Abstract
Objective: To assess the association between the healthcare system’s efficiency and policy factors (the types of healthcare systems and various health policy indicators). Methods: In this study, a data envelopment analysis (DEA) with bootstrapping was applied to the healthcare system’s efficiency to correct the bias of efficiency scores and to rank countries appropriately. We analyzed data mainly from the OECD (Organization for Economic Co-operation and Development) Health Data from 2014. After obtaining the efficiency score result, we analyzed which policy factor caused the inefficiency of the healthcare system by Tobit Regression. Results: Based on five types of healthcare system classification, the result suggested that the social health insurance (e.g., Austria, Germany, Switzerland) showed the lowest efficiency score on average when compared to other types of systems, but evidence of a statistically significant difference in healthcare efficiency among four types of healthcare systems was not found. It was shown that the pure technological efficiency of the healthcare system was negatively influenced by two main factors: user choice for basic insurance coverage and degree of decentralization to sub-national governments. Conclusions: Our findings suggest that countries with relatively low healthcare system efficiency may learn from countries that implement policies related to a low level of user choice and a high level of centralization to achieve more economical allocation of their healthcare resources.
Highlights
data envelopment analysis (DEA) has an advantage in testing efficiency among other approaches such as stochastic frontier analysis (SFA) as it does not require any assumptions about the production frontier and is able to deal with complex systems that have multiple inputs and outputs such as a healthcare system [19]
It shows that Luxembourg, Greece, and Israel had the highest healthcare system efficiency and Germany, Austria, and the Slovak Republic had the lowest efficiency
The main contents of our analysis are as follows: (1) the Social Health Insurance system showed the least efficiency score on average when compared to other types of systems but we could not find evidences of a statistically significant difference of healthcare efficiency between the four types of healthcare system; and (2) through the Tobit Regression, user information, user choice, and decentralization showed that these three policy factors had a negative impact on the efficiency of healthcare systems
Summary
Countries like Brazil, Russia, India, China, and South Africa (BRICS) have recently made efforts to achieve universal health coverage [1]. Health care reform to improve people’s standard of living is a major issue in many countries. There is still a lot of debate about how to change healthcare policy on issues of ‘centralization versus decentralization’ [2]. For example, whether to give patients a choice of healthcare provider or not is controversial among European countries even [3,4]. Universal health coverage (UHC), which is nowadays a ‘universal agreement’, still has room for ‘how’ to achieve UHC considering the distinct context of each country [5]. It is important to analyze which healthcare system is better and what policies have a positive impact on public health
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