title: The efficiency of health care production in OECD countries: A systematic review and meta-analysis of cross-country comparisons.
abstract: There has been an ongoing interest in the analysis and comparison of the efficiency of health care systems using nonparametric and parametric applications. The objective of this study was to review the current state of the literature and to synthesize the findings on health system efficiency in OECD countries. We systematically searched five electronic databases through August 2014 and identified 22 studies that analyzed the efficiency of health care production at the country level. We summarized these studies with view on their sample, methods, and utilized variables. We developed and applied a checklist of 14 items to assess the quality of the reviewed studies along four dimensions: reporting, external validity, bias, and power. Moreover, to examine the internal validity of findings we meta-analyzed the efficiency estimates reported in 35 models from ten studies. The qualitative synthesis of the literature indicated large differences in study designs and methods. The meta-analysis revealed low correlations between country rankings suggesting a lack of internal validity of the efficiency estimates. In conclusion, methodological problems of existing cross-country comparisons of the efficiency of health care systems draw into question the ability of these comparisons to provide meaningful guidance to policy-makers.
authors.affiliation: Universität Hamburg, Hamburg Center for Health Economics, Esplanade 36, 20354 Hamburg, Germany. Electronic address: yauheniya.varabyova@uni-hamburg.de.
authors.forename: Yauheniya
authors.initials: Y
authors.lastname: Varabyova
authors.affiliation: Universität Hamburg, Hamburg Center for Health Economics, Esplanade 36, 20354 Hamburg, Germany.
authors.forename: Julia-Maria
authors.initials: JM
authors.lastname: Müller
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards*; D017598:Efficiency, Organizational; D006291:Health Policy; D006801:Humans; D066150:Organisation for Economic Co-Operation and Development / Q000458:organization & administration
keywords: Health care production; Nonparametric and parametric efficiency analysis; OECD countries; Systematic review