title: Public resource usage in health systems: a data envelopment analysis of the efficiency of health systems of autonomous communities in Spain.
abstract: OBJECTIVE
  The efficiency in the management of public resources is one of the main pillars of the welfare state. The objective of this work is to analyze the efficiency of the public resources that regional governments in Spain (Autonomous Communities (AC)) invest in health systems (HS).
  
  
  METHODS
  A dataset from of the Ministry of Health, Social Services and Equality of Spain has been used, which contains the most important indicators from the National HS. The following variables have been chosen in this study: the health care expenses per resident, the percentage of this investment that is forwarded to labour expenses, frequency of hospital care services, frequency of specialized external health care services and, primary health care services in medicine and nursing per resident.
  
  
  METHODS
  To this end, Data Envelopment Analysis (DEA) is applied, which enables researchers and managers to obtain measurements of efficiency of the analyzed regions, and to propose corrective steps to achieve efficiency for inefficient HS. Moreover, the super-efficiency measurement is shown for a constant and a variable scale.
  
  
  RESULTS
  The results show that there are three groups of AC, first a group composed by six HS that are globally efficient, a second group composed by eight HS that are globally inefficient, and a third group composed by three HS that are efficient in some terms and their efficiency can be improved.
  
  
  CONCLUSIONS
  It is concluded that DEA is an appropriate method for evaluating efficiencies of health systems and giving the adjustments for the application of economic, social and organizational policies to improve their efficiencies.
authors.affiliation: Department of Accounting and Financial Economics, Universidad de Sevilla, Facultad de Ciencias Económicas y Empresariales, Avda. Ramón y Cajal, 1, 41018, Sevilla, Spain. Electronic address: mscampos@us.es.
authors.forename: M S
authors.initials: MS
authors.lastname: Campos
authors.affiliation: Department of Computer Languages and Systems, Universidad de Sevilla, Escuela Técnica Superior de Ingeniería Informática, Avda. Reina Mercedes s/n, 41012, Sevilla, Spain. Electronic address: afdez@us.es.
authors.forename: A
authors.initials: A
authors.lastname: Fernández-Montes
authors.affiliation: Department of Applied Economics I, Universidad de Sevilla, Facultad de Ciencias Económicas y Empresariales, Avda. Ramón y Cajal, 1, 41018, Sevilla, Spain. Electronic address: gavi@us.es.
authors.forename: J M
authors.initials: JM
authors.lastname: Gavilan
authors.affiliation: Department of Applied Economics I, Universidad de Sevilla, Facultad de Ciencias Económicas y Empresariales, Avda. Ramón y Cajal, 1, 41018, Sevilla, Spain. Electronic address: velasco@us.es.
authors.forename: F
authors.initials: F
authors.lastname: Velasco
mesh_terms: D017598:Efficiency, Organizational; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D009111:Local Government; D009313:National Health Programs / Q000458:organization & administration*; D012946:Social Welfare; D013030:Spain
keywords: Autonomous communities; DEA; Efficiency; Public health; Public resources