The Efficiency of Health Services in Spain Based on Data Envelopment Analysis (DEA). The Singularity of Health Efficiency

Objectives: To study the comparative efficiency of the regional health services in Spain through DEA and shed light on the orientations of health policies to improve the public perception of health services as well as the participation of citizens in formulating health Policies and setting priorities. Study design: Comparative analysis of the efficiency of the health services of the different regions of Spain through DEA. Methods: It uses a non-oriented approach in which efficiency is sought via an increase of the variables considered desirable, the natural unified health efficiency is employed for this aim, while the managerial unified is utilised for a decrease of the undesirable variables. The two are related through the so-called managerial natural unified health efficiency. Results: Orientations of the health policy are indicated which each of the health systems analysed must follow in order to improve its efficiency. There are two types of possible adjustments to be carried out: natural adjustments which require the increase of the resources used, and managerial adjustments which require the decrease of the resources used. While the first only require the increase of the inputs, the second involve the modification of managerial policies which improve the results. The study enables a grouping of the health systems into four blocks in which the efficiencies can be attained through natural y/o managerial adjustments. Conclusion: The lack of efficiency can always be solved through the increase of the budget provision and only in some cases via the improvement of resource management policies.