title: Measuring Efficiency of Health Systems of the Middle East and North Africa (MENA) Region Using Stochastic Frontier Analysis.
abstract: OBJECTIVE
  The main purpose of this study is to measure the technical efficiency of twenty health systems in the Middle East and North Africa (MENA) region to inform evidence-based health policy decisions. In addition, the effects of alternative stochastic frontier model specification on the empirical results are examined.
  
  
  METHODS
  We conducted a stochastic frontier analysis to estimate the country-level technical efficiencies using secondary panel data for 20 MENA countries for the period of 1995-2012 from the World Bank database. We also tested the effect of alternative frontier model specification using three random-effects approaches: a time-invariant model where efficiency effects are assumed to be static with regard to time, and a time-varying efficiency model where efficiency effects have temporal variation, and one model to account for heterogeneity.
  
  
  RESULTS
  The average estimated technical inefficiency of health systems in the MENA region was 6.9 % with a range of 5.7-7.9 % across the three models. Among the top performers, Lebanon, Qatar, and Morocco are ranked consistently high according to the three different inefficiency model specifications. On the opposite side, Sudan, Yemen and Djibouti ranked among the worst performers. On average, the two most technically efficient countries were Qatar and Lebanon. We found that the estimated technical efficiency scores vary substantially across alternative parametric models.
  
  
  CONCLUSIONS
  Based on the findings reported in this study, most MENA countries appear to be operating, on average, with a reasonably high degree of technical efficiency compared with other countries in the region. However, there is evidence to suggest that there are considerable efficiency gains yet to be made by some MENA countries. Additional empirical research is needed to inform future health policies aimed at improving both the efficiency and sustainability of the health systems in the MENA region.
authors.affiliation: School of Health and Environmental Studies, Hamdan Bin Mohammad Smart University, Dubai, United Arab Emirates. s.hamidi@hbmsu.ac.ae.
authors.forename: Samer
authors.initials: S
authors.lastname: Hamidi
authors.affiliation: Health Care Administration, The William G. McGowan School of Business, King's College, Wilkes-Barre, USA.
authors.forename: Fevzi
authors.initials: F
authors.lastname: Akinci
mesh_terms: D000293:Adolescent; D000328:Adult; D000352:Africa, Northern / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology* / Q000517:prevention & control / Q000628:therapy; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D017598:Efficiency, Organizational; D005260:Female; D005382:Financing, Personal; D005102:Health Expenditures / Q000706:statistics & numerical data; D006291:Health Policy; D006801:Humans; D015994:Incidence; D008017:Life Expectancy / Q000639:trends; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D011634:Public Health / Q000191:economics / Q000592:standards* / Q000639:trends; D013269:Stochastic Processes; D014881:Water Supply / Q000592:standards* / Q000706:statistics & numerical data; D055815:Young Adult