Assessment of regional productive performance of European health systems under a metatechnology framework
Section snippets
Introduction and motivation
As documented in the Aging Report (2012) of the European Commission, during most of the second half of the 20th century healthcare spending grew faster than national income. Moving ahead to the 21st century, in the EU27, total expenditure on healthcare amounted to 10.2% of GDP in 2009, of which a substantial part (7.8%) is public expenditure. The ever-increasing proportion of health spending in government expenditure across Europe makes this topic crucial in the policy debate on how to ensure
Brief literature review
Although there are difficulties in applying efficiency concepts to health systems, there is an extensive empirical literature on the pervasiveness of inefficiency in the health sector at both macro and micro levels.5 Academics and economists have recently focused on the amount of resources devoted by government to social policies but also on the outcomes
Classification of European health systems
Our analysis is carried out at European regional level for 17 countries. Their healthcare systems are clustered according to a typology recently developed by Bohm et al. (2012, 2013).8 The typology by Rothgang and Wendt
Methodological underpinnings and hypotheses tested
Our methodological framework is developed in two interconnected stages. In the first stage, we present the theoretical and methodological underpinnings regarding the estimation of the directional distance function. In the second stage, we discuss expansion in a metafrontier framework presenting the theoretical basis for its inclusion.
Data and variables
In order to test our hypotheses we employ a dataset that allows (i) the introduction of some apparent regional heterogeneity and (ii) examination of different technology health systems without involving any micro-level idiosyncrasies but in conjunction with regional-specific heterogeneity. In this direction, we devised, the dataset employed in this paper combining information provided by key statistics on monetary and non-monetary aspects of healthcare in the European Union (EU) (Health-Care
Results and discussion
The presentation and discussion of the empirical results follows the two stage structure of the analysis. The regional-specific efficiency scores with respect to the three different health systems are first presented and discussed. The metatechnology efficiency scores and the associated technology gaps which arises in the context of the metafrontier are then used to examine technological spillovers.
Conclusions
The current literature on the productive performance of health systems generally use data from individual countries or groups of countries with same or different health systems imposing a technological homogeneous environment. This specific assumption creates severe risks on the benchmarking process when technology heterogeneity issues are not handled appropriately Furthermore, the assumption of common factors can be restrictive and sometimes unrealistic, leading to misleading inferences.
Funding
The University of Naples Parthenope, under the Competitive Research Project “Institutional and Economic Imbalances in the Eurozone and the European Union”, financed this work.
Acknowledgements
The authors would like to thank the Editor Prof. Sushanta Mallick and two anonymous Referees for their valuable comments that helped to improve the manuscript. The authors are also grateful to prof. Kostas Tsekouras for his insightful comments on earlier versions of this paper. Any remaining errors are the sole responsibility of the authors.
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