Title: The efficiency of healthcare spending in lower-middle-income countries: an empirical investigation using a two-stage data envelopment analysis approach

Authors: Israa A. El Husseiny

Addresses: Economics Department, Faculty of Economics and Political Science, Cairo University, Giza, 12613, Egypt

Abstract: This study examines the technical efficiency of healthcare systems and its determinants in a sample of 49 lower-middle-income countries using a "two-stage data envelopment analysis (DEA)" approach. The first stage of analysis indicates that the overall efficiency potential gains range from 2% under the output-oriented approach to 38.7% under the input-oriented approach. Among the examined countries, Algeria, Bangladesh, Lao PDR, Sri Lanka, Tunisia, and Vietnam have fully efficient healthcare systems under both orientations of efficiency. Sri Lanka and Bangladesh are the most referenced countries under the output-oriented and input-oriented approaches, respectively. In contrast, Nigeria and Micronesia have the least efficient healthcare systems under the output-oriented and input-oriented approaches, respectively. The second stage of analysis indicates that while GDP per capita, government health expenditure as percentage of total health expenditure, and population density tend to have a positive impact on health efficiency, unemployment seems to have a negative one.

Keywords: technical efficiency; healthcare systems; lower-middle-income countries; DEA; data envelopment analysis; health resources; health outputs; Tobit.

DOI: 10.1504/IJHTM.2021.119171

International Journal of Healthcare Technology and Management, 2021 Vol.18 No.3/4, pp.250 - 274

Received: 14 Nov 2020
Accepted: 08 Jun 2021

Published online: 26 Nov 2021 *

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