OECD SAĞLIK SİSTEMLERİ ÇOK SAFHALI ETKİNLİK ANALİZİ

Öz

Bu makale, 2000 - 2011 yılları arasında, 34 OECD ülkesinin panel veri seti kullanarak ülkeleri çapındaki sağlık sistemlerinin teknik etkinliğini, çevresel faktörleri ve sağlık harcaması seviyelerinin etkilerini de dikkate alarak ölçmektedir. Çalışmada etkinlik seviyelerini, Veri Zarflama Analizi (DEA) tekniğini kullanarak, üretim ve tedarik olmak üzere 2 safhalı süreçte belirtilmiştir. OECD ülkeleri çapındaki % 3.05 düzeyinde bulunan etkinlik kaybı, 1.38 yıllık doğumda beklenen yaşam beklentisi kaybı ve 1000 canlı doğum başına 0.75 bebek ölümü anlamına gelmektedir. Diğer yandan çevresel etkenler ve yetersiz sağlık harcamaları nedeniyle bu kayıplar, neredeyse ikiye katlanıp, % 5.65 etkinlik kaybı ya da 2.4 yıl doğumda yaşam beklentisi ve 1.5 bebek ölümüne ulaşmaktadır. Ölçülen etkinlik kaybı, % 21 üretim ve % 79 tedarik merkezli olmakla beraber, ülkeden ülkeye büyük değişiklik göstermektedir; dolayısıyla da bu kayıpların telafisi için gerekli çözümler ve bunlara ilişkin politikalar da farklı olacaktır.

Anahtar Kelimeler

• Sağlık Sistemleri,Etkinlik,Veri Zarflama Analizi,DEA,OECD

A MULTI-STAGE EFFICIENCY ANALYSIS OF OECD HEALTHCARE SYSTEMS

Öz

This paper measures the multi-stage technical efficiency of healthcare systems across OECD Countries between 2000 and 2011, based on a 34 country panel data set, taking into account the impact of environmental variables and health expenditure levels. We measure technical efficiencies in a two-stage process—the production of health services and the subsequent provision of health outcomes—using output-oriented Data Envelopment Analysis (DEA). An overall inefficiency of 3.05% across OECD countries translates into an average loss of 1.38 years of life expectancy at birth and an additional 0.75 infant deaths per 1000 live births, exacerbated by environmental variables and inadequate healthcare spending, almost doubling the total OECD outcome loss to 5.65%, or 2.4 years of life expectancy and 1.5 infant deaths per 1000 live births. Measured inefficiency is split 21%/79% between production and provision. The type of inefficiencies exhibited, the solutions to these, and the resulting policy implications vary greatly.

Anahtar Kelimeler

• Healthcare,Efficiency,DATA ENVELOPMENT ANALYSIS,DEA,OECD

Kaynakça

1. Arocena, P., and Prado, A.G. (2007). Accounting For Quality İn The Measurement Of Hospital Performance: Evidence From Costa Rica, Health Economics, 16, 667–685.
2. Banker R.D., Charnes A. and Cooper, (1984), WW. Some Models For Estimating Technical And Scale Inefficiencies in Data Envelopment Analysis, Management Science, 30,1078–92.
3. Bilsen M. and Davutyan N. (2014). Hospital Efficiency With Risk Adjusted Mortality As Undesirable Output: The Turkish Case, Springer US, 2014-10-01, 73-88Carey, K. (2003). Hospital Cost Efficiency and System Membership, Inquiry 40 (1), 25–38.
4. Charnes A, Cooper W.W. and Rhodes E. (1978). Measuring the Efficiency Of Decision Making Units. European Journal of Operational Research, 2(6), 429–44.
5. Charnes, A., Cooper, W. W., Golany, B., Halek, R., Klopp, G. and Schmitz, E. (1986). Two-phase Data Envelopment Analysis Approaches To Policy Evaluation And Management Of Army Recruiting Activities: Tradeoffs Between Joint Services And Army Advertising. Research Report CCS #532, Center for Cybernetic Studies, University of Texas-Austin, Austin, TX.
6. Chen, Y., Cook, W. D. and Zhu, J. (2010). Deriving the DEA Frontier For Two-Stage Processes. European Journal of Operational Research, 202, 138–142.
7. Cutler, D.M. and A. Lleras-Muney (2010), Understanding Differences in Health Behaviour by Education, Journal of Health Economics 29, 1-28.
8. Dismuke C.E. and Sena V. (2001). Is There A Trade-Off Between Quality And Productivity? The Case Of Diagnostic Technologies in Portugal, Ann Oper Res, 107, 101–116.

9. Evans, D. B., Tandon, A., Murray, C. J. L. and Lauer, J. A. (2001). The Comparative Efficiency of National Health Systems in Producing Health: An Analysis of 191 Countries. GPE Discussion Paper Series No. 29. Geneva: WHO, EIP/GPE/EQC.
10. Färe, R S. And Grosskopf, (2000). Network DEA, Socio-Economic Planning Sciences, 34(1), 35-49, ISSN 0038-0121
11. Farrell M.J. (1957). The Measurement Of Productive Efficiency, Journal of Royal Statistical Society (Series A), 120(3), 253–281.
12. Gerdtham U.G., Søgaard J., Andersson F. And Jönsson B.(1992), An Econometric Analysis Of Health Care Expenditure: A Cross-Section Study of the OECD Countries, Journal of Health Economics, 11(1), 63-84, ISSN 0167-6296.
13. Häkkinen, U. and I. Joumard (2007). Cross-Country Analysis of Efficiency in OECD Health Care Sectors: Options for Research, OECD Economics Department Working Papers, No. 554, OECD Publishing.
14. Hauck K and Street A. (2006). Performance Assessment in The Context Of Multiple Objectives: A Multivariate Multilevel Analysis. Journal of Health Economics 25(6): 1029–1048.
15. Hollingsworth, B. and Wildman, J. (2002). The Efficiency of Health Production: Reestimating the WHO Panel Data Using Parametric and Nonparametric Approaches to Provide Additional Information, Working Paper No. 131. Melbourne: Monash University, Centre for Health Program Evaluation.
16. Hollingsworth, B. (2008). The Measurement Of Efficiency And Productivity Of Health Care Delivery. Health Economics, 17, 1107–1128.
17. Jacobs, R., Smith, P. C., and Street, A. (2006). Measuring Efficiency in Health Care. New York: Cambridge University Press.
18. Jamison, D. T., Sandbu, M. and Wang, J. (2001). Cross Country Variation in Mortality Decline, 1962-87: The Role of Country Specific Technical Progress. CMH Working Paper No. WGI: 4. Geneva: WHO, Commission on Macroeconomics and Health.
19. Kessler, D. P., and M. B. McClellan. (2002). The Effects of Hospital Ownership on Medical Productivity, RAND Journal of Economics, 33 (3): 488–506.
20. Koechlin F, Lorenzoni L. and Schreyer P. (2010). Comparing Price Levels Of Hospital Services Across Countries: Results Of Pilot Study, OECD Health Working Papers Number 53. Paris: OECD Publishing, 2010.
21. Lochner, L. (2011), Non-Production Benefits of Education: Crime, Health, and Good Citizenship, Working Paper 16722, National Bureau of Economic Research.
22. Löthgren, M. And Tambour, M. (1999). Productivity and Customer Satisfaction in Swedish Pharmacies: A Dea Network Model. European Journal of Operational Research, 115, 449–458.
23. Lorenzoni L., Belloni A. and Sassi F.(2014). Health-care Expenditure And Health Policy İn The USA Versus Other High-Spending OECD Countries, The Lancet, 384(9937), 83-92, ISSN 0140-6736, http://dx.doi.org/10.1016/S0140-6736(14)60571-7.
24. Martin, A. B., Hartman, M., Whittle, L., and Catlin, A. (2014). National Health Spending in 2012: Rate Of Health Spending Growth Remained Low For The Fourth Consecutive Year, Health Affairs, 33(1), 67–77.
25. Muñiz, M., Paradi, J., Ruggiero, J. and Z. Yang (2006). Evaluating Alternative DEA Models Used To Control For Non-Discretionary Inputs, Computers and Operations Research, 33, 1173-1183.
26. Murray, J.L. and D.B. Evans (2003). Health System Performance Assessment. Debates, Methods and Empiricism, World Health Organization, Geneva.
27. Newhouse JP. (1994). Frontier Estimation: How Useful A Tool For Health Economics?. Journal of Health Economics, 13(3), 317–322.
28. Nunamaker, T. R., and Lewin, A. Y. (1983). Measuring routine Nursing Efficiency: A Comparison Of Cost Per Patient Day And Data Envelopment Analysis Models/Comment, Health Services Research, 18(2), 183-208.
29. OECD(2013). Health at a Glance 2013: OECD Indicators, https://www.oecd.org/els/health-systems/Health-at-a-Glance-2013.pdf (31.12.2013)
30. OECD(2013). Health Statistics 2013-Frequently Requested Data http://www.oecd.org/health/oecdhealthdata2013-frequentlyrequesteddata.htm (31.12.2013)
31. O’Neill, L., Rauner, M., Heidelberger, K., and Kraus, M. (2008). A Cross National Comparison And Taxonomy Of DEA Based Hospital Efficiency Studies. Socio-Economic Planning Sciences, 42, 158–189.
32. Ozcan Y.A. (2008). Health Care Benchmarking And Performance Evaluation An Assessment Using Data Envelopment Analysis (DEA), Springer, Newton. ISBN: 978-0-387-75447-5
33. Ray, S. (2004). Data Envelopment Analysis: Theory And Techniques For Economics And Operations Research. Cambridge: Cambridge University Press.
34. Ruggiero, J., (1998). Non-discretionary Inputs in Data Envelopment Analysis, European Journal of Operational Research, 111: 461-469.
35. Sahin, I., and Ozcan, Y. (2000). Public Sector Hospital Efficiency For Provincial Markets in Turkey. Journal of Medical Systems, 24(6), 307–320.
36. Salomon, J. A., Mathers, C. D., Murray, C. J. L., and Ferguson, B. (2001). Method for Life Expectancy and Healthy Life Expectancy Uncertainty Analysis. Global Programme on Evidence for Health Policy Working Paper No. 10. Geneva: WHO.
37. Schwartz, W.B., and D.N. Mendelson. (1994). Eliminating Waste and Inefficiency Can Do Little to Contain Costs, Health Affairs, 13, 224-238.
38. Sherman, H. D. (1984). Hospital Efficiency Measurement And Evaluation: Empirical Test Of A New Technique. Medical Care, 22(10), 922–938.
39. Simon, J., Simon, C., and Arias, A. (2011). Changes in Productivity Of Spanish University Libraries. Omega, 39, 578–588.
40. Skinner, J., E. Fisher, and J. E. Wennberg. (2005). The Efficiency of Medicare, In: Wise D, ed. Analyses in the Economics Of Aging, Chicago: University of Chicago Press, 2005:129-57.
41. Sulku SN, (2011). The Health Sector Reforms And The Efficiency Of Public Hospitals in Turkey: Provincial Markets.” Eur J Public Health.,22(5), 634-8.
42. Wang, C. H., Gopal, R. D., and Zionts, S. (1997). Use of Data Envelopment Analysis in Assessing Information Technology Impact On Firm Performance. Annals of Operations Research, 73, 191–213.
43. Wang, J., Jamison, D. T., Bos, E., Preker, A. and Peaboy, J. (1999). Measuring Country Performance on Health: Selected Indicators for 115 Countries. Human Development Network, Health, Nutrition and Population Studies. Washington, DC: World Bank.
44. WHO (2000), The World Health Report 2000. Health Systems: Improving Performance, World Health Organisation, Geneva.
45. WHO(2013). World Health Organization, Body Mass Index (BMI) 2013 http://apps.who.int/gho/data/node.main.BMIANTHROPOMETRY?lang=en (31.12.2013)
46. Zuckerman, S., J. Hadley, and L. Iezzoni. (1994). Measuring Hospital Efficiency with Frontier Cost Functions, Journal of Health Economics, 13 (3), 255–80; discussion 335–40.