1. Benchmarking the Efficiency of Health Systems Across the European Union: A Data Envelopment Analysis Approach

2. AUTHORS

Asimopoulou¹ TG, Flokou A,¹ Theodorou P,¹ Aletras V,^1,2 Niakas D^1,3

¹School of Social Sciences, Postgraduate Course – Health Care Management, Hellenic Open University, Patra, Greece

²Department of Business Administration, School of Business Administration, University of Macedonia

³Medical School, National and Kapodistrian University of Athens

Abstract ID:

Event: Conference 2025

3. Abstract

Purpose: Health systems are today at the center of attention, as rising costs and increasing demand for quality services intensify the need for optimal utilization of limited resources to achieve the maximum possible social benefit. In this context, the assessment of efficiency levels and the subsequent decision to implement improvement measures constitute a common goal across European health systems. The purpose of the present study is to evaluate the efficiency of the healthcare systems of the 27 member states of the European Union (EU), for the years 2014 and 2022, to identify, within a benchmarking framework, the best-performing countries and to assess, for the other countries, the extent to which existing resources are utilized in producing health outcomes, thereby providing a basis for comparison and potential improvements.

Materials and Methods: Initially, data on inputs and outputs were collected from international and authoritative databases such as Eurostat and the OECD's annual “Health at a Glance” reports. The efficiency scores of the 27 EU member states were evaluated using the Data Envelopment Analysis (DEA) method. Specifically, the Constant Returns to Scale (CRS), Variable Returns to Scale (VRS), Non-Increasing Returns to Scale (NIRS), and Non-Decreasing Returns to Scale (NDRS) models were applied to derive technical and scale efficiency scores, while the super-efficiency model was also employed to rank the best-performing countries. An input-oriented (resource-minimizing) approach was chosen. The inputs used included the number of physicians, nurses, and hospital beds per 100,000 inhabitants, as well as per capita health expenditure. The outputs consisted of life expectancy at birth, healthy life years, and the infant survival rate.

Results: In 2014, the average technical efficiency of EU countries was estimated at 63.1% (CRS), 63.9% (VRS), 63.9% (NIRS), and 63.1% (NDRS). In 2022, efficiency levels increased across all models to 65.4% (CRS), 69.3% (VRS), 69.3% (NIRS), and 65.4% (NDRS). In the super-efficiency model, the top positions in both years were interestingly occupied by countries with different health systems as well as different economic and social profiles. A significant improvement in scale efficiency was observed over the study period, with the number of scale-efficient countries increasing from twelve in 2014 to eighteen in 2022.

Conclusions: High levels of efficiency were recorded in both 2014 and 2022 among EU countries, with a clear increase in all DEA models in 2022 compared to 2014, indicating progress in more efficient use of resources in policy-making by most countries, despite the impact of the COVID-19 pandemic. In summary, the DEA method can provide a useful tool for assessing the efficiency of healthcare systems and benchmarking between countries. Although it mainly focuses on the quantitative dimension of resource use, it can provide valuable insights for policy-making. The inclusion of additional dimensions, such as quality, accessibility, and patient satisfaction, could enhance the interpretability of the results.

4. Keywords (up to 5): Health care systems, Efficiency, Data Envelopment Analysis (DEA), Benchmarking, European Union

5. JEL codes: C61, D24, H51, I18