A conditional nonparametric analysis for measuring the efficiency of regional public healthcare delivery: An application to Greek prefectures

Abstract

Objectives: The purpose of this study is to measure the Greek public healthcare delivery efficiency from a regional perspective by applying conditional nonparametric models. Methods: The study reviews the existing literature on performance measurement and proposes models on these grounds. By using data envelopment analysis (DEA) and free disposal hull (FDH) models, the performance of public health delivery services of the Greek prefectures is evaluated. The efficiency levels of the Greek prefectures are compared and analyzed in a regional context. By using convex and non-convex models alongside with bootstrap techniques and conditional full frontier applications the paper develops models for regional public health delivery policy evaluation. Results: The paper shows that higher levels of GDP per capita (GDPc) have a negative influence on the efficiency of regional healthcare delivery, indicating that regional economic growth does not ensure better healthcare delivery service. Furthermore the results reveal that population density increases the prefectures' efficiency of public health provision, indicating the over-supply of health services by urban hospitals. Finally, several healthcare delivery inefficiencies have been reported among the Greek prefectures emphasizing a poor state of healthcare delivery. Conclusions: The results indicate that after the reform of the Greek national healthcare system in 2000-2002, the absence of a unified healthcare policy was accompanied with misallocation of healthcare resources among the Greek prefectures creating socioeconomic health inequalities. (C) 2010 Elsevier Ireland Ltd. All rights reserved.