With the healthcare sector accounting for a sizeable proportion of national expenditures, the pursuit of efficiency has become a central objective of policymakers within most health systems. However, the analysis and measurement of efficiency is a complex undertaking, not least due to the multiple objectives of health care organizations and the many gaps in information systems. In response to this complexity, research in organizational efficiency analysis has flourished. This 2006 book examines some of the most important techniques currently available to measure the efficiency of systems and organizations, including data envelopment analysis and stochastic frontier analysis, and also presents some promising new methodological approaches. Such techniques offer the prospect of many new and fruitful insights into health care performance. Nevertheless, they also pose many practical and methodological challenges. This is an important critical assessment of the strengths and limitations of efficiency analysis applied to health and health care.
• Examines the relevance of efficiency analysis to health care • Offers a constructive but critical perspective, often lacking in many efficiency analysis texts • Examines the implications for policy of using efficiency models
Figures; Tables; Preface; Acknowledgements; 1. Efficiency in health care; 2. The components of an efficiency model; 3. Stochastic frontier analysis of cross-sectional data; 4. Stochastic frontier analysis of panel data; 5. Data envelopment analysis; 6. The Malmquist Index; 7. A comparison of SFA and DEA; 8. Unresolved issues and challenges in efficiency measurement; 9. Some alternative approaches to measuring performance; 10. Conclusions; Appendix; References; Author index; Subject index; Acronyms.
'Many health efficiency researchers have locked themselves into becoming experts in a small set of methods, but this excellent book illustrates why everyone's toolkit needs to be more expansive to answer the policy questions at hand. And more importantly, it explains how to choose the right model for the right policy question.' James F. Burgess, Jr, Boston University School of Public Health
'The book is a valuable review of the state of the art in measuring efficiency in health care and it practical uses for policy. It is an essential reference guide for analysts and students alike. A major service provided by the authors has been to collate and review a large and growing theoretical and applied literature, providing an easy one-stop reference for analysts working in this area. The focus not just on methods, but also on practical policy implications, is invaluable to people seeking to improve the performance of health systems.' David B. Evans, Director of the Department of Health Systems Financing (HFS), World Health Organization
'A book covering the mechanics and practice of efficiency measurement in health and health care is long overdue, with several hundred applications now published in this area. The authors are world leaders in this field and cover all the appropriate areas, from basic to complex techniques, through to practical applications. Their book will be of use to all those interested, at whatever level, in performance measurement in health service provision, as it clearly points out the advantages and pitfalls (an important point) of implementing such analyses. I highly recommend this text.' Bruce Hollingsworth, Centre for Health Economics, Monash University, Melbourne, Australia
'This introduction to the practice of measuring efficiency in health care is accessible to non-economists as well as to economists. Earlier textbooks on efficiency have not focused on health care organisations. Thus, an important feature of the book is the inclusion of practical examples and solutions related to empirical measurement of efficiency in a complex and unique sector. It is of great value to policymakers, administrators and researchers who wish to understand how to measure and analyze the performance of health care organisations.' Unto Häkkinen, Centre for Health Economics at Stakes (CHESS), Helsinki
' … the most important techniques currently available to measure the efficiency of systems and organizations …' International Social Security Review