通过 MCDA 和 DEA 对 28 个卫生系统进行效率评估。

IF 2.7 3区 经济学 Q1 ECONOMICS
Martin Dlouhý, Pavel Havlík
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引用次数: 0

摘要

背景:政策制定者一直在讨论不断增长的医疗支出,他们应该知道医疗系统是否高效。我们可以通过国际卫生系统效率评估为他们提供这方面的信息。本研究的主要目标是(a) 通过多重标准决策分析(MCDA)和数据包络分析(DEA)对 28 个发达国家的卫生系统效率进行评估;(b) 为捷克共和国确定合理的基准国家,并收集有关卫生系统投入和产出相对重要性的信息:我们使用 MCDA 和 DEA 评估了 28 个发达国家卫生系统的效率。模型包括四个卫生系统投入(卫生支出占 GDP 的相对比例、医生、护士和病床数量)和三个卫生系统产出(出生时预期寿命、健康预期寿命和婴儿死亡率)。样本涵盖 27 个经合组织国家和俄罗斯,后者也被纳入经合组织数据库。为了确定投入和产出权重,我们向捷克共和国的卫生政策专家发放了调查问卷:我们从 27 位捷克卫生政策专家那里获得了关于卫生系统投入和产出相对重要性的主观信息。我们使用四个 MCDA 模型和两个 DEA 模型对卫生系统的效率进行了评估。根据 MCDA 模型,我们发现土耳其、波兰和以色列拥有高效的卫生系统。捷克共和国分别排在第 16、19、15 和 17 位。捷克共和国卫生系统的基准国家是以色列、爱沙尼亚、卢森堡、意大利、英国、西班牙、斯洛文尼亚和加拿大。采用规模收益不变的 DEA 模型确定了四个技术上高效的卫生系统:土耳其、英国、加拿大和瑞典。捷克共和国是表现最差的卫生系统之一。采用规模收益可变的 DEA 模型确定了 15 个技术上有效的卫生系统。我们发现,效率结果相当稳健。除了两个例外,每对模型之间的斯皮尔曼等级相关性在 0.05 的水平上都有统计学意义:在制定模型的过程中,我们研究了医疗效率测量的误区,并采用了几种实用的解决方案。我们认为 MCDA 和 DEA 首先是探索性方法,而不是提供确定答案的方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Efficiency evaluation of 28 health systems by MCDA and DEA.

Background: Policymakers, who are constantly discussing growing health expenditures, should know whether the health system is efficient. We can provide them with such information through international health system efficiency evaluations. The main objectives of this study are: (a) to evaluate the efficiency of health systems in 28 developed countries by multiple-criteria decision analysis (MCDA) and data envelopment analysis (DEA) and (b) to identify reasonable benchmark countries for the Czech Republic, for which we collect information on the relative importance of health system inputs and outputs.

Methods: We used MCDA and DEA to evaluate the efficiency of the health systems of 28 developed countries. The models included four health system inputs (health expenditure as a relative share of GDP, the number of physicians, nurses, and hospital beds) and three health system outputs (life expectancy at birth, healthy life expectancy, and infant mortality rate). The sample covers 27 OECD countries and Russia, which is also included in the OECD database. To determine the input and output weights, we used a questionnaire sent to health policy experts in the Czech Republic.

Results: We obtained subjective information on the relative importance of the health system inputs and outputs from 27 Czech health policy experts. We evaluated health system efficiency using four MCDA and two DEA models. According to the MCDA models, Turkey, Poland, and Israel were found to have efficient health systems. The Czech Republic ranked 16th, 19th, 15th, and 17th. The benchmark countries for the Czech Republic's health system were Israel, Estonia, Luxembourg, Italy, the UK, Spain, Slovenia, and Canada. The DEA model with the constant returns to scale identified four technically efficient health systems: Turkey, the UK, Canada, and Sweden. The Czech Republic was found to be one of the worst-performing health systems. The DEA model with the variable returns to scale identified 15 technically efficient health systems. We found that efficiency results are quite robust. With two exceptions, the Spearman rank correlations between each pair of models were statistically significant at the 0.05 level.

Conclusions: During the model formulation, we investigated the pitfalls of efficiency measurement in health care and used several practical solutions. We consider MCDA and DEA, above all, as exploratory methods, not methods providing definitive answers.

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来源期刊
CiteScore
3.90
自引率
4.20%
发文量
59
审稿时长
13 weeks
期刊介绍: Health Economics Review is an international high-quality journal covering all fields of Health Economics. A broad range of theoretical contributions, empirical studies and analyses of health policy with a health economic focus will be considered for publication. Its scope includes macro- and microeconomics of health care financing, health insurance and reimbursement as well as health economic evaluation, health services research and health policy analysis. Further research topics are the individual and institutional aspects of health care management and the growing importance of health care in developing countries.
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