Three decades in healthcare service efficiency evaluation: a bootstrapping Data Envelopment Analysis (DEA) of Ministry of Health Malaysia.

Background: One of the most important ways to boost the health system's performance and lower the rising cost of healthcare is to increase its efficiency. The objective of this study is to evaluate the efficiency of the MOH in providing public health services and to gauge the progress of health plans in Malaysia.

Methods: Three output variables (number of admissions, number of outpatient attendances, and number of maternal and child health attendances) and six input variables (budget allocation, number of doctors, dentists, pharmacists, nurses, and community nurses) were used in a Data Envelopment Analysis (DEA) Window Analysis. Eight input-output models' bias-corrected efficiency scores were obtained using bootstrapping.

Setting: Ministry level in public health service.

Participant: 28 Decision making units (DMUs) from 1995 to 2022.

Results: Robust performance over the study period was shown by the mean bias-corrected efficiency score of 0.974 (95% CI: 0.907-0.989) under the Variable Returns to Scale (VRS) model. Lower Constant Returns to Scale (CRS) model scores, on the other hand, draw attention to scale-level inefficiencies. During the COVID-19 pandemic, efficiency decreased due to higher input demands and limited outputs.

Conclusions: Although MOH has attained a high level of technological efficiency, expanding operations and resolving inequalities in rural areas remain difficult. Targeted tactics including telemedicine adoption, resource redistribution, and a move towards preventive treatment are advised in order to improve fairness and resilience.