title: Comparing efficiency of health systems across industrialized countries: a panel analysis.
abstract: BACKGROUND
  Rankings from the World Health Organization (WHO) place the US health care system as one of the least efficient among Organization for Economic Cooperation and Development (OECD) countries. Researchers have questioned this, noting simplistic or inappropriate methodologies, poor measurement choice, and poor control variables. Our objective is to re-visit this question by using newer modeling techniques and a large panel of OECD data.
  
  
  METHODS
  We primarily use the OECD Health Data for 25 OECD countries. We compare results from stochastic frontier analysis (SFA) and fixed effects models. We estimate total life expectancy as well as life expectancy at age 60. We explore a combination of control variables reflecting health care resources, health behaviors, and economic and environmental factors.
  
  
  RESULTS
  The US never ranks higher than fifth out of all 36 models, but is also never the very last ranked country though it was close in several models. The SFA estimation approach produces the most consistent lead country, but the remaining countries did not maintain a steady rank.
  
  
  CONCLUSIONS
  Our study sheds light on the fragility of health system rankings by using a large panel and applying the latest efficiency modeling techniques. The rankings are not robust to different statistical approaches, nor to variable inclusion decisions.
  
  
  CONCLUSIONS
  Future international comparisons should employ a range of methodologies to generate a more nuanced portrait of health care system efficiency.
authors.affiliation: Department of Family Medicine, School of Medicine, University of Washington, 4311 11th Ave. NE, Suite 210, Box 354982, Seattle, WA, 98195, USA. bfrogner@uw.edu.
authors.forename: Bianca K
authors.initials: BK
authors.lastname: Frogner
authors.affiliation: Department of Economics, University of California, Santa Barbara, 2127 North Hall, Mail Stop 9210, Santa Barbara, CA, 93106, USA. frech@econ.ucsb.edu.
authors.forename: H E
authors.initials: HE
authors.lastname: Frech
authors.affiliation: Finance Department, Carlson School of Management, University of Minnesota, 321 19th St. South, 3-122, Minneapolis, MN, 55455, USA. sparente@umn.edu.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Parente
mesh_terms: D026683:Advisory Committees; D019985:Benchmarking; D057225:Data Mining; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D019049:Developed Countries; D017598:Efficiency, Organizational / Q000592:standards*; D006295:Health Resources / Q000191:economics; D006801:Humans; D008017:Life Expectancy; D008483:Medical Assistance; D015203:Reproducibility of Results; D014944:World Health Organization