Author:
GraŻyna Kozuń-Cieślak Faculty of Economics and Finance, Casimir Pulaski University of Technology and Humanities, ul. Chrobrego 31, 26-600, Radom, Poland

Search for other papers by GraŻyna Kozuń-Cieślak in
Current site
Google Scholar
PubMed
Close
Restricted access

Abstract

This paper examines the Bismarckian and Beveridgean-style healthcare systems in 25 OECD countries to identify the relationship between the efficiency of the country's healthcare delivery arrangement and its economic wealth. The Data Envelopment Analysis (DEA) is applied as a quantitative tool. I examine three models using infant mortality and potential years of life lost as output indicators. These models differ only in the way of expressing healthcare inputs. The DEA computations show that neither the Bismarckian nor the Beveridgean healthcare system has a clear advantage over the other when inputs are expressed by health expenditure as a percentage of GDP. The model which uses USD per head expenditure data at purchasing power parity shows a slight advantage of the Beveridge-style systems. This confirms the common opinion that the Bismarck-style systems perform worse in controlling the costs. When inputs are expressed using physical units (medical staff and equipment), DEA shows that the Beveridge system is significantly more efficient than the Bismarckian ones. I analyse the relationship between the DEA scores and the country's GDP per capita, as well. This analysis shows that more developed economies are technically less efficient. These findings are consistent with the belief that technical efficiency is only one of the many criteria that determine the quality of the healthcare system and patient satisfaction.

  • Andersen, P.Petersen, N. C. (1993): A Procedure for Ranking Efficient Units in Data Envelopment Analysis. Management Science, 39(10): 12611264.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Asandului, L.Roman, M.Fatulescu, P. (2014): The Efficiency of Healthcare Systems in Europe: A Data Envelopment Analysis Approach. Procedia Economics and Finance, 10: 261268.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Banker, R.Charnes, A.Cooper, W. W. (1984): Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis. Management Science, 30(9): 10781092.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Banker, R.Das, S.Datar, S. M. (1989): Analysis of Cost Variances for Management Control in Hospitals. Research in Governmental and Non-Profit Account, 5: 268291.

    • Search Google Scholar
    • Export Citation
  • Bates, L.Santerre, R. (2013): Does the U.S. Health Care Sector Suffer from Baumol’s Cost Disease? Evidence from the 50 States. Journal of Health Economics, 32: 386391.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Baumol, W. J. (1993): Health Care, Education and the Cost Disease: A Looming Crisis for Public Choice. In: Rowley, C. K.Schneider, F.Tollison, R. D. (eds): The Next Twenty-Five Years of Public Choice. Springer, Dordrecht, pp. 1728.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Björnberg, A. (2016): Euro-Health Consumer Index. Health Consumer Powerhouse Ltd.

  • Busse, R.Saltman, R. B.Dubois, H. F. W. (2004): Organization and Financing of Social Health Insurance Systems: Status and Recent Policy Developments. In: Saltman, R. B.Busse, R.Figueras, J. (eds): Social Health Insurance Systems in Western Europe. Open University Press, pp. 6271.

    • Search Google Scholar
    • Export Citation
  • Charnes, A.Cooper, W. W.Rhodes, E. L. (1978): Measuring the Efficiency of Decision-Making Units. European Journal of Operational Research, 2(6): 429444.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cheng, G.Qian, Z.Zervopoulos, P. D. (2011): Overcoming the Infeasibility of Super-Efficiency DEA Model: A Model with Generalized Orientation. MPRA Paper, No. 31991.

    • Search Google Scholar
    • Export Citation
  • Colombier, C. (2017): Drivers of Health-Care Expenditure: What Role Does Baumol's Cost Disease Play? Social Science Quarterly, 98(5): 16031623.

  • Cooper, W. W.Seiford, L. M.Tone, K. (2007): Data Envelopment Analysis. A Comprehensive Text with Models. Springer.

  • Delnoij, D. M. (2013): Bismarck or Beveridge: Primary Care Matters. European Journal of Public Health, 23(3): 349.

  • Dinca, G.Dinca, M. S.Andronic, M. L. (2020): The Efficiency of the Healt Care Sytems in EU Countries - A DEA Analysis. Acta Oeconomica, 70(1): 1936.

    • Search Google Scholar
    • Export Citation
  • Dlouhý, M. (2016): Efficiency of National Health Systems: Data Envelopment Analysis with Unobservable Measures. In: Hradec Economic Days 2016, University Hradec Králové, pp. 162168.

    • Search Google Scholar
    • Export Citation
  • Dutu, R.Sicari, P. (2016): Public Spending Efficiency in the OECD: Benchmarking Health Care, Education and General Administration. OECD Economics Department Working Papers, No. 1278, Paris.

    • Search Google Scholar
    • Export Citation
  • Elola, J. (1996): Health Care System Reforms in Western European Countries: The Relevance of Health Care Organization. International Journal of Health Services, 26: 239251.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Farrell, M. J. (1957): The Measurement of Productive Efficiency. The Journal of the Royal Statistical. Series A (General), 120(3): 253290.

  • Figueras, J.Saltman, R. B.Busse, R.Dubois, H. F. W. (2004): Patterns and Performance in Social Health Insurance Systems. In: Saltman, R. B.Busse, R.Figueras, J. (eds): Social Health Insurance Systems in Western Europe. Maidenhead: Open University Press, pp. 81140.

    • Search Google Scholar
    • Export Citation
  • Freeman, R. (1998): Competition in Context: The Politics of Healthcare Reform in Europe. International Journal for Quality in Healthcare, 10(5): 395401.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Galama, T. J.Hullegie, P.Meijer, E.Outcau, S. (2012): Is There Empirical Evidence for Decreasing Returns to Scale in a Health Capital Model? Health Economics, 21(9): 10801100.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Goodin, R. E.Wilenski, P. (1984): Beyond Efficiency: The Logical Underpinnings of Administrative Principles. Public Administration Review, 44: 513.

  • Grossman, M. (1972): The Demand for Health: A Theoretical and Empirical Investigation. NBER Books.

  • Grossman, M. (1982): The Demand for Health after a Decade. Journal of Health Economics, 1(1): 13.

  • Grossman, M. (2004): The Demand for Health, 30 Years Later: A Very Personal Retrospective and Prospective Reflection. Journal of Health Economics, 23(4): 629636.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hartwig, J. (2008): What Drives Health Care Expenditure? Baumol’s Model of ‘Unbalanced Growth’ Revisited. Journal of Health Economics, 27: 603623.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Joumard, I.André, C.Nicq, C. (2010): Healthcare Systems: Efficiency and Institutions. OECD Economics Department Working Papers, No. 769, Paris.

    • Search Google Scholar
    • Export Citation
  • Kutzin, J.Cashin, C.Jakab, M. (2010): Implementing Health Financing Reform. Lessons from Countries in Transition. World Health Organization Observatory Studies, Series No 21.

    • Search Google Scholar
    • Export Citation
  • Kuvikova, H. (2004): Zdravotnicke systemy sveta v kontexte zvysovania realnych financnych zdrojom (Worldwide Health Care Systems in Context of Real Financial Resources Increasing). Ekonomicky casopis, 52(8): 957972.

    • Search Google Scholar
    • Export Citation
  • Lameire, N.Joffe, P.Wiedeman, M. (1999): Healthcare Systems – An International Review: An Overview. Nephrology Dialysis. Transplantation, 14(6): 39.

    • Search Google Scholar
    • Export Citation
  • Medeiros, J.Schwierz, C. (2015): Efficiency Estimates of Health Care Systems. Economic Papers, No. 549. Publication Office of the European Union, Luxembourg.

    • Search Google Scholar
    • Export Citation
  • Mihályi, P. (2017): Recent Changes in the Hungarian Healthcare System, 2010–2017. Zdrowie Publiczne I Zarządzanie, 15(3): 242250.

    • Search Google Scholar
    • Export Citation
  • Nemec, J.Kolisnichenko, N. (2006): Market-Based Healthcare Reforms in Central and Eastern Europe: Lessons after Ten Years of Change. International Review of Administrative Sciences, 72(1): 1126.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Or, Z.Cases, C.Lisac, M.Vrangbaek, K.Winblad, U.Bevan, G. (2010): Are Health Problems Systemic? Politics of Access and Choice under Beveridge and Bismarck Systems. Health Economics. Policy and Law, 5(3): 269293.

    • Search Google Scholar
    • Export Citation
  • Pelone, F.Giulio De Belvis, A.Volpe, M. – Ricciardi, W. (2008): Is There a Relationship between Healthcare Models and Their Performance Assessment? The Results of an Extensive Review. Italian Journal of Public Health, 62: 102106.

    • Search Google Scholar
    • Export Citation
  • Reinhardt, U. E. (2009): The Mounting Price of Health Care's Status Quo. The New York Times.

  • Russo, L. X. (2016): Cost Disease of Health Care and No Growth. Economic and Environmental Studies, 16(4): 717728.

  • Rutgers, M. R.Meer, H. (2010): The Origins and Restriction of Efficiency in Public Administration. Regaining Efficiency as the Core Value of Public Administration. Administration and Society, 42(7): 755799.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Saltman, R. B. Figueras, J. (1998): Analyzing the Evidence on European Healthcare Reforms. Health Affairs, 17(2): 85108.

  • Stone, D. (2012): Policy Paradox, the Art of Political Decision Making. New York: W.W. Norton & Company Inc.

  • Tone, K. (2001): Slacks-Based Measure of Efficiency in Data Envelopment Analysis. European Journal of Operational Research, 130(3): 498509.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tone, K. (2002): A Slacks-Based Measure of Super-Efficiency in Data Envelopment Analysis. European Journal of Operational Research, 143(1): 3241.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wagstaff, A. (2009): Social Health Insurance vs. Tax-Financed Health Systems – Evidence from the OECD. Policy Research Working Paper, No. 482, The World Bank.

    • Search Google Scholar
    • Export Citation
  • Waldo, D. (1948): The Administrative State. New York: Holmes & Meier.

  • Wendt, C. (2009): Mapping European Healthcare Systems: A Comparative Analysis of Financing Service Provision and Access to Healthcare. Journal of European Social Policy, 19(5): 432445.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Zee, J.Kroneman, M. W. (2007): Bismarck or Beveridge: A Beauty Contest between Dinosaurs. BMC Health Services Research, 7: 94.

  • Collapse
  • Expand
The author instructions are available in PDF.
Please, download the file from HERE.

 

The description of the refereeing procedure is available in PDF.
Please, download the file from HERE.

 

Senior editors

Editors-in-Chief: István P. Székely, Dóra Győrffy

Editor(s): Judit Ványai

Associate Editors

  • Péter Benczúr, Joint Joint Research Center, European Commission
  • Dóra Benedek, International Monetary Fund
  • Balázs Égert, OECD
  • Dániel Prinz, World Bank
  • Rok Spruk, University of Ljubljana, School of Economics and Business, Slovenia

Editorial Board

  • Anders Åslund, Georgetown University and Advisory Council of CASE, USA
  • István Benczes, Corvinus University of Budapest, Hungary 
  • Agnieszka Chłoń-Domińczak, SGH Warsaw School of Economics, Poland
  • Fabrizio Coricelli, University of Siena, Italy
  • László Csaba, Corvinus University of Budapest, Hungary and Central European University, Austria
  • Beáta Farkas, Faculty of Economics and Business Administration, University of Szeged, Hungary
  • Péter Halmai, Budapest University of Technology and Economics, and National University of Public Service, Hungary
  • Martin Kahanec, Central European University, Austria
  • Michael Landesmann, The Vienna Institute for International Economic Studies (WIIW), Austria
  • Péter Mihályi, Corvinus University of Budapest, Hungary
  • Debora Revoltella, European Investment Bank

Corvinus University of Budapest
Department of Economics
Fővám tér 8 Budapest, H-1093, Hungary
E-mail: vanyai.judit@krtk.hu  

Indexing and Abstracting Services:

  • CABELLS Journalytics
  • EconLit
  • Elsevier GEO Abstracts
  • GEOBASE
  • Index Copernicus
  • International Bibliographies IBZ and IBR
  • JEL
  • Referativnyi Zhurnal
  • RePEc
  • SCOPUS
  • Social Science Citation Index

 

2023  
Web of Science  
Journal Impact Factor 0.7
Rank by Impact Factor Q3 (Economics)
Journal Citation Indicator 0.23
Scopus  
CiteScore 1.4
CiteScore rank Q3 (Economics and Econometrics)
SNIP 0.385
Scimago  
SJR index 0.218
SJR Q rank Q4

Acta Oeconomica
Publication Model Hybrid
Submission Fee none
Article Processing Charge 900 EUR/article
Printed Color Illustrations 40 EUR (or 10 000 HUF) + VAT / piece
Regional discounts on country of the funding agency World Bank Lower-middle-income economies: 50%
World Bank Low-income economies: 100%
Further Discounts Editorial Board / Advisory Board members: 50%
Corresponding authors, affiliated to an EISZ member institution subscribing to the journal package of Akadémiai Kiadó: 100%
Subscription fee 2025 Online subsscription: 700 EUR / 768 USD
Print + online subscription: 820 EUR / 900 USD
Subscription Information Online subscribers are entitled access to all back issues published by Akadémiai Kiadó for each title for the duration of the subscription, as well as Online First content for the subscribed content.
Purchase per Title Individual articles are sold on the displayed price.

Acta Oeconomica
Language English
Size B5
Year of
Foundation
1966
Volumes
per Year
1
Issues
per Year
4
Founder Magyar Tudományos Akadémia
Founder's
Address
H-1051 Budapest, Hungary, Széchenyi István tér 9.
Publisher Akadémiai Kiadó
Publisher's
Address
H-1117 Budapest, Hungary 1516 Budapest, PO Box 245.
Responsible
Publisher
Chief Executive Officer, Akadémiai Kiadó
ISSN 0001-6373 (Print)
ISSN 1588-2659 (Online)

Monthly Content Usage

Abstract Views Full Text Views PDF Downloads
Apr 2024 124 2 1
May 2024 76 0 0
Jun 2024 84 0 0
Jul 2024 123 0 0
Aug 2024 140 0 0
Sep 2024 55 0 0
Oct 2024 0 0 0