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Institutional arrangements and efficiency of health care delivery systems

The European Journal of Health Economics volume 6, pages 215–222 (2005)Cite this article

Abstract

This study examined the efficiency of health care delivery systems in 24 OECD countries. Practicing physicians, practicing nurses, inpatient beds, and pharmaceuticals were considered as inputs to treat populations of various age groups. Data envelopment analysis (DEA) was utilized to calculate efficiency. We also calculated input efficiency that should be helpful in determining excess number of physicians, nurses, inpatient beds, and pharmaceuticals consumed. Institutional arrangements affect efficiency: public-contract and public-integrated countries are more efficient than public-reimbursement countries. Countries in which physicians are paid in wages and salaries and countries with capitation have higher efficiency than fee-for-service countries. Countries in which a primary care physician acts as a gatekeeper are also more efficient than countries without gatekeepers.

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References

  1. Afriat SN (1972) Efficiency estimation of production functions. Int Econ Rev 13:568–598

    Google Scholar 

  2. Brockman H (2002) Why is less money spent on health care for the elderly than for the population? Health care rationing in German hospitals. Soc Sci Med 55:593–608

    Google Scholar 

  3. Charnes A, Cooper WW, Rhodes E (1978) Measuring the efficiency of decision making units. Eur J Operation Res 2:429–444

    Google Scholar 

  4. Chirikos TN, Sear AM (2000) Measuring hospital efficiency: a comparison of two approaches. Health Serv Res 34:1389–1408

    Google Scholar 

  5. Coelli TJ (1996) A guide to DEAP version 2.1: a data envelopment analysis (computer) program. CEPA working paper 96/8. University of New England: Armidale

    Google Scholar 

  6. Evans DB, Tandon A, Murray CJM, Lauer JA (2000) The comparative efficiency of national health systems in producing health: an analysis of 191 countries. GPE discussion paper series, no. 29, EIP/GPE/EQC, World Health Organization

    Google Scholar 

  7. Farrell MJ (1957) The measurement of productive efficiency. J R Stat Soc series A 120 part 3

  8. Gerdtham UG, Jonsson B (2000) International comparisons of health expenditures: Theory, data and econometric analysis. In: Culyer AJ, Newhouse JP (eds) Handbook of health economics. Elsevier: Amsterdam

  9. Grosskopt S, Valdmanis V (1987) Measuring hospital performance: a nonparametric approach. J Health Econ 6:89–107

    Google Scholar 

  10. Gupta SK, Verhoeven HM (1997) The efficiency of government expenditure: experiences from Africa. IMP working paper no. WP/97/15 International Monetary Fund: Washington

  11. Leu RE (1986) The public-private mix and international health care costs. In: Culyer AJ, Honsson B (eds) Public private health services. Basil Blackwell: Oxford

    Google Scholar 

  12. Lovell CAK (2001) Production frontiers, productive efficiency. In: Fried HO, Lovell CAK, Martin AB, Whittle LS, Levit KR (eds) Trends in state health care expenditures and funding: 1980–1998. Healthcare Financ Rev 22, http://www.meps.ahrq.gov/data_pub/hc_fydata96.htm

  13. Newhouse JP (1992) Medical care costs: How much welfare loss? J Econ Perspect 6:3–21

    Google Scholar 

  14. Newhouse JP (1977) Medical care expenditure: a cross-national survey. J Hum Resources 12:115–125

    Google Scholar 

  15. OECD (1992) The reform of health care: A comparative analysis of seven OECD countries. Health Policy Stud no. 2

    Google Scholar 

  16. OECD (1994) Health care reform: controlling spending and increasing efficiency. Economics Department working papers no. 149

    Google Scholar 

  17. OECD (2000) Health data 2000: a comparative analysis of 29 countries. Organisation for Economic Co-operation and Development: Paris

  18. OECD (2000) Determinants of health outcomes in industrialized countries: a pooled cross-country, time series analysis. OECD Econ Stud 30

    Google Scholar 

  19. OECD (2001) Health at a glance. Organisation for Economic Co-operation and Development: Paris

  20. OECD (2003) Health data 2003: a comparative analysis of 29 countries. Organisation for Economic Co-operation and Development: Paris

  21. Roos NP, Montogomery P, Roos LL (1987) Health care utilization in the years prior to death. Milbank Q 65:231–254

    Google Scholar 

  22. Schmidt SS (ed) The measurement of productive efficiency Oxford University Press, New York

  23. Seinford ABLM, Thrall RM (1990) Recent developments in DEA: the mathematical approach to frontier analysis. J Econometrics 46:7–38

    Google Scholar 

  24. Weisbroad BA (1991) Health care quadrilemma: an essay on technological change, insurance, quality of care and cost containment. J Econ Literature 29:523–552

    Google Scholar 

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  1. Vasanthakumar N. Bhat

    Present address: , 435 Waite Street, Hamden, CT, 06517, USA

Affiliations

  1. Lubin School of Business, Pace University, New York, NY, USA

    Vasanthakumar N. Bhat

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  1. Vasanthakumar N. Bhat
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Correspondence to Vasanthakumar N. Bhat.

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Bhat, V.N. Institutional arrangements and efficiency of health care delivery systems. Eur J Health Econ 6, 215–222 (2005). https://doi.org/10.1007/s10198-005-0294-1

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  • DOI: https://doi.org/10.1007/s10198-005-0294-1

Keywords

  • Delivery of health care
  • OECD countries
  • Data envelopment analysis
  • Health system performance
  • Health system efficiency