The efficiency of health production: re‐estimating the WHO panel data using parametric and non‐parametric approaches to provide additional information

Abstract

The World Health Report 2000 focuses on the performance of health-care systems around the globe. The report uses efficiency measurement techniques to create a league table of health-care systems, highlighting good and bad performers. Efficiency is measured using panel data methods. This paper suggests that the WHO's estimation procedure is too narrow and that contextual information is hidden by the use of one method. This paper uses and validates a range of parametric and non-parametric empirical methods to measure efficiency using the WHO data. The rankings obtained are compared to the WHO league table and we demonstrate that there are trends and movements of interest within the league tables. We recommend that the WHO broaden its range of techniques in order to reveal this hidden information.

Distinguishing between heterogeneity and inefficiency: stochastic frontier analysis of the World Health Organization's panel data on national health care systems

“…We will return to the model specification in Section 5.) Hollingsworth and Wildman (2002) (HW) also revisited the DALE results. They redid the computations using the nonparametric, data envelopment methods rejected by ETML.…”

“…This section of the WHR has been heavily criticized for numerous reasons related to the overall objectives, the quality and validity of the effectiveness measures, the input data used, and the appropriateness of the methodology. [See, e.g., Gravelle et al (2002a,b) (GJJS), Williams (2001) and Hollingsworth and Wildman (2002) (HW).] On January 8, 2001, coincident with the 2001 meeting of the Allied Social Science Association in New Orleans, the authors of the frontier study convened a panel of researchers specifically to discuss the econometric methodology.…”

Assessment of the effectiveness of social expenditures of Russian regions through the DEA method

“…Studies comparing the results of parametric and non-parametric techniques have been inconclusive (see for example Chirikos andSear, 2000 andHollingsworth andWildman, 2003, on health). Nevertheless, there is agreement that non-parametric model results depend on the presence of outliers to create the production frontier and are very sensitive in the case of heterogeneous units (Fiorentino, Karmann, and Koetter, 2006).…”

The efficiency of the local health systems: investigating the roles of health administrations and health care providers

“…Understanding how large inefficiency are and where in the production process improvements could be made, is key for Governments Hakkinen 2009) (Papanicolas and Smith 2014) . Add refs Efficiency in healthcare has been analysed as the difference between the observed and optimal productivity mostly of providers, including hospitals, but also individual practitioners, primary healthcare units, clinics, nursing homes, public health teams and primary healthcare facilities (Hollingsworth and Wildman 2003, Hollingsworth 2008, Hollingsworth and Peacock 2008, Hussey, de Vries et al 2009, Kirigia, Sambo et al 2011, Au, Hollingsworth et al 2014. The efficiency of health systems has also been addressed, mostly at national level through cross-countries comparisons (Gravelle, Jacobs et al 2003, Hollingsworth and Wildman 2003, Greene 2004, Retzlaff-Roberts, Chang et al 2004, but also at sub-national level, by comparing states (Kathuria and Sankar 2005, Prachitha and Shanmugam 2012), districts (Kinfu 2013, Kinfu andSawhney 2015) or lower level health authorities (Giuffrida 1999, Giuffrida, Gravelle et al 2000, Giuffrida and Gravelle 2001, PuigJunoy and Ortún 2004, Varela, Martins et al 2010).…”