Value efficiency analysis of health systems: does public financing play a role?

Abstract

Aims/Background This study measures the performance of the health system in 165 countries and its relationship with public financing. Methods We use value efficiency analysis (VEA), a refinement of data envelopment analysis (DEA), to measure the efficiency of the health systems using data on healthy life expectancy and disability adjusted life years as health outcomes. Expenditure on health and education are used as inputs to the health system. Results The group of high income OECD countries shows the largest indexes of efficiency and also the lowest dispersion. In contrast, low income countries also have the most inefficient health systems, which implies that there are more opportunities for improvement. The average efficiency score is 0.96 for high income countries, 0.83 for upper-middle income countries, 0.86 for lower-middle income countries and only 0.76 for low income countries. Only 17 countries have a score equal to 1 and therefore are completely efficient and can be taken as referents. The index of efficiency is found to be positively associated with government expenditure on health as a percentage of total expenditure on health. ConclusionsThe analysis of the results shows that the public share in health expenditure and the weight of health expenditure in public budgets are two factors positively associated with the performance of the health systems. The study also highlights the advantages of using VEA over DEA in the measurement of performance.

The Efficiency of Post‐Communist Countries’ Health Systems

“…life expectancy, infant mortality, inequality in access, incidence of certain diseases, etc. [1]. Although there may be some controversy as to the suitability of some of these variables as important outcomes of health care, most of the analyses conducted on the level of systems use life expectancy and infant mortality to assess the performance of health systems (e.g.…”

“…The analysis carried out for the 165 countries for which data were available in the WHO database shows that the share of public health-care spending and the size of health-care spending in public budgets are two factors positively related to the functioning of health-care systems [1]. A modiied DEA model was used, allowing for the introduction of weight restrictions, which increases the discriminatory strength of the method.…”

“…All countries regardless of their level of economic development endeavour to improve the quality and accessibility of health services, which requires objective and reliable assessment of the functioning of their health systems. Both policymakers and society expect the best possible outputs of the health systems, due to the relatively large expenditures allocated for their functioning [1].…”

Impact of the Financing Structure on Efficiency of Healthcare Systems in the Former Eastern Bloc Countries

“…One of the fundamental difficulties indicated by many authors is providing the definition of the outcomes of healthcare systems [e.g. Retzlaff-Roberts et al 2004;Afonso, Aubyn 2005;González et al 2010;Hadad et al 2013;Papanicolas, Smith 2013]. The main outcome of the system is the improvement of the health of society, however measuring such a parameter is difficult.…”

Editorial

“…In their value efficiency analysis of international health systems, Gonzalez et al state that countries with governments showing deeper commitment to the development and financing of the health care systems also use their ressources more efficiently in the improvement of relevant health outcomes (Gonzalez et al 2010). …”