title: Determinants of healthcare system's efficiency in OECD countries.
abstract: OBJECTIVE
  Firstly, to compare healthcare systems' efficiency (HSE) using two models: one incorporating mostly inputs that are considered to be within the discretionary control of the healthcare system (i.e., physicians' density, inpatient bed density, and health expenditure), and another, including mostly inputs beyond healthcare systems' control (i.e., GDP, fruit and vegetables consumption, and health expenditure). Secondly, analyze whether institutional arrangements, population behavior, and socioeconomic or environmental determinants are associated with HSE.
  
  
  METHODS
  Data envelopment analysis (DEA) was utilized to calculate OECD countries' HSE. Life expectancy and infant survival rate were considered as outputs in both models. Healthcare systems' rankings according to the super-efficiency and the cross-efficiency ranking methods were used to analyze determinants associated with efficiency.
  
  
  RESULTS
  (1) Healthcare systems in nine countries with large and stable economies were defined as efficient in model I, but were found to be inefficient in model II; (2) Gatekeeping and the presence of multiple insurers were associated with a lower efficiency; and (3) The association between socioeconomic and environmental indicators was found to be ambiguous.
  
  
  CONCLUSIONS
  Countries striving to improve their HSE should aim to impact population behavior and welfare rather than only ensure adequate medical care. In addition, they may consider avoiding specific institutional arrangements, namely gatekeeping and the presence of multiple insurers. Finally, the ambiguous association found between socioeconomic and environmental indicators, and a country's HSE necessitates caution when interpreting different ranking techniques in a cross-country efficiency evaluation and needs further exploration.
authors.affiliation: Department of Industrial Engineering and Management, Shamoon College of Engineering, Beer-Sheva, Israel.
authors.forename: Sharon
authors.initials: S
authors.lastname: Hadad
authors.forename: Yossi
authors.initials: Y
authors.lastname: Hadad
authors.forename: Tzahit
authors.initials: T
authors.lastname: Simon-Tuval
mesh_terms: D003695:Delivery of Health Care / Q000191:economics*; D019049:Developed Countries / Q000191:economics*; D017598:Efficiency, Organizational / Q000191:economics*; D005260:Female; D005638:Fruit; D059066:Gross Domestic Product / Q000639:trends; D005102:Health Expenditures / Q000639:trends; D006742:Hospital Bed Capacity / Q000191:economics; D006801:Humans; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D008017:Life Expectancy / Q000639:trends; D016014:Linear Models; D008297:Male; D010820:Physicians / Q000600:supply & distribution; D012959:Socioeconomic Factors; D014675:Vegetables