Evaluating health systems’ efficiency towards universal health coverage: A data envelopment analysis
To estimate the technical efficiency of health systems toward achieving universal health coverage (UHC) in 191 countries. We applied an output-oriented data envelopment analysis approach to estimate the technical efficiency of the health systems, including the UHC index (a summary measure that captu...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2024-03-01
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| Series: | Inquiry: The Journal of Health Care Organization, Provision, and Financing |
| Online Access: | https://doi.org/10.1177/00469580241235759 |
| _version_ | 1797268021891301376 |
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| author | Paul Eze MPH Chidumebi Judith Idemili MSc Lucky Osaheni Lawani FWACS, MD |
| author_facet | Paul Eze MPH Chidumebi Judith Idemili MSc Lucky Osaheni Lawani FWACS, MD |
| author_sort | Paul Eze MPH |
| collection | DOAJ |
| description | To estimate the technical efficiency of health systems toward achieving universal health coverage (UHC) in 191 countries. We applied an output-oriented data envelopment analysis approach to estimate the technical efficiency of the health systems, including the UHC index (a summary measure that captures both service coverage and financial protection) as the output variable and per capita health expenditure, doctors, nurses, and hospital bed density as input variables. We used a Tobit simple-censored regression with bootstrap analysis to observe the socioeconomic and environmental factors associated with efficiency estimates. The global UHC index improved from the 2019 estimates, ranged from 48.4 (Somalia) to 94.8 (Canada), with a mean of 76.9 (std. dev.: ±12.0). Approximately 78.5% (150 of 191) of the studied countries were inefficient (ϕ < 1.0) with respect to using health system resources toward achieving UHC. By improving health system efficiency, low-income, lower-middle-income, upper-middle-income, and high-income countries can improve their UHC indices by 4.6%, 5.5%, 6.8%, and 4.1%, respectively, by using their current resource levels. The percentage of health expenditure spent on primary health care (PHC), governance quality, and the passage of UHC legislation significantly influenced efficiency estimates. Our findings suggests health systems inefficiency toward achieving UHC persists across countries, regardless of their income classifications and WHO regions, as well as indicating that using current level of resources, most countries could boost their progress toward UHC by improving their health system efficiency by increasing investments in PHC, improving health system governance, and where applicable, enacting/implementing UHC legislation. |
| first_indexed | 2024-04-25T01:25:52Z |
| format | Article |
| id | doaj.art-84f76ff230bd457eb5f119ffd4a700c3 |
| institution | Directory Open Access Journal |
| issn | 0046-9580 1945-7243 |
| language | English |
| last_indexed | 2024-04-25T01:25:52Z |
| publishDate | 2024-03-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Inquiry: The Journal of Health Care Organization, Provision, and Financing |
| spelling | doaj.art-84f76ff230bd457eb5f119ffd4a700c32024-03-08T21:04:18ZengSAGE PublishingInquiry: The Journal of Health Care Organization, Provision, and Financing0046-95801945-72432024-03-016110.1177/00469580241235759Evaluating health systems’ efficiency towards universal health coverage: A data envelopment analysisPaul Eze MPH0Chidumebi Judith Idemili MSc1Lucky Osaheni Lawani FWACS, MD2Penn State University, University Park, PA, USAUniversity of Toronto, Toronto, ON, CanadaUniversity of Toronto, Toronto, ON, CanadaTo estimate the technical efficiency of health systems toward achieving universal health coverage (UHC) in 191 countries. We applied an output-oriented data envelopment analysis approach to estimate the technical efficiency of the health systems, including the UHC index (a summary measure that captures both service coverage and financial protection) as the output variable and per capita health expenditure, doctors, nurses, and hospital bed density as input variables. We used a Tobit simple-censored regression with bootstrap analysis to observe the socioeconomic and environmental factors associated with efficiency estimates. The global UHC index improved from the 2019 estimates, ranged from 48.4 (Somalia) to 94.8 (Canada), with a mean of 76.9 (std. dev.: ±12.0). Approximately 78.5% (150 of 191) of the studied countries were inefficient (ϕ < 1.0) with respect to using health system resources toward achieving UHC. By improving health system efficiency, low-income, lower-middle-income, upper-middle-income, and high-income countries can improve their UHC indices by 4.6%, 5.5%, 6.8%, and 4.1%, respectively, by using their current resource levels. The percentage of health expenditure spent on primary health care (PHC), governance quality, and the passage of UHC legislation significantly influenced efficiency estimates. Our findings suggests health systems inefficiency toward achieving UHC persists across countries, regardless of their income classifications and WHO regions, as well as indicating that using current level of resources, most countries could boost their progress toward UHC by improving their health system efficiency by increasing investments in PHC, improving health system governance, and where applicable, enacting/implementing UHC legislation.https://doi.org/10.1177/00469580241235759 |
| spellingShingle | Paul Eze MPH Chidumebi Judith Idemili MSc Lucky Osaheni Lawani FWACS, MD Evaluating health systems’ efficiency towards universal health coverage: A data envelopment analysis Inquiry: The Journal of Health Care Organization, Provision, and Financing |
| title | Evaluating health systems’ efficiency towards universal health coverage: A data envelopment analysis |
| title_full | Evaluating health systems’ efficiency towards universal health coverage: A data envelopment analysis |
| title_fullStr | Evaluating health systems’ efficiency towards universal health coverage: A data envelopment analysis |
| title_full_unstemmed | Evaluating health systems’ efficiency towards universal health coverage: A data envelopment analysis |
| title_short | Evaluating health systems’ efficiency towards universal health coverage: A data envelopment analysis |
| title_sort | evaluating health systems efficiency towards universal health coverage a data envelopment analysis |
| url | https://doi.org/10.1177/00469580241235759 |
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