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An examination of health care efficiency in Canada: a two-stage semi-parametric approach

Published online by Cambridge University Press:  03 June 2024

Barry Watson Open the ORCID record for Barry Watson [Opens in a new window]  and
Gholam R. Amin Open the ORCID record for Gholam R. Amin [Opens in a new window]
Barry Watson*
Affiliation:
Faculty of Business, University of New Brunswick, 100 Tucker Park Road, PO Box 5050, Saint John, New Brunswick, E2L 4L5, Canada
Gholam R. Amin
Affiliation:
Faculty of Business, University of New Brunswick, 100 Tucker Park Road, PO Box 5050, Saint John, New Brunswick, E2L 4L5, Canada
*
Corresponding author: Barry Watson; Email: bwatson@unb.ca
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Abstract

Using data envelopment analysis, we examine the efficiency of Canada's universal health care system by considering a set of labour (physicians) and capital (beds) inputs, which produce a level of care (measured in terms of health quality and quantity) in a given region. Data from 2013–2015 were collected from the Canadian Institute for Health Information regarding inputs and from the Canadian Community Health Survey and Statistics Canada regarding our output variables, health utility (quality) and life expectancy (quantity). We posit that variation in efficiency scores across Canada is the result of regional heterogeneity regarding socioeconomic and demographic disparities. Regressing efficiency scores on such covariates suggests that regional unemployment and an older population are quite impactful and associated with less efficient health care production. Moreover, regional variation indicates the Atlantic provinces (Newfoundland, Prince Edward Island, Nova Scotia, New Brunswick) are quite inefficient, have poorer economic prospects, and tend to have an older population than the rest of Canada. Oaxaca-Blinder decompositions suggest that the latter two factors explain about one-third of this efficiency gap. Based on our two-stage semi-parametric analysis, we recommend Canada adjust their transfer payments to reflect these disparities, thereby potentially reducing inequality in regional efficiency.

Keywords

health careefficiencydata envelopment analysisdecompositionCanadaH51I11I14
Type
Article
Information
Health Economics, Policy and Law , First View , pp. 1 - 20
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Copyright
Copyright © The Author(s), 2024. Published by Cambridge University Press

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References

Afonso, A and St. Aubyn, M (2011) Assessing health efficiency across countries with a two-step and bootstrap analysis. Applied Economic Letters 18, 1427–1430.CrossRefGoogle Scholar
Afonso, GP, Ferreira, DC and Figueira, JR (2023) A network-DEA model to evaluate the impact of quality and access on hospital performance. Annals of Operations Research, 1–31.Google ScholarPubMed
Aletras, V, Kontodimopoulos, N, Zagouldoudis, A and Niaka, D (2007) The short-term effect on technical and scale efficiency of establishing regional health systems and general management in Greek NHS hospitals. Health Policy 83, 236–245.CrossRefGoogle ScholarPubMed
Allin, S, Grignon, M and Wang, L (2016) The determinants of efficiency in the Canadian health care system. Health Economics, Policy and Law 11, 39–65.CrossRefGoogle ScholarPubMed
Asakawa, K, Feeny, D, Senthilselvan, A, Johnson, J and Rolfson, D (2009) Do the determinants of health differ between people living in the community and in institutions? Social Science & Medicine 69, 345–353.CrossRefGoogle ScholarPubMed
Asandului, L, Roman, M and Fatulescu, P (2014) The efficiency of healthcare systems in Europe: a data envelopment analysis approach. Procedia Economics and Finance 10, 261–268.CrossRefGoogle Scholar
Athanassopoulos, A and Gounaris, C (2001) Assessing the technical and allocative efficiency of hospital operations in Greece and its resource allocation implications. European Journal of Operation Research 133, 416–431.CrossRefGoogle Scholar
Badunenko, O and Mozharovskyi, P (2016) Nonparametric frontier analysis using stata. The Stata Journal 16, 550–589.CrossRefGoogle Scholar
Bahari, A and Emrouznejad, A (2014) Influential DMUs and outlier detection in data envelopment analysis with an application to health care. Annals of Operations Research 223, 95–108.CrossRefGoogle Scholar
Banker, R, Charnes, A and Cooper, W (1984) Some models for estimating technical and scale inefficiencies in data envelopment analysis. Management Science 30, 1078–1092.CrossRefGoogle Scholar
Barua, B and Moir, M (2019) Waiting Your Turn: Wait Times for Health Care in Canada. Vancouver, BC: The Fraser Institute.Google Scholar
Beland, D and Tombe, T (2023) Reforming Canada's federal health-care funding arrangements. Canadian Public Administration 66, 28–44.CrossRefGoogle Scholar
Blinder, A (1973) Wage discrimination: reduced form and structural estimates. Journal of Human Resources 8, 436–455.CrossRefGoogle Scholar
Canadian Institute for Health Information (2010) Have Health Card, Will Travel: Out-of-Province/Territory Patients. Analysis in Brief.Google Scholar
Charnes, A, Cooper, W and Rhodes, E (1978) Measuring the efficiency of decision making units. European Journal of Operational Research 2, 429–444.CrossRefGoogle Scholar
Chowdhury, H and Zelenyuk, V (2016) Performance of hospital services in Ontario: DEA with truncated regression approach. Omega 63, 111–122.CrossRefGoogle Scholar
Chowdhury, H, Zelenyuk, V, Laporte, A and Wodchis, W (2014) Analysis of productivity, efficiency and technological changes in hospital services in Ontario: how does case-mix matter? International Journal of Production Economics 150, 74–82.CrossRefGoogle Scholar
Chuang, C, Change, P and Lin, R (2011) An efficiency data envelope analysis model reinforced by classification and regress tree for hospital performance evaluation. Journal of Medical Systems 35, 1075–1983.CrossRefGoogle Scholar
Cooper, W, Seiford, L and Tone, K (2007) Introduction to Data Envelopment Analysis and its Uses: With DEA-Solver Software and References. New York, USA: Springer.Google Scholar
Cotton, J (1988) On the decomposition of wage differentials. Review of Economics and Statistics 70, 236–243.CrossRefGoogle Scholar
Dario, C, Simar, L and Wilson, P (2018) Central limit theorems for conditional efficiency measures and tests of the ‘separability’ condition in non-parametric, two stage models of production. The Journal of Econometrics 21, 170–191.CrossRefGoogle Scholar
De Nicola, A, Gitto, S and Mancuso, P (2013) Evaluating Italian public hospital efficiency using bootstrap DEA and CART. International Journal of Applied Decision Sciences 6, 281–292.CrossRefGoogle Scholar
Denton, M and Walters, V (1999) Gender differences in structural and behavioral determinants of health: an analysis of the social production of health. Social Science & Medicine 48, 1221–1235.CrossRefGoogle ScholarPubMed
Di Matteo, L (2017) Winners and losers in the changing world of the Canada Health Transfer. The Hill Times.Google Scholar
Dorling, D (2009) Unemployment and health. BMJ 338, b829.CrossRefGoogle ScholarPubMed
Drummond, M (2001) Introducing economic and quality of life measurements into clinical studies. Annals of Medicine 33, 344–349.CrossRefGoogle ScholarPubMed
Dyson, R, Allen, R, Camanho, A, Podinovski, V, Sarrico, C and Shale, E (2001) Pitfalls and protocols in DEA. European Journal of Operational Research 132, 245–259.CrossRefGoogle Scholar
Emrouznejad, A and Yang, G (2018) A survey and analysis of the first 40 years of scholarly literature in DEA. Socio-Economic Planning Sciences 61, 4–8.CrossRefGoogle Scholar
Esmail, N and Wrona, D (2008) Medical Technology in Canada. Vancouver, BC: The Fraser Institute.Google Scholar
Flokou, A, Kontodimopoulos, N and Niaka, D (2011) Employing post-DEA cross-evaluation and cluster analysis in a sample of Greek NHS hospitals. Journal of Medical Systems 35, 1–14.CrossRefGoogle Scholar
Fortin, N (2008) The gender wage gap among young adults in the United States: the importance of money vs. people. The Journal of Human Resources 43, 886–920.CrossRefGoogle Scholar
Fortin, N, Lemieux, T and Firpo, S (2011) Handbook of Labor Economics, 4th Edition, Chapter Decomposition Methods in Economics. North Holland: Elsevier.Google Scholar
Garcia-Lacalle, J and Martin, E (2010) Rural vs urban hospital performance in a ‘competitive’ public health service. Social Science & Medicine 71, 1131–1140.CrossRefGoogle Scholar
Gearhart, R and Michieka, N (2018) A comparison of the robust conditional order-m estimation and two stage DEA in measuring healthcare efficiency among California counties. Economic Modelling 73, 395–406.CrossRefGoogle Scholar
Grootendorst, P, Feeny, D and Furlong, W (2000) Health utilities index mark 3 evidence of construct validity for stroke and arthritis in a population health survey. Medical Care 38, 290–299.CrossRefGoogle Scholar
Halliday, TJ (2014) Unemployment and mortality: evidence from the PSID. Social Science & Medicine 113, 15–22.CrossRefGoogle ScholarPubMed
Horsman, J, Furlong, W, Feeny, D and Torrance, G (2003) The health utilities index (HUI): concepts, measurement properties and applications. Health and Quality of Life Outcomes 1, 1–13.CrossRefGoogle ScholarPubMed
Jann, B (2019) The Blinder-Oaxaca decomposition for linear regression modes. The Stata Journal 8, 453–479.CrossRefGoogle Scholar
Khushalani, J and Ozcan, Y (2017) Are hospitals producing quality care efficiently? An analysis using dynamic network data envelopment analysis (DEA). Socio-Economic Planning Sciences 60, 15–23.CrossRefGoogle Scholar
Kohl, S, Schoenfelder, J, Fügener, A and Brunner, J (2019) The use of data envelopment analysis (DEA) in healthcare with a focus on hospitals. Health Care Management Science 22, 245–286.CrossRefGoogle ScholarPubMed
Kopec, J, Williams, J, To, T and Austin, P (2000) Measuring population health: correlates of the health utilities Index among English and French Canadians. Canadian Journal of Public Health 91, 465–470.CrossRefGoogle ScholarPubMed
Lavergne, M and Kephart, G (2012) Examining variations in health within rural Canada. Rural and Remote Health 12, 34–46.Google ScholarPubMed
Law, S, Haghiri, M and Nolan, J (2010) Determining the relative efficiency of cancer treatments in Nova Scotia using the patient as the unit of analysis. The Canadian Journal of Regional Science 33, 163–176.Google Scholar
Lewis, HF and Sexton, TR (2004) Network DEA: efficiency analysis of organizations with complex internal structure. Computers & Operations Research 31, 1365–1410.CrossRefGoogle Scholar
Li, Y, Lei, X and Morton, A (2019) Performance evaluation of nonhomogeneous hospitals: the case of Hong Kong hospitals. Health Care Management Science 22, 215–228.CrossRefGoogle ScholarPubMed
Liu, J, Lu, L, Lu, W and Lin, B (2013) Data envelopment analysis 1978–2010: a citation-based literature survey. Omega 41, 3–15.CrossRefGoogle Scholar
Marchildon, G and Mou, H (2013) How Ottawa Spends, 2013–2014: The Harper Government: Mid-Term Blues and Long-Term Plans, Chapter The Conservative 10-Year Canada Health Transfer Plan: Another Fix for a Generation? Ottawa, ON: McGill-Queen's University Press.CrossRefGoogle Scholar
Marchildon, G and Mou, H (2014) A needs-based allocation formula for Canada health transfer. Canadian Public Policy 40, 209–223.CrossRefGoogle Scholar
Marques, R and Carvalho, P (2013) Estimating the efficiency of Portuguese hospitals using an appropriate production technology. International Transactions in Operational Research 20, 233–249.CrossRefGoogle Scholar
McIntyre, L, Kwok, C, Emery, J and Dutton, D (2016) Impact of a guaranteed annual income program on Canadian seniors’ physical, mental and functional health. Canadian Journal of Public Health 107, e176–e182.CrossRefGoogle ScholarPubMed
McKee-Ryan, F, Song, Z, Wanberg, CR and Kinicki, AJ (2005) Psychological and physical well-being during unemployment: a meta-analytic study. Journal of Applied Psychology 90, 53–76.CrossRefGoogle ScholarPubMed
Molina, M, Humphries, B, Guertin, J, Feeny, D and Tarride, J (2023) Health utilities index mark 3 scores for children and youth: population norms for Canada based on cycles 5 (2016 and 2017) and 6 (2018 and 2019) of the Canadian health measures survey. Health Reports 34, 29–39.Google ScholarPubMed
Mou, H (2021) What Now? Canada Health Transfer: Background and Future. Calgary, AB: Canada West Foundation.Google Scholar
Neumark, D (1988) Employers’ discriminatory behaviour and the estimation of wage discrimination. Journal of Human Resources 23, 279–295.CrossRefGoogle Scholar
Newbold, K and Danforth, J (2003) Health status and Canada's immigrant population. Social Science & Medicine 57, 1981–1995.CrossRefGoogle ScholarPubMed
Oaxaca, R (1973) Male-female wage differentials in urban labor markets. International Economic Review 14, 693–709.CrossRefGoogle Scholar
Oaxaca, R and Ransom, M (1994) On discrimination and the decomposition of wage differentials. Journal of Econometrics 61, 5–21.CrossRefGoogle Scholar
Patrick, D and Erickson, P (1993) Health Status and Health Policy: Quality of Life in Health Care Evaluation and Resource Allocation. New York, NY: Oxford University Press.Google Scholar
Podinovski, VV (2021) Variable and constant returns-to-scale production technologies with component processes. Operations Research 70, 1238–1258.CrossRefGoogle Scholar
Reimers, C (1983) Labor market discrimination against Hispanic and Black men. Review of Economics and Statistics 65, 570–579.CrossRefGoogle Scholar
Sherman, H and Zhu, J (2006) Service Productivity Management: Improving Service Performance Using Data Envelopment Analysis (DEA). New York, USA: Springer.CrossRefGoogle Scholar
Simar, L and Wilson, P (2002) Non-parametric tests of returns to scale. European Journal of Operational Research 139, 115–132.CrossRefGoogle Scholar
Simar, L and Wilson, P (2007) Estimation and inference in two-stage, semi-parametric models of production processes. Journal of Econometrics 136, 31–64.CrossRefGoogle Scholar
Simar, L and Wilson, P (2011) Two-stage DEA: caveat emptor. Journal of Productivity Analysis 36, 205–218.CrossRefGoogle Scholar
Statistics, Canada (2018) Health Region Peer Groups – Working Paper, 2018. Ottawa, ON: Statistics Canada.CrossRefGoogle Scholar
Tombe, T (2020) Provincial debt sustainability in Canada: demographics, federal transfers, and COVID-19. Canadian Tax Journal 68, 1083–1122.Google Scholar
Tombe, T (2022) Fiscal sustainability and diverging fortunes in Atlantic Canada. Atlantic Canada Economic Review 3, 1–18.Google Scholar
Tone, K and Tsutsui, M (2009) Network DEA: a slacks-based measure approach. European Journal of Operational Research 197, 243–252.CrossRefGoogle Scholar
United, Nations (2015) Transforming our World: The 2030 Agenda for Sustainable Development. New York, NY: UN General Assembly.Google Scholar
Walker, D (2018) Does participation in health information exchange improve hospital efficiency? Health Care Management Science 31, 426–438.CrossRefGoogle Scholar
Zhang, X, Tone, K and Lu, Y (2018) Impact of the local public hospital reform on the efficiency of medium-sized hospitals in Japan: an improved slacks-based measure data envelopment analysis approach. Health Services Research 53, 896–918.CrossRefGoogle ScholarPubMed