Sorin Gabriel ANTON


The aim of the paper is to assess the technical efficiency of twenty health systems from Central and Eastern Europe (CEE) and Commonwealth of Independent States (CIS). We used an output-oriented Data Envelopment Analysis (DEA) to measure the technical efficiency of the health systems using the latest data available on infant death and life expectancy as health outcomes. Our results show that technical efficiency varies across these health systems and this translates into potential savings of resources. The average efficiency scores for all heath systems were 0.98 for life expectancy at birth and only 0.821 for infant mortality. More than half of the health systems in the sample were technically inefficient in 2009 for both outputs. We found that 30% of national health systems were technically efficient for both outputs.

Full text: PDF


Technical efficiency, health system, Data Envelopment Analysis, health outcomes, Central and Eastern Europe, Commonwealth of Independent States.

JEL Codes

C14, H11


Afonso, A. and St. Aubyn, M., 2006. Relative Efficiency of Health Provision: a DEA Approach with Non-discretionary Inputs. Department of Economics at the School of Economics and Management (ISEG). Lisbon: Technical University of Lisbon.

Anton, S. G. and Onofrei, M., 2012. Health Care Performance and Health Financing System in Selective Countries from Central and Eastern Europe. A Comparative Study. Transylvanian Review of Administrative Sciences, 35E, pp. 22-32.

Asiskovitch, S., 2010. Gender and Health Outcomes: The Impact of Healthcare Systems and Their Financing on Life Expectancies of Women and Men. Social Science and Medicine, 70, pp. 886-895.

Babazono, A. and Hilman, A.L., 1994. A Comparison of International Health Outcomes and Health Care Spending. International Journal of Technology Assessment in Health Care, 10(3), pp. 376-381.

Banker, R.D., Charnes, A. and Cooper, W.W., 1984. Some models for estimating technical and scale inefficiencies in Data Envelopment Analysis. Management Science, 30(9), pp. 1078-92.

Berger, M.C., and Messer, J., 2002. Public Financing of Health Expenditures, Insurance, and Health Outcomes. Applied Economics, 34(17), pp. 2105-2113.

Bhat, V., 2005. Institutional Arrangements and Efficiency of Health Care Delivery Systems. The European Journal of Health Economics, 6(3), pp. 215‐222.

Borisov, D., Cicea, C. and Turlea, C., 2012. DEA Model for Assessing Efficiency in Providing Health Care. Management Research and Practice, 4(1), pp. 5-18.

Charnes, A., Cooper, W.W. and Rhodes, E., 1978. Measuring the efficiency of decision making units. European Journal of Operational Research, 2(6), pp. 429-444.

DeRosario, J.M., 1999. Healthcare System Performance Indicators: A New Beginning for a Reformed Canadian Healthcare System. Journal for Healthcare Quality, 21(1), pp. 37-41.

Elola, J., Daponte, A. and Navarro, V., 1995. Health Indicators and the Organization of Health Care Systems in Western Europe. American Journal of Public Health, 85(10), pp. 1397-1401.

Evans, D.B., Tandon, A., Murray, C.J.L. and Lauer, J.A., 2000. The Comparative Efficiency of National Health Systems in Producing Health: An Analysis of 191 Countries. GPE Discussion Paper Series, No. 29, Geneva: World Health Organization.

Farrell, M. J., 1957. The Measurement of Productive Efficiency. Journal of the Royal Statistic Society, 120(III), pp. 253-281.

Grigoli, F., 2012. Public Expenditure in the Slovak Republic: Composition and Technical Efficiency. IMF Working Paper, WP 173, Washington: International Monetary Fund.

Grosskopf, S., Self, S. and Zaim, O., 2006. Estimating the efficiency of the system of healthcare financing in achieving better health. Applied Economics, 38(13), pp. 1477-1488.

Hadad, S., Hadad, Y. and Simon-Tuval, T., 2011. Determinants of healthcare system’s efficiency in OECD countries. The European Journal of Health Economics, DOI: 10.1007/s10198-011-0366-3Online First™.

Häkkinen, U. and Joumard, I., 2007. Cross-Country Analysis of Efficiency in OECD Health Care Sectors: Options for Research. OECD Economics Department Working Papers, No. 554, Paris: Organization for Economic Cooperation and Development.

Hitiris, T. and Posnett, J., 1992. The Determinants and Effects of Health Expenditure in Developed Countries. Journal of Health Economics, 11(2), pp. 173-181.

Hollingsworth, B. and Wildman, J., 2003. The efficiency of health production: re-estimating the WHO panel data using parametric and non-parametric approaches to provide additional information. Health Economics, 12(6), pp. 493-504.

Kirigia, J.M., Zere, E., Greene, A.W. and Emrouznejad, A., 2007. Technical Efficiency, Efficiency Change, Technical Progress and Productivity Growth in the National Health Systems of Continental African Countries. Eastern Africa Social Science Research Review, 23 (2), pp. 19-40.

Jafarov, E. and Gunnarsson, V., 2008. Government Spending on Health Care and Education in Croatia: Efficiency and Reform Options. IMF Working Paper, WP 136, Washington: International Monetary Fund.

Joumard, I., André, C. and Nicq, C., 2010. Health Care Systems: Efficiency and Institutions. OECD Economics Department Working Papers, No. 769, Paris: Organization for Economic Cooperation and Development.

Joumard, I., Andre, C., Nicq, C. and Chatal, O., 2008. Health Status Determinants: Lifestyle, Environment, Health Care Resources and Efficiency. OECD Economics Department Working Papers, No. 627, Paris: Organization for Economic Cooperation and Development.

Mirmirani, S., Li, H.C. and Ilacqua, J.A., 2008. Health Care Efficiency in Transition Economies: An Application of Data Envelopment Analysis. International Business & Economics Research Journal, 7(2), pp. 47-55.

OECD, 2010. Health Care Systems: Getting More Value for Money. OECD Economics Department Policy Notes, No. 2, Paris: Organization for Economic Cooperation and Development.

Or, Z., 2000a. Exploring the Effects of Health Care on Mortality across OECD Countries. Labour Market and Social Policy Occasional-Papers, No. 46, Paris: Organization for Economic Cooperation and Development.

Or, Z., 2000b. Determinants of Health Outcomes in Industrialised Countries: A Pooled, Cross-Country, Time-Series Analysis. OECD Economic Studies, No. 30, Paris: Organization for Economic Cooperation and Development.

Raguseo, D. and Vlček, P., 2007. The Health Care in Europe: A Multi-Criteria Approach. International Archives, 70(3), pp. 46-55.

Rajkumar, A.S. and Swaroop, V., 2008. Public Spending and Outcomes: Does Governance Matter?. Journal of Development Economics, 86(1), pp. 96-111.

Retzlaff-Roberts, D., Chang, C.F. and Rubin, R.M., 2004. Technical efficiency in the use of health care resources: a comparison of OECD countries. Health Policy, 69(1), pp. 55-72.

Self, S. and Grabowski, R., 2003. How effective is Public Health Expenditure in Improving Overall Health? A Cross-country Analysis. Applied Economics, 35(7), pp. 835-845.

Sinimole, K.R., 2012. Evaluation of the efficiency of national health systems of the members of World Health Organization. Leadership in Health Services, 25(2), pp.139 – 150.

Spinks, J. and Hollingsworth, B., 2009. Cross‐Country Comparisons of Technical Efficiency of Health Production: A Demonstration of Pitfalls. Applied Economics, 41(4‐6), pp. 417‐427.

Thornton, J., 2002. Estimating a health production function for the US: some new evidence. Applied Economics, 34, pp. 59–62.

Tandon, A., Murray, C. J. L., Lauer, J. A. and Evans, D., 2000. Measuring overall health system performance for 191 countries, GPE discussion Paper Series 30, Geneva: World Health Organization.

World Health Organization, 2012. European Health for All Database, Regional Office for Europe,

Verhoeven, M., Gunnarsson, V. and Lugaresi, S., 2007. The Health Sector in the Slovak Republic: Efficiency and Reform. IMF Working Paper, WP 226, Washington: International Monetary Fund.

Zhang, N., Hu, A., and Zheng, J., 2007. Using Data Envelopment Analysis approach to estimate the health production efficiencies in China. Frontiers of Economics in China, 2 (1), pp. 1-23.