背景:政策制定者,他们不断讨论不断增长的医疗支出,应该知道卫生系统是否有效。我们可以通过国际卫生系统效率评估向他们提供此类信息。这项研究的主要目标是:(a)通过多标准决策分析(MCDA)和数据包络分析(DEA)评估28个发达国家的卫生系统效率,以及(b)确定合理的基准国家捷克共和国,为此,我们收集有关卫生系统输入和输出的相对重要性的信息。
方法:我们使用MCDA和DEA评估了28个发达国家的卫生系统的效率。这些模型包括四个卫生系统投入(卫生支出占GDP的相对份额,医生的数量,护士,和医院病床)和三个卫生系统输出(出生时的预期寿命,健康的预期寿命,和婴儿死亡率)。样本涵盖27个经合组织国家和俄罗斯,这也包括在经合组织的数据库中。要确定输入和输出权重,我们使用了一份发给捷克共和国卫生政策专家的问卷.
结果:我们从27位捷克卫生政策专家那里获得了有关卫生系统输入和输出的相对重要性的主观信息。我们使用四个MCDA和两个DEA模型评估了卫生系统效率。根据MCDA模型,土耳其,波兰,和以色列被发现有有效的卫生系统。捷克共和国排名第16位,19日,15th,和17号。捷克共和国卫生系统的基准国家是以色列,爱沙尼亚,卢森堡,意大利,英国,西班牙,斯洛文尼亚,和加拿大。具有恒定规模收益的DEA模型确定了四个技术有效的卫生系统:土耳其,英国,加拿大,和瑞典。捷克共和国被认为是表现最差的卫生系统之一。具有规模收益变量的DEA模型确定了15个技术有效的卫生系统。我们发现效率结果相当稳健。除了两个例外,每对模型之间的Spearman等级相关性在0.05水平上具有统计学意义.
结论:在模型制定过程中,我们调查了医疗保健中效率测量的陷阱,并使用了几种实用的解决方案。我们考虑MCDA和DEA,最重要的是,作为探索性方法,而不是提供明确答案的方法。
BACKGROUND: Policymakers, who are constantly discussing growing health expenditures, should know whether the health system is efficient. We can provide them with such information through international health system efficiency evaluations. The main objectives of this study are: (a) to evaluate the efficiency of health systems in 28 developed countries by multiple-criteria decision analysis (MCDA) and data envelopment analysis (DEA) and (b) to identify reasonable benchmark countries for the Czech Republic, for which we collect information on the relative importance of health system inputs and outputs.
METHODS: We used MCDA and DEA to evaluate the efficiency of the health systems of 28 developed countries. The models included four health system inputs (health expenditure as a relative share of GDP, the number of physicians, nurses, and hospital beds) and three health system outputs (life expectancy at birth, healthy life expectancy, and infant mortality rate). The sample covers 27
OECD countries and Russia, which is also included in the
OECD database. To determine the input and output weights, we used a questionnaire sent to health policy experts in the Czech Republic.
RESULTS: We obtained subjective information on the relative importance of the health system inputs and outputs from 27 Czech health policy experts. We evaluated health system efficiency using four MCDA and two DEA models. According to the MCDA models, Turkey, Poland, and Israel were found to have efficient health systems. The Czech Republic ranked 16th, 19th, 15th, and 17th. The benchmark countries for the Czech Republic\'s health system were Israel, Estonia, Luxembourg, Italy, the UK, Spain, Slovenia, and Canada. The DEA model with the constant returns to scale identified four technically efficient health systems: Turkey, the UK, Canada, and Sweden. The Czech Republic was found to be one of the worst-performing health systems. The DEA model with the variable returns to scale identified 15 technically efficient health systems. We found that efficiency results are quite robust. With two exceptions, the Spearman rank correlations between each pair of models were statistically significant at the 0.05 level.
CONCLUSIONS: During the model formulation, we investigated the pitfalls of efficiency measurement in health care and used several practical solutions. We consider MCDA and DEA, above all, as exploratory methods, not methods providing definitive answers.