Health system efficiency in OECD countries: dynamic network DEA approach

Dynamic network data envelopment analysis model with fuzzy inputs and outputs: An application for Iranian Airlines

Improving efficiency of health sector is of particular importance in all countries. To reach this end, it is paramount to measure the efficiency. On the other hand, there are many factors that affect the efficiency of health systems. This study aimed to measure the Technical Efficiency (TE) of health systems in Economic Cooperation Organization (ECO) countries during 2004-10 and to determine the factors affecting their TE. This was a descriptive-analytical and panel study. The required data were gathered using library and field studies, available statistics and international websites through completing data collection forms. In this study, the TE of health systems in 10 ECO countries was measured using their available data and Data Envelopment Analysis (DEA) through two approaches. The first approach used GDP per capita, education and smoking as its inputs and life expectancy and infant mortality rates as the outputs. The second approach, also, used the health expenditures per capita, the number of physicians per thousand people, and the number of hospital beds per thousand people as its inputs and life expectancy and under-5 mortality rates as the outputs. Then, the factors affecting the TE of health systems were determined using the panel data logit model. Excel 2010, Win4Deap 1.1.2 and Stata 11.0 were used to analyze the collected data. According to the first approach, the mean TE of health systems was 0.497 and based on the second one it was 0.563. Turkey and Turkmenistan had, respectively, the highest and lowest mean of efficiency. Also, the results of panel data logit model showed that only GDP per capita and health expenditures per capita had significant relationships with the TE of health systems. In order to maximize the TE of health systems, health policy-makers should pay special attention to the proper use of healthcare resources according to the people's needs, the appropriate management of the health system resources, allocating adequate budgets to the health sector, establishing an appropriate referral system to provide better public access to health services according to their income and needs, among many others.

Universalization of Access to Sanitation Services and the Efficiency of Brazilian Water and Sewage Utility Companies: A Dynamic Network Analysis

The objective of this paper is to assess the sustainability of supply chains by proposing a dynamic network data envelopment analysis (DNDEA) model in the presence of interval data, due to the fact that in many real-world applications, the condition of convexity in the production technology might be violated. To prevent this issue, a DNDEA model based on the free disposal hull (FDH) approach is developed. For the first time, this paper develops a DNDEA version of the free disposal hull (FDH) model in the context of the SCOR framework. It is also shown that this model always presents a finite efficiency score for assessing the sustainability of supply chains. Moreover, using this model, real benchmarks can be calculated to improve the sustainability of unsustainable supply chains. A case study in print industry is given. The results validate our proposed model.

Nested dynamic network data envelopment analysis models with infinitely many decision making units for portfolio evaluation

How can we make valid and useful comparisons of different health care systems?

Background: Gains in bank efficiency improvement have widely been regarded as one of the most effective and efficient means of ensuring sustainability of a financial system. Aim: This article proposes a relative dynamic two-stage network data envelopment analysis model for measurement of bank efficiency based on the slack-based measure. Setting: Twenty-seven banks in Ghana during the period of 2009–2014. Methods: By considering simultaneous processes within the framework of two-stage data envelopment analysis, the slack-based measure approach identifies the sources of inefficiency in the banks. Results: In the empirical analysis, non-performing loans are an undesirable output in one production process, which should also be treated as a carry-over factor; that is to say, some non-performing loans from the preceding year can be collected in the current year. The carry-over factors should be used to indicate the presence of performance gaps that exist in the banks. The proposed model was used to measure the efficiency of the 27 banks in Ghana during the period of 2009–2014. We also present useful suggestions for improvement in bank efficiency based on the empirical results. Conclusion: The 27 main commercial banks in Ghana are far from efficient. For all banks, the efficiency score in the second stage is much higher than that of the first stage. That means more attention should be paid to the first stage of production in order to increase the banks’ efficiency.

No abstract available.

Assessing the performance of water supply operations in Chinese water companies: A union dynamic multi-activity network data envelopment analysis

This study evaluates the circular economy performance of global chemical companies from 2013 to 2022, focusing on production efficiency and circular efficiency. Dynamic network Data Envelopment Analysis model is employed to assess the overall, production and circular performance of firms. Additionally, management decision matrix is presented, offering firms a clearer understanding of their efficiency levels and a detailed projection analysis on the optimization adjustments needed for both resource inputs and outputs. The findings reveal varying levels of overall efficiency among the observed firms. While some companies have managed to maintain or improve their efficiency over the study period, others exhibit significant inefficiencies. Opportunities for operational streamlining and resource optimization are identified, particularly in reducing resource consumption without compromising production capacity. The analysis of circular efficiency further highlights substantial potential for improving sustainability practices, particularly through enhanced waste reuse and a reduction in environmental impact. This study provides practical implication of circular economy performance in the chemical industry, offering a new way to measure and improve resource efficiency and sustainability practices.

Efficiency is the application of resources in a way that maximizes intended results. Policymakers around the world are prioritising health system efficiency as nations strive for universal health coverage. The study used the data envelopment analysis and the Tobit regression approach, the current study evaluated the technical efficiency of the health care system and its determinants. The study established that the average efficiency of the SADC countries is 78 percent signifying high levels of inefficiencies. Further the study found that the most efficient countries were Angola, Botswana, Eswatini, Mauritius, Mozambique, and Malawi. The number of practitioners i.e. physicians and nurses, primary school graduation rates, and national income all have a beneficial impact on the efficiency of the health system. The use of nitrous oxide in agriculture and vulnerable employment have a negative impact on technical efficiency. The study recommends that SADC countries should improve on resource use to improve on technical efficiency, train more doctors, nurses, and other medical professionals. Additionally, nations should implement pro-growth policies to boost revenue to capacitate their health systems with beds and other requisite equipment.

BackgroundHealth systems are complex, consisting of multiple interacting structures and actors whose effective coordination is paramount to enhancing health system goals. Health sector coordination is a potential source of inefficiency in the health sector. We examined how the coordination of the health sector affects health system efficiency in Kenya.MethodsWe conducted a qualitative cross-sectional study, collecting data at the national level and in two purposely selected counties in Kenya. We collected data using in-depth interviews (n = 37) with national and county-level respondents, and document reviews. We analyzed the data using a thematic approach.ResultsThe study found that while formal coordination structures exist in the Kenyan health system, duplication, fragmentation, and misalignment of health system functions and actor actions compromise the coordination of the health sector. These challenges were observed in both vertical (coordination within the ministry of health, within the county departments of health, and between the national ministry of health and the county department of health) and horizontal coordination mechanisms (coordination between the ministry of health or the county department of health and non-state partners, and coordination among county governments). These coordination challenges are likely to impact the efficiency of the Kenyan health system by increasing the transaction costs of health system functions. Inadequate coordination also impairs the implementation of health programmes and hence compromises health system performance.ConclusionThe efficiency of the Kenyan health system could be enhanced by strengthening the coordination of the Kenyan health sector. This can be achieved by aligning and harmonizing the intergovernmental and health sector-specific coordination mechanisms, strengthening the implementation of the Kenya health sector coordination framework at the county level, and enhancing donor coordination through common funding arrangements and integrating vertical disease programs with the rest of the health system. The ministry of health and county departments of health should also review internal organizational structures to enhance functional and role clarity of organizational units and staff, respectively. Finally, counties should consider initiating health sector coordination mechanisms between counties to reduce the fragmentation of health system functions across neighboring counties.

ObjectiveUniversal health coverage (UHC) is a major pathway to save many people from catastrophic and impoverishing healthcare spending and address the inequality in health and healthcare. The objective of this paper is to assess the efficiency with which health systems in sub-Saharan Africa (SSA) are utilizing healthcare resources to progress towards achieving the UHC goal by 2030.MethodsThe study followed the guidelines proposed by the World Health Organization (WHO) and World Bank joint UHC monitoring framework and the computational operationalization approach proposed by Wagstaff et al. (2015) to estimate the UHC index for each of the 30 selected SSA countries. The bootstrapping output-oriented data envelopment analysis (DEA) was used to estimate the bias-corrected technical efficiency scores and examine the environmental factors that influence health system efficiency.ResultsThe estimated UHC levels ranged from a minimum of 52% to a maximum of 81% (SD=8.6%) with a median coverage of 66%. The average bias-corrected efficiency score was 0.81 left(95% CI:0.77-0.85right). The study found that education, governance quality, public health spending, external health funding, and prepayment arrangements that pool funds for health had a positive significant effect on health system efficiency in improving UHC, while out-of-pocket payment had a negative impact.ConclusionThe results show that health systems in SSA can potentially enhance UHC levels by at least 19% with existing healthcare resources if best practices are adopted. Policymakers should aim at improving education, good governance, and healthcare financing architecture to reduce out-of-pocket payments and over-reliance on donor funding for healthcare to achieve UHC.

This study evaluates the operational and revenue generation efficiency of English Premier League (EPL) clubs from 2014/15 to 2023/24 using a novel Dynamic Network Data Envelopment Analysis (DNDEA) model under the Variable Returns to Scale (VRS) assumption. By integrating dynamic and network structures, the model decomposes club performance into sequential stages, specifically operational conversion and revenue generation, and traces the intertemporal transmission of economic, sporting, and social factors. Unlike traditional static DEA models that treat efficiency as time-invariant and “black-boxed”, the DNDEA model provides a temporal-diagnostic lens that detect shifts in efficiency trajectories and inter-stage feedback across seasons. Results reveal two enduring archetypes: high-performing clubs that achieve competitive outcomes with limited financial inputs through effective resource management, and financial giants that excel in revenue generation but struggle to translate investments into consistent sporting success. Dynamic analysis shows system efficiency peaked in 2014/15 before declining sharply in 2015/16 and 2018/19, respectively, driven by imbalances between escalating financial investments and stagnating on-field performance. Operational inefficiencies in Stage 1 (resource conversion) were more critical than those in Stage 2 (revenue generation), underscoring challenges in aligning short-term investments with long-term sustainability. The study advances sports analytics by providing a holistic framework for evaluating football club efficiency, emphasizing actionable strategies such as optimizing talent acquisition, prioritizing dual-return investments, and leveraging fan engagement.

Currently, there is a search for timely care and intervention on patients with dementia, which have reasonable costs and allow the sustainability and efficiency of national health and social care systems (Livingston et al., 2017). Cognitive interventions delivered in the patient's home can be an excellent alternative, due to their feasibility(Jang et al., 2021) and accessibility (Rai et al., 2021) to the intervention. The aim of this paper is to describe the evidence on cognitive intervention performed at home for patients with MCI and mild dementia. To describe its characteristics and outcomes, and to address its feasibility and usability. A systematic review was performed using the PRISMA recommendations. We reviewed 190 records from four databases: PubMed, CINAHL, Web of Science, and PsycInfo.The quality of the studies was assessed using the tool "Assessment (mERA) checklist7" (World Health Organization, 2016) RESULT: Ten papers were included. With a mean quality score of 0.76/1 (91.7% agreement). The sample contains (N = 777) patients (MA 75.9). 80% have an education >7 years. 87.1% have a diagnosis of mild dementia. There are (N = 628) caregivers (MA 64.8). Seventy percent (n = 440) are women. Positive results were found in: 71% of studies that looked for results on cognition. 66% of the studies that looked for results on mood and behavioral symptoms. 83% of studies that looked for results on functionality/quality of life. 100% of the studies that looked feasibility, and 75% of the studies that looked for results on the caregiver. Cognitive intervention in the home of patients with MCI and early dementia showed positive results at a cognitive, emotional and behavioral levels. Likewise, in the caregiving relationship, emotional health and quality of life of caregivers. The use of assistive technologies in the home has some benefits over face-to-face care. Outcome-cost ratio can be a cost-effective solution for the sustainability and efficiency of national health and social care systems.