title: How efficient are New Zealand's District Health Boards at producing life expectancy gains for Māori and Europeans?
abstract: OBJECTIVE
  Use data envelopment analysis (DEA) to measure the efficiency of New Zealand's District Health Boards (DHBs) at achieving gains in Māori and European life expectancy (LE).
  
  
  METHODS
  Using life tables for 2006 and 2013, a two-output DEA model established the production possibility frontier for Māori and European LE gain. Confidence limits were generated from a 10,000 replicate Monte Carlo simulation.
  
  
  RESULTS
  Results support the use of LE change as an indicator of DHB efficiency. DHB mean income and education were related to initial LE but not to its rate of change. LE gains were unrelated to either the initial level of life expectancy or to the proportion of Māori in the population. DHB efficiency ranged from 79% to 100%. Efficiency was significantly correlated with DHB financial performance.
  
  
  CONCLUSIONS
  Changes in LE did not depend on the social characteristics of the DHB. The statistically significant association between efficiency and financial performance supports its use as an indicator of managerial effectiveness. Implications for public health: Efficient health systems achieve better population health outcomes. DEA can be used to measure the relative efficiency of sub-national health authorities at achieving health gain and equity outcomes.
authors.affiliation: Planning Funding and Outcomes, Auckland and Waitemata District Health Boards, New Zealand.|School of Population Health, University of Auckland, New Zealand.
authors.forename: Peter
authors.initials: P
authors.lastname: Sandiford
authors.affiliation: Centro de Investigaciones de Economía y Gestión en Salud, Universidad Politécnica de Valencia, Spain.
authors.forename: David Juan José Vivas
authors.initials: DJJV
authors.lastname: Consuelo
authors.affiliation: Accounting and Finance, University of Auckland Business School, New Zealand.
authors.forename: Paul
authors.initials: P
authors.lastname: Rouse
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008017:Life Expectancy / Q000208:ethnology*; D015993:Life Tables; D008297:Male; D009026:Mortality / Q000208:ethnology; D009313:National Health Programs / Q000458:organization & administration*; D009520:New Zealand / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*
keywords: Maori; New Zealand; data envelopment analysis; efficiency; life expectancy