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Healthcare policy tools as determinants of health-system efficiency: evidence from the OECD

Published online by Cambridge University Press:  12 December 2011

Dominika Wranik
Dominika Wranik*
Affiliation:
School of Public Administration, Faculty of Management, Dalhousie University, Halifax, Nova Scotia, Canada
*
*Correspondence to: Dr Dominika Wranik, School of Public Administration, Faculty of Management, Dalhousie University, 6100 University Avenue, 3012 Rowe Building, Halifax, Nova Scotia, Canada B3H3N4. E-mail: [email protected]
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Abstract

This paper assesses which policy-relevant characteristics of a healthcare system contribute to health-system efficiency. Health-system efficiency is measured using the stochastic frontier approach. Characteristics of the health system are included as determinants of efficiency. Data from 21 OECD countries from 1970 to 2008 are analysed. Results indicate that broader health-system structures, such as Beveridgian or Bismarckian financing arrangements or gatekeeping, are not significant determinants of efficiency. Significant contributors to efficiency are policy instruments that directly target patient behaviours, such as insurance coverage and cost sharing, and those that directly target physician behaviours, such as physician payment methods. From the perspective of the policymaker, changes in cost-sharing arrangements or physician remuneration are politically easier to implement than changes to the foundational financing structure of the system.

Type
Articles
Information
Health Economics, Policy and Law , Volume 7 , Issue 2 , 02 March 2012 , pp. 197 - 226
Copyright
Copyright © Cambridge University Press 2011

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References

Anand, S.Hanson, K. (1997), ‘Disability-adjusted life years: a critical review’, Journal of Health Economics, 16: 685–702.CrossRefGoogle ScholarPubMed
Anell, A. (2005), ‘Swedish healthcare under pressure’, Health Economics, 14: S237–S254.CrossRefGoogle ScholarPubMed
Akaho, E., Coffin, G. D., Kusano, T., Locke, L.Okamoto, T. (1998), ‘A proposed optimal health care system based on a comparative study conducted between Canada and Japan’, Canadian Journal of Public Health, 89: 301–307.CrossRefGoogle ScholarPubMed
Arnesen, T.Nord, E. (1999), ‘The value of DALY life: problems with ethics and validity of disability adjusted life years’, British Medical Journal, 319: 1423–1425.CrossRefGoogle ScholarPubMed
Ashton, T.Tenbensel, T. (2010), ‘Reform and re-reform of the New Zealand System’, in K. Okma and L. Crivelli (eds), Six Countries, Six Reform Models: The Healthcare Reform Experience of Israel, The Netherlands, New Zealand, Singapore, Switzerland and Taiwan, World Scientific.Google Scholar
Ashton, T., Cumming, J.McLean, J. (2004), ‘Contracting for health services in a public health system: the New Zealand experience’, Health Policy, 69: 21–31.CrossRefGoogle Scholar
Barros, P. P. (1998), ‘The black box of health care expenditure growth determinants’, Health Economics, 7: 533–544.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
Battese, G. E.Coelli, T. J. (1995), ‘A model for technical inefficiency effects in a stochastic frontier production function for panel data’, Empirical Economics, 20: 325–332.CrossRefGoogle Scholar
Bellanger, M. M.Mosse, P. R. (2005), ‘The search for the Holy Grail: combining decentralized planning and contracting mechanisms in the French health care system’, Health Economics, 14, Supplement: S119–S132.CrossRefGoogle ScholarPubMed
Berger, M. C.Messer, J. (2002), ‘Public financing of health expenditures, insurance, and health outcomes’, Applied Economics, 34: 2105–2113.CrossRefGoogle Scholar
Bhat, N. V. (2005), ‘Institutional arrangements and efficiency of health care delivery systems’, European Journal of Health Economics, 50: 215–222.CrossRefGoogle Scholar
Bolin, K., Lindgren, A., Lindgren, B.Lundborg, B. (2009), ‘Utilization of physician services in the 50+ population: the relative importance of individual versus institutional factors in 10 European countries’, International Journal of Health Care Finance and Economics, 9(1): 83–112.CrossRefGoogle ScholarPubMed
Coelli, T. J., Rao, D. S. P., O'Donnell, C. J.Battese, G. E. (2005), An Introduction to Efficiency and Productivity Analysis, Second Edition, New York, NY: Springer.Google Scholar
Cremieux, P., Ouellette, P.Pilon, C. (1999), ‘Health care spending as determinants of health outcomes’, Health Economics, 8: 627–639.3.0.CO;2-8>CrossRefGoogle ScholarPubMed
Custers, T., Arah, O. A.Klazinga, N. S. (2007), ‘Is there a business case for quality in the Netherlands? A critical analysis of the recent reforms of the health care system’, Health Policy, 82: 226–239.CrossRefGoogle Scholar
Delnoij, D., Van Merode, G., Paulus, A.Groenewegen, P. (2000), ‘Does general practitioner gatekeeping curb health care expenditure?’, Journal of Health Services Research and Policy, 79: 375–398.Google Scholar
Ellison, G. T. (2002), ‘Letting the GINI out of the bottle? Challenges facing the relative income hypothesis’, Social Science and Medicine, 54: 561–576.CrossRefGoogle ScholarPubMed
Evans, D. B., Tandon, A., Murray, C. J. L., Lauer, J. A. (2000), ‘The comparative efficiency of national health systems in producing health: an analysis of 191 countries’, GPE Discussion Paper Series no. 29, Geneva, Switzerland: World Health Organization.Google Scholar
France, G., Taroni, F.Donatini, A. (2005), ‘The Italian health-care system’, Health Economics, 14, Supplement: S187–S202.CrossRefGoogle ScholarPubMed
Garcia Marinoso, B.Jelovac, I. (2003), ‘GPs payment contracts and their referral practice’, Journal of Health Economics, 842: 1–19.Google Scholar
Gauld, R., Ikegami, N., Barr, M. D., Chiang, T.-L., Gould, D.Kwon, S. (2006), ‘Advanced Asia's health systems in comparison’, Health Policy, 79: 325–336.CrossRefGoogle ScholarPubMed
Gerdtham, U.-G.Lothgren, M. (2002), ‘New panel results on co-integration of international health expenditure and GDP’, Applied Economics, 34: 1679–1686.CrossRefGoogle Scholar
Gerdtham, U.-G.Lothgren, M. (2001), ‘Health system effects on cost-efficiency in OECD countries’, Applied Economics, 33: 643–647.CrossRefGoogle Scholar
Gerdtham, U.-G., Jonsson, B., MacFarlan, M.Oxley, H. (1998), ‘The determinants of health care expenditure in the OECD countries: a pooled analysis’, in P. Zweifel (ed.), Health, the Medical Profession and Regulation, Dordrecht: Kluwer Academic Publishers, 113–134.CrossRefGoogle Scholar
Gerdtham, U.-G., Scgaard, J., Andersson, F.Jonsson, B. (1992), ‘Econometric analysis of health expenditure: a cross-sectional study of the OECD countries’, Journal of Health Economics, 11: 63–84.CrossRefGoogle Scholar
Glied, S. (2009), ‘Single payer as a financing mechanism’, Journal of Health Politics, Policy and Law, 34(4): 593–615.CrossRefGoogle ScholarPubMed
Gonzales, P. (2009), ‘Gatekeeping versus direct-access when patient information matters’, Health Economics, 19(6): 730–754.CrossRefGoogle Scholar
Gravelle, H. (1998), ‘How much of the relation between population mortality and unequal distribution of income is a statistical artifact?’, British Medical Journal, 316: 382–385.CrossRefGoogle Scholar
Gravelle, H., Jacobs, R., Jones, A. M.Street, A. (2003), ‘Comparing the efficiency of national health systems: a sensitivity analysis of the WHO approach’, Applied Health Economics and Health Policy, 2(3): 141–147.Google ScholarPubMed
Greene, W. (2003), Econometric Analysis, Fifth Edition, Upper Saddle River, NJ: Prentice Hall.Google Scholar
Greene, W. (2004), ‘Distinguishing between heterogeneity and inefficiency: stochastic frontier analysis of the World health Organization's panel data on national health care systems’, Health Economics, 13: 959–980.CrossRefGoogle ScholarPubMed
Greene, W. (2007a), LIMDEP Version 9.0, New York, NY: Econometric Software Inc., ESI.Google Scholar
Greene, W. (2007b), ‘Econometric Modeling Guide and Reference Guide’, LimDep Econometric Software Manuals, E24: E24-1–E24-45.Google Scholar
Grignon, M. (2008), ‘The role of education in health system performance’, Economic Education Revies, 27: 299–307.CrossRefGoogle Scholar
Gusmano, M. K., Weisz, D.Rodwin, V. G. (2009), ‘Achieving horizontal equity: must we have a single-payer health system?’, Journal of Health Politics, Policy and Law, 34(4): 617–633.CrossRefGoogle ScholarPubMed
Hakkinen, U. (2005), ‘The impact of changes in Finland's health care system’, Health Economics, 14, Supplement: S101–S118.CrossRefGoogle ScholarPubMed
Hansen, P.King, A. (1996), ‘The determinants of health care expenditure: a cointegration approach’, Journal of Health Economics, 15: 127–137.CrossRefGoogle ScholarPubMed
Hitiris, T.Posnett, J. (1992), ‘The determinants and effects of health expenditure in developed countries’, Journal of Health Economics, 11: 173–181.CrossRefGoogle ScholarPubMed
Hollingsworth, B., Peacock, S. (2008), ‘Efficiency measurement in health and health care’, Routledge International Studies in Health Economics, Routledge, UK, 82–134.CrossRefGoogle Scholar
Hollingsworth, B.Wildman, J. (2003), ‘The efficiency of health production: re-estimating the WHO panel data using parametric and nonparametric approaches to provide additional information’, Health Economics, 12: 493–504.CrossRefGoogle ScholarPubMed
Hurst, J. (1992), The Reform of Health Care: A Comparative Analysis of Seven OECD Countries. Health Policy Studies, volume 2, Paris: OECD (as cited in Gerdthan and Lothgren 2001, Gerdtham 1998, Bhat 2005).Google Scholar
Hussey, P.Anderson, G. F. (2003), ‘A comparison of single- and multi-payer health insurance systems and options for reform’, Health Policy, 66: 215–228.CrossRefGoogle ScholarPubMed
Jegers, M., Kesteloot, K., De Greave, D.Gilles, W. (2002), ‘A typology for provider payment systems in health care’, Health Policy, 60: 255–273.CrossRefGoogle ScholarPubMed
Joumard, I., Andre, C., Nicq, C. (2010), ‘Health care systems: efficiency and institutions’, OECD Economics Department Working Papers no. 769. OECD Publishing; doi:10.1787/5kmfp51f5f9t-en.CrossRefGoogle Scholar
Joumard, I., Andre, C., Ninq, C., Chatal, O. (2008), ‘Health status determinants: lifestyle, environment, health care resources and efficiency’, OECD Economics Department Working Paper no. 627. OECD Publishing; doi:10.1787/240858500130.CrossRefGoogle Scholar
Kawachi, I.Kennedy, B. P. (1999), ‘Income inequality and health: pathways and mechanisms’, Health Services Research, 34: 215–227.Google ScholarPubMed
Kawachi, I.Kennedy, B. P. (1997), ‘Health and social cohesion: why care about income inequality?’, British Medical Journal, 314: 1037–1040.CrossRefGoogle ScholarPubMed
Kumbhakar, S.Orea, L. (2002), Efficiency Measurement Using Stochastic Frontier Latent Class Models. Efficiency Series Papers, University of Oviedo, Oviedo, Spain.Google Scholar
Kutzin, J. (2001), ‘A descriptive framework for country-level analysis of health care financing arrangements’, Health Policy, 56(3): 171–204.CrossRefGoogle ScholarPubMed
Lopez-Casanovas, G., Costa-Font, J.Planas, I. (2005), ‘Diversity and regional inequalities in the Spanish “system of health care services” ’, Health Economics, 14, Supplement: S221–S235.CrossRefGoogle Scholar
Lorgelly, P.Lindley, J. (2008), ‘What is the relationship between income inequality and health? Evidence from the BHPS’, Health Economics, 17: 249–265.CrossRefGoogle ScholarPubMed
Mossialos, E., Allin, S.Davaki, K. (2005), ‘Analysing the Greek health system: A tale of fragmentation and inertia’, Health Economics, 14, Supplement: S151–S168.CrossRefGoogle ScholarPubMed
Navarro, V. (2000), ‘Assessment of the World Health Report 2000’, The Lancet, 356: 1598–1601.CrossRefGoogle ScholarPubMed
Nixon, J.Ulmann, P. (2006), ‘The relationship between health care expenditure and health outcomes’, European Journal of Health Economics, 7: 7–18.CrossRefGoogle ScholarPubMed
Newhouse, J. (1977), ‘Medical-care expenditure: a cross-national survey’, The Journal of Human Resources, 12: 115–125.CrossRefGoogle ScholarPubMed
Newhouse, J. (1994), ‘Frontier estimation: how useful a tool for health economists?’, Journal of Health Economics, 13(3): 317–322.CrossRefGoogle Scholar
Oliveira, M. D.Bevan, G. (2003), ‘Measuring geographic inequities in the Portugese health care system: an estimation of hospital care needs’, Health Policy, 66: 277–293.CrossRefGoogle Scholar
Oliver, A. (2005), ‘The English National Health Service: 1979–2005’, Health Economics, 14, Supplement: S75–S99.CrossRefGoogle ScholarPubMed
Or, Z. (2001), ‘Exploring the effects of health care on mortality across OECD countries’, OECD Labour and Social Policy Occasional Papers no. 46, OECD Publishing.Google Scholar
Or, Z., Wang, J.Jamison, D. (2005), ‘International differences in the impact of doctors on health: a multilevel analysis of OECD countries’, Journal of Health Economics, 24: 531–560.CrossRefGoogle Scholar
Pedersen, K. M. (2002), ‘The World Health Report 2000: dialogue of the deaf?’, Health Economics, 11: 93–101.CrossRefGoogle ScholarPubMed
Pitt, M.Lee, L. (1981), ‘The measurement and sources of technical inefficiency in Indonesian weaving industry’, Journal of Development Economics, 9: 43–64.CrossRefGoogle Scholar
Richardson, J., Wildman, J.Robertson, I. K. (2003), ‘A critique of the World Health Organization's evaluation of health system performance’, Health Economics, 12: 355–366.CrossRefGoogle ScholarPubMed
Roberts, J. (1999), ‘Sensitivity of elasticity estimates for OECD health care spending: analysis of a dynamic heterogeneous data field’, Health Economics, 8: 459–472.3.0.CO;2-U>CrossRefGoogle ScholarPubMed
Ruhm, C. J. (2000), ‘Are recessions good for your health’, The Quarterly Journal of Economics, 115(2): 617–650.CrossRefGoogle Scholar
Schmidt, P.Sickles, R. (1984), ‘Production frontiers with panel data’, Journal of Business Economics and Statistics, 2: 367–374.CrossRefGoogle Scholar
Schokkaert, E.Van de Voorde, C. (2005), ‘Health care reform in Belgium’, Health Economics, 14, Supplement: S25–S39.CrossRefGoogle ScholarPubMed
Self, S.Grabowski, R. (2003), ‘How effective is public health expenditure in improving overall health? A cross-country analysis’, Applied Economics, 35: 835–845.CrossRefGoogle Scholar
Simar, L.Wilson, P. W. (2007), ‘Estimation and inference in two-stage, semi-parametric models of production processes’, Journal of Econometrics, 136: 31–64.CrossRefGoogle Scholar
Spinks, J.Hollingsworth, B. (2009), ‘Cross-country comparisons of technical efficiency of health production: a demonstration of pitfalls’, Applied Economics, 41: 417–427.CrossRefGoogle Scholar
Street, A. (2003), ‘How much confidence should we place in efficiency estimates?’, Health Economics, 12: 895–902.CrossRefGoogle ScholarPubMed
Tandon, A., Murray, C. J. L., Lauer, J. A., Evans, D. B. (2001), ‘Measuring overall health system performance for 191 countries’. GPE Discussion Paper Series no. 30, Geneva, Switzerland: World Health Organization.Google Scholar
Thomson, S., Foubiser, T.Mossialos, E. (2010), ‘Can user charges make health care more efficient?’, British Medical Journal, 341: 487–489.CrossRefGoogle ScholarPubMed
Tountas, Y., Karnaki, P.Pavi, E. (2002), ‘Reforming the reform: the Greek national health system in transition’, Health Policy, 62: 15–29.CrossRefGoogle ScholarPubMed
Van den Noord, P., Hagen, T., Iversen, T. (1998), ‘The Norwegian health care system’, OECD Economics Department Working Paper no. 198, OECD Publishing, http://dx.doi.org/10.1787/571585217086.CrossRefGoogle Scholar
Vuong, Q. (1989), ‘Likelihood ratio tests for model selection and non-nested hypotheses’, Econometrica, 57: 307–334.CrossRefGoogle Scholar
Wagner, T., Heisler, M.Piette, J. (2008), ‘Prescription drug co-payments and cost-related medication underuse’, Health Economics, Policy and Law, 3(1): 51–67.CrossRefGoogle ScholarPubMed
Wagstaff, A.van Doorslaer, E. (2000), ‘Income inequality and health: what does the literature tell us?’, Annual Review of Public Health, 21: 543–567.CrossRefGoogle ScholarPubMed
Weale, A.Clark, S. (2010), ‘Co-payments in the NHS: An analysis of the normative arguments’, Health Economics, Policy and Law, 5(2): 225–246.CrossRefGoogle ScholarPubMed
Wildman, J., Gravelle, H.Sutton, M. (2003), ‘Health and income inequality: attempting to avoid the aggregation problem’, Applied Economics, 35: 999–1004.CrossRefGoogle Scholar
Wiley, M. M. (2005), ‘The Irish health system: developments in strategy, structure, funding and delivery since 1980’, Health Economics, 14, Supplement: S169–S186.CrossRefGoogle ScholarPubMed
Wilkinson, R. G.Pickett, K. E. (2006), ‘Income inequality and population health: a review and explanation of the evidence’, Social Science and Medicine, 62: 1768–1784.CrossRefGoogle ScholarPubMed
Wranik, D.Durier-Copp, M. (2010), ‘Physician remuneration methods for family physicians in Canada: expected outcomes and lessons learned’, Health Care Analysis, 18: 35–59.CrossRefGoogle ScholarPubMed