to more robust efficiency scores when looking across different output measures, only looking at the more homogeneous OECD countries. It finds that the United States, if excluding the percent of healthcare expenditures that are publicly financed, is one of the more inefficient healthcare delivery systems in the world. What are commonly thought of as well-run healthcare systems (Austria and France) are either inefficient themselves or have variation in their efficiency rankings, showcasing difficulties in using other countries' healthcare systems as models for reform. It also finds that there has been productivity regression in all countries except the United States. These highlight the difficulties in cross-country efficiency comparisons.