Productive Efficiency and Heterogeneity of Health Care Systems: Results of a Measurement for OECD Countries

Health system efficiency is a major target of health policy but its conceptualization and measurement are still a problem in health economics. Because health status is influenced by many factors outside the health system, I argue that measurements of health system efficiency should focus on the process of turning financial input into additional health output rather than the levels of health status reached. When analyzing levels of health status using regression methods, the appropriate efficiency indicator is hence not a country-specific intercept based on the achieved health status, but a coun- try-specific slope for input factors in the production function of health outcomes. The slopes represent health system effi- ciency, while the intercepts represent health relevant heterogeneity among countries. Using data on OECD members these slopes are estimated. Countries differ far more in their residual heterogeneity than in the rate by which their health system turns money into life years.