Hamidi Samer, Akinci Fevzi
School of Health and Environmental Studies, Hamdan Bin Mohammad Smart University, Dubai, United Arab Emirates.
Health Care Administration, The William G. McGowan School of Business, King's College, Wilkes-Barre, USA.
Appl Health Econ Health Policy. 2016 Jun;14(3):337-47. doi: 10.1007/s40258-016-0230-9.
The main purpose of this study is to measure the technical efficiency of twenty health systems in the Middle East and North Africa (MENA) region to inform evidence-based health policy decisions. In addition, the effects of alternative stochastic frontier model specification on the empirical results are examined.
We conducted a stochastic frontier analysis to estimate the country-level technical efficiencies using secondary panel data for 20 MENA countries for the period of 1995-2012 from the World Bank database. We also tested the effect of alternative frontier model specification using three random-effects approaches: a time-invariant model where efficiency effects are assumed to be static with regard to time, and a time-varying efficiency model where efficiency effects have temporal variation, and one model to account for heterogeneity.
The average estimated technical inefficiency of health systems in the MENA region was 6.9 % with a range of 5.7-7.9 % across the three models. Among the top performers, Lebanon, Qatar, and Morocco are ranked consistently high according to the three different inefficiency model specifications. On the opposite side, Sudan, Yemen and Djibouti ranked among the worst performers. On average, the two most technically efficient countries were Qatar and Lebanon. We found that the estimated technical efficiency scores vary substantially across alternative parametric models.
Based on the findings reported in this study, most MENA countries appear to be operating, on average, with a reasonably high degree of technical efficiency compared with other countries in the region. However, there is evidence to suggest that there are considerable efficiency gains yet to be made by some MENA countries. Additional empirical research is needed to inform future health policies aimed at improving both the efficiency and sustainability of the health systems in the MENA region.
本研究的主要目的是衡量中东和北非（MENA）地区20个卫生系统的技术效率，以为循证卫生政策决策提供依据。此外，还考察了替代随机前沿模型设定对实证结果的影响。
我们进行了一项随机前沿分析，利用世界银行数据库中1995 - 2012年期间20个中东和北非国家的二级面板数据来估计国家层面的技术效率。我们还使用三种随机效应方法测试了替代前沿模型设定的效果：一种是效率效应在时间上被假定为静态的时不变模型，一种是效率效应具有时间变化的时变效率模型，以及一种考虑异质性的模型。
中东和北非地区卫生系统的平均估计技术无效率为6.9%，在这三种模型中的范围为5.7 - 7.9%。在表现最佳的国家中，黎巴嫩、卡塔尔和摩洛哥在三种不同的无效率模型设定下排名一直很高。相反，苏丹、也门和吉布提则位列表现最差的国家之中。平均而言，技术效率最高的两个国家是卡塔尔和黎巴嫩。我们发现，在替代参数模型中，估计的技术效率得分差异很大。
基于本研究报告的结果，与该地区其他国家相比，大多数中东和北非国家平均而言似乎在以相当高的技术效率运作。然而，有证据表明一些中东和北非国家仍有相当大的效率提升空间。需要进行更多的实证研究，以为未来旨在提高中东和北非地区卫生系统效率和可持续性的卫生政策提供依据。
