Evaluating the decentralisation of the Spanish healthcare system: a data envelopment analysis approach

Abstract

Objectives: The aim of the study was to answer whether the central government has been more efficient than the regional governments or vice versa. Likewise, through the analysis of the data, the aim was to shed light on whether decentralisation has had a positive impact on the efficiency of the hospital sector or not.

Design: In this paper, we have used data envelopment analysis to analyse the evolution of efficiency in the last 10 Autonomous Regions to receive healthcare competences at the end of 2001.

Participants: For this study, we have taken into account the number of beds and full-time workers as inputs and the calculation of basic care units as outputs to measure the efficiency of the Spanish public sector, private sector and jointly in the years 2002, 2007, 2012 and 2017 for the last Autonomous Regions receiving healthcare competences.

Results: Of the Autonomous Regions that received the transfers at the end of 2001, the following stand out for their higher efficiency growth: the Balearic Islands (81.44% improvement), the Madrid Autonomous Region, which practically reached absolute efficiency levels (having increased by 63.77%), and La Rioja which, together with the Balearic Islands which started from very low values, improved notably (46.13%).

Conclusion: In general, it can be observed that the transfer of responsibilities in the health sector has improved efficiency in the National Health Service.

Jel classification: C14; I18; H21.

Keywords: data envelopment analysis; devolution; efficiency; health decentralisation; national health system.

Figure 1

Comparison of the efficiency values of the National Health System of all autonomous regions (including Ceuta and Melilla) in 2002 and 2017.

Figure 2

Comparison of the efficiency values of the NHS and the private sector of all the autonomous regions (including Ceuta and Melilla) in 2002 and 2017. NHS, National Health Service.