Benchmarking the Efficiency of Health Systems Across the European Union: A Data Envelopment Analysis Approach

Abstract

Between 2014 and 2022, the European Union faced a series of complex challenges,
stemming, on the one hand, from the prolonged effects of the 2008 financial crisis and, on
the other hand, the outbreak of the COVID-19 pandemic, which caused profound social and
economic changes. In response to these pressures, healthcare systems across the EU
underwent significant adjustments — both in terms of structural organization and financing
— under the guidance of policymakers. Amidst this socioeconomic turmoil, performance
evaluation has emerged as a critical means of safeguarding the operational integrity of
healthcare systems and ensuring the continued quality of healthcare delivery. As part of
this effort, Data Envelopment Analysis (DEA) has proven to be a particularly valuable tool,
as it assesses the extent to which inputs are effectively converted into outputs, allowing for
both cross-country comparisons and the detection of improvements in performance. This
study aims to evaluate the technical efficiency of the 27 EU Member States by applying DEA
models under the assumption of constant (CRS), variable (VRS), non-increasing (NIRS), and
non-decreasing (NDRS) returns to scale. The objective is to identify fully efficient countries,
investigate the possible causes of inefficiency, and propose policy recommendations to
improve the performance of national healthcare systems.
JEL Classifications: C61, D24, H51, I18

Keywords: Health care systems, Efficiency, Data Envelopment Analysis (DEA),
Benchmarking, European Union