Duke 2008 | ASHE | Equity and Efficiency in Health and Healthcare

The measurement of efficiency and productivity of health service delivery has become a small industry. This is a review of over 300 published papers on frontier efficiency measurement. The techniques used are mainly based on non-parametric data envelopment analysis, but there is increasing use of parametric techniques, such as stochastic frontier analysis. Applications to hospitals and other health care organizations and areas are reviewed and summarised, and some meta-type analysis undertaken. Cautious conclusions are that public provision may be potentially more efficient than private, in certain settings. The paper also considers conceptualizations of efficiency, and points to dangers and opportunities in generating such information. Finally some criteria for assessing the use and usefulness of efficiency studies are established, with a view to helping both researchers, and those assessing whether or not to act upon published results.