Comparing US State Health Efficiencies Employing Data Envelope Analysis

Abstract

Over the past several decades, there have been improvements in health outcomes such as life expectancy, infant mortality rates and maternal mortality rates. Yet, the improvements in national health indicators often have not resulted in significantly reducing burdens of chronic disease among US citizens. Burden of disease studies examining population health employ assessments to measure chronic disease and disability burdens. We used the disability-adjusted life year (DALY) as the measure for overall disease burden. Our paper evaluates the efficiency of health care resources on a state-by-state population basis in the US by examining the 50 states through the application of a non-parametric method known as data envelope analysis (DEA). DEA allows multi-input and multioutput analysis. We conducted analyses to compare each state vis-a-vis the other states to examine the efficiency of the use of health resources in relation to disease burdens. We used three input variables-the number of physicians per 100,000 residents per state, the number of hospital beds per 1000 inhabitants per state and the public health funding per capita per state and one output variable- disability adjusted life years to reflect burden of disease. The study was conducted over a six-year duration (2008-2014). Our study demonstrates that there are varying levels of efficiency in the utilization of health resources (i.e. number of physicians, number of hospital beds and public health expenditures) among the 50 US states in affecting the output of disease burden. It appears that the Western US states and the northern most Midwest regions are the most efficient relative to the other states. The least efficient states were clustered in the south Midwestern region. The states showing the most improvement include the previously least efficient south-eastern states. This indicates that these south-eastern states are “catching up” or improving relative to the other states, but still have a large gap in efficiency utilization. The Western states with high efficiency also had higher use of technology. In contrast, the North-Midwestern states with high efficiency values had lower use of technology. This finding appears to show that these North-Midwestern states are efficient with their use of health resources, but their efficiency is not due to technological improvements as in the Western states.