Measuring the efficiency of health systems in Asia: a data envelopment analysis

• Published in: BMJ open Vol. 9; no. 3; p. e022155
• Main Authors: Ahmed, Sayem, Hasan, Md Zahid, MacLennan, Mary, Dorin, Farzana, Ahmed, Mohammad Wahid, Hasan, Md Mehedi, Hasan, Shaikh Mehdi, Islam, Mohammad Touhidul, Khan, Jahangir A M
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 27.03.2019; BMJ Publishing Group
• Subjects: Asia; Benchmarking; Cancer; Data envelopment analysis; Delivery of Health Care - methods; Delivery of Health Care - organization & administration; Efficiency; Efficiency, Organizational - standards; Expenditures; GDP; Gross Domestic Product; Health care; Health Economics; Health Expenditures; Health services; Hospitals; Humans; Medicin och hälsovetenskap; Mortality; Outcome and Process Assessment, Health Care; Personal health; Productivity; Public health; Quality Improvement - organization & administration; Quality Indicators, Health Care; Asia; China; Asian Countries; health systems efficiency; data envelopment analysis; technical efficiency
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2018-022155

ObjectiveThis study aims to estimate the technical efficiency of health systems in Asia.SettingsThe study was conducted in Asian countries.MethodsWe applied an output-oriented data envelopment analysis (DEA) approach to estimate the technical efficiency of the health systems in Asian countries. The DEA model used per-capita health expenditure (all healthcare resources as a proxy) as input variable and cross-country comparable health outcome indicators (eg, healthy life expectancy at birth and infant mortality per 1000 live births) as output variables. Censored Tobit regression and smoothed bootstrap models were used to observe the associated factors with the efficiency scores. A sensitivity analysis was performed to assess the consistency of these efficiency scores.ResultsThe main findings of this paper demonstrate that about 91.3% (42 of 46 countries) of the studied Asian countries were inefficient with respect to using healthcare system resources. Most of the efficient countries belonged to the high-income group (Cyprus, Japan, and Singapore) and only one country belonged to the lower middle-income group (Bangladesh). Through improving health system efficiency, the studied high-income, upper middle-income, low-income and lower middle-income countries can improve health system outcomes by 6.6%, 8.6% and 8.7%, respectively, using the existing level of resources. Population density, bed density, and primary education completion rate significantly influenced the efficiency score.ConclusionThe results of this analysis showed inefficiency of the health systems in most of the Asian countries and imply that many countries may improve their health system efficiency using the current level of resources. The identified inefficient countries could pay attention to benchmarking their health systems within their income group or other within similar types of health systems.