Regional Performance Measurement of Healthcare Systems in the EU: A Non-parametric Approach
The main purpose of the article is to estimate the regional performance of healthcare systems within the EU at the NUTS 2 level. Using multiple regional inputs and outputs to characterize healthcare provision, non-parametric methodology is applied to evaluate the relative efficiency of 151 regions in old EU member states (EU-15) and 54 regions in new EU member states (EU-13) in the period 2007–2012. The empirical results show that efficiency differs significantly across the selected regions. In general, less developed regions show a relatively high level of efficiency whereas capital regions seem to be the least efficient regions since they mainly serve as national medical centres employing a disproportionally large amount of health resources. The empirical study also finds evidence of the potential to improve health outcomes by ensuring a sufficient level of healthcare resources in those regions that are lagging behind significantly.
Afonso, A., Schuknecht L. & Tanzi, V. (2005) Public Sector Efficiency: An International Comparison, Public Choice, 123(3-4), pp. 321-347.
Afonso, A. & St. Aubyn, M. (2005) Non-parametric Approaches to Education and Health Efficiency in OECD Countries, Journal of Applied Economics, 8(2), pp. 227-246.
Aletras, V., Kontodimopoulos, N., Zagouldoudis, A. & Niakas, D. (2007) The short-term effect on technical and scale efficiency of establishing regional health systems and general management in Greek NHS hospitals, Health Policy, 83(2-3), pp. 236-245.
Aristovnik, A. (2012) Measuring Relative Efficiency in Health and Education Sector: The Case of East European Countries, Actual Problems of Economics/Aktual'ni Problemi Ekonomìki, 136(10), pp. 305-314.
Aristovnik, A. (2014) Efficiency of the R&D Sector in the EU-27 at the Regional Level: An Application of DEA, Lex localis-Journal of Local Self-Government, 12(3), pp. 519-531, doi: 10.4335/12.3.519-531(2014).
Charnes, A., Cooper, W. W. & Rhodes, E. (1978) Measuring the efficiency of decision making units, European Journal of Operational Research, 2 (6), pp. 429-444.
Chen, C. P., Hu, J. L. & Yang, C. H. (2011) R&D efficiency of multiple innovative outputs: The role of the national innovation system, Innovation: Management, policy & practice, 13, pp. 341–360.
Cheng, G., Zervopoulos, P. D. (2014) Estimating the technical efficiency of health care systems: A cross-country comparison using the directional distance function, European Journal of Operational Research, 238(3), pp. 899-910.
Committee of the Regions (2012) The management of health systems in the EU Member States - The role of local and regional authorities (Brussels: Progress Consulting S.r.l. and Living Prospects Ltd.).
Čok, M., Urban, I. & Verbič, M. (2013) Income redistribution through taxes and social benefits: The case of Slovenia and Croatia, Panoeconomicus, 60(5), pp. 667-686.
De Nicola, A., Gitto, S. & Mancuso, P. (2011) A two-stage DEA model to evaluate the efficiency of the Italian health system, MPRA Paper 39126 (Munuich: University Library of Munich, Germany).
Eurostat (2014) Eurostat regional yearbook (Brussels: European Commission).
Finžgar, M. & Oplotnik, Ž. J. (2013) Comparison of Fiscal Decentralization Systems in EU-27 According to Selected Criteria, Lex localis-Journal of Local Self-Government, 11(3), 651-672, doi:
Goldstein, H. (1990) Data Envelopment Analysis: an exposition and critique, Evaluation & Research in Education, 4(1), pp. 17-20.
Gupta, S. & Verhoeven, M. (2001) The efficiency of government expenditure Experiences from Africa, Journal of Policy Modelling, 23(4), pp. 433-467.
Halkos, G. E. & Tzeremes, N. G. (2011) A conditional nonparametric analysis for measuring the efficiency of regional public healthcare delivery: An application to Greek prefectures, Health policy, 103(1), 73-82.
Hoffman, I. (2013) Some Thoughts on the Main European Models of the Municipal Health Services, Lex localis-Journal of Local Self-Government, 11(3), pp. 631-650.
Hu, H. H., Qi, Q. & Yang, C. H. (2012) Analysis of hospital technical efficiency in China: Effect of health insurance reform, China Economic Review, 23(4), pp. 865-877.
Kontodimopoulos, N., Nanos, P. & Niakasmeasures, D. (2006) Balancing efficiency of health services and equity of access in remote areas in Greece, Health Policy, 76(1), pp. 49-57.
Linna, M., Hakkinen, U. & Magnussen, J. (2006) Comparing hospital cost efficiency between Norway and Finland, Health Policy, 77(3), pp. 268–278.
Obadić, A. & Aristovnik, A. (2011) Relative efficiency of higher education in Croatia and Slovenia: an international comparison, Amfiteatru Economic, 13(30), pp. 362-376.
Retzlaff-Roberts, D., Chang, C. & Rubin, R. M. (2004) Technical efficiency in the use of health care resources: a comparison of OECD countries, Health Policy, 69(1), pp. 55–72.
Rogelj, A. & Brezovnik, B. (2013) Universal Health Services, Lex localis-Journal of Local Self-Government, 11(3), pp. 687-708.
Spinks, J. & Hollingsworth, B. (2005) Health production and the socioeconomic determinants of health in OECD countries: the use of efficiency models (Monash: Monash University. Centre for Health Economics).
Thomson, S., Foubister, T. & Mossialos, E. (2009) Financing health care in the European Union: challenges and policy responses (Geneva: World Health Organization).
Tiemann, O. & Schreyögg, J. (2012) Changes in hospital efficiency after privatization, Health Care Management Science, 15(4), pp. 310-326.
Vodovnik, Z. (2013) Employment relationships in the public sector - a balance between the state, local and autonomous regulations, Lex localis - Journal of Local Self-Government, 11(3), pp. 497-512.
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