Journal of Applied Economic Research
ISSN 2712-7435
Comparative Analysis of Municipal Healthcare Efficiency Using the DEA Method: The Case of Sverdlovsk Region
Svetlana V. Begicheva, Elena G. Kalabina, Dmitry M. Nazarov
Ural State University of Economics, Yekaterinburg, Russia
Abstract
The primary task of government bodies responsible for the formation and implementation of health policy is to ensure the availability and quality of medical care, subject to the efficient use of resources in each constituent entity of the Russian Federation. However, territorial differences in the distribution and use of resources can lead to differences in the efficiency of medical organizations. The relevance of the study is due to the need to assess these differences in order to develop measures to optimize the functioning of municipal health care systems. The aim of the study is to conduct a comparative analysis of the efficiency of municipal health care systems in the Sverdlovsk region from 2012 to 2021 in order to identify problems associated with ensuring equal access to quality medical care in the region and caused by territorial inequalities in the distribution and use of health care resources. The hypothesis of the study suggests that the efficiency of municipal health care systems demonstrates significant territorial differences and is characterized by relative stability over time, with the exception of periods of crisis. The efficiency assessment was performed using the Data Envelopment Analysis (DEA) method. The visualization of the research results was carried out using cartograms. The information base of the research was the annual reports of the Medical Information and Analytical Center of the Sverdlovsk Region. The research sample was compiled on the basis of open data on the resources and activities of medical institutions of 56 municipalities for the period from 2012 to 2021. During the study, disproportion in the distribution and use of resources by medical institutions of municipalities were identified. Differences in the efficiency of medical institutions of municipalities were determined, groups of relatively efficient and inefficient municipal healthcare systems were identified, and for the latter, potential opportunities for optimizing the use of resources while maintaining the current level of medical services were calculated. The results of the study confirm the stability of territorial differences and can be used in developing strategies to improve the efficiency of municipal healthcare management.
Keywords
performance evaluation; Data Envelopment Analysis; DEA method; operational environment analysis; municipal health care; health care; medical institutions
JEL classification
C61, D61, I14References
1. Asandului, L., Roman, M., Fatulescu, P. (2014). The efficiency of healthcare systems in Europe: a data envelopment analysis approach. Procedia Economics and Finance, Vol. 10, 261–268. https://doi.org/10.1016/S2212-5671(14)00301-3
2.Popescu, C., Asandului, L., Fatulescu, P. (2014). A data envelopment analysis for evaluating Romania’s health system. Procedia-Social and Behavioral Sciences, Vol. 109, 1185–1189. https://doi.org/10.1016/j.sbspro.2013.12.609
3. Rugol, L., Son, I., Starodubov, V., Menshikova, L. (2020). Problems related to inpatient care organization and approaches towards its modernization. Social Aspects of Population Health, Vol. 66, No. 1, 1. (In Russ.). https://doi.org/10.21045/2071-5021-2020-66-1-1
4. Chernew, M. (2010). Health Care Spending Growth: Can We Avoid Fiscal Armageddon? INQUIRY: The Journal of Health Care Organization, Provision, and Financing, Vol. 47, Issue 4, 285–295. https://doi.org/10.5034/inquiryjrnl_47.04.285
5. Kalashnikov, K.N. (2015) Resource security of healthcare in Russia: issues of territorial differentiation. Economic and Social Changes: Facts, Trends, Forecast, Vol. 37, No. 1, 72–87. (In Russ.). https://doi.org/10.15838/esc/2015.1.37.5
6. Chereshnev, V.A., Krivenko, N.V., Krylov, V.G. (2021) Comprehensive assessment of the efficiency and sustainability of the regional health care system. Economy of Regions, Vol. 17. No. 1, 31–43. (In Russ.). https://doi.org/10.17059/ekon.reg.2021-1-3
7. Travnikova, D.A. (2021) Evaluation of performance indicators of municipal and regional health management bodies in the Sverdlovsk region with the use of the rating method. Discussion, Vol. 104, No. 1, 31–40. (In Russ.). https://doi.org/10.24411/2077-7639-2019-10089
8. Ivina, V.Yu., Karmatskikh, O.G., Anufrieva, E.V. (2022) Assessment of the effectiveness of management of the activities of a medical organization to reduce mortality from diseases of the circulatory system based on the analysis of data on the activities of medical organizations of the Sverdlovsk Region for the period 2018-2020. Journal of Ural Medical Academic Science, Vol. 19, No. 5, 523–532. (In Russ.). https://doi.org/10.22138/2500-0918-2022-19-5-523-532
9. Safarov, M.A. (2023). Quality of accessibility vs quality accessibility of medical service in Russia: Measurement issues. Journal of New Economy, Vol. 24, No. 1, 126–141. https://doi.org/10.29141/2658-5081-2023-24-1-6
10. Jaafaripooyan, E., Emamgholipour, S., Raei, B. (2017). Efficiency measurement of health care organizations: What models are used? Medical Journal of the Islamic Republic of Iran, Vol. 31, Issue 1, 86. doi.org/10.14196/mjiri.31.86
11. Hollingsworth, B. (2008). The measurement of efficiency and productivity of health care delivery. Health Economics, Vol. 17, Issue 10, 1107–1128. https://doi.org/10.1002/hec.1391
12. Hussey, P.S., de Vries, H., Romley, J., Wang, M.C., Chen, S.S., Shekelle, P.G., McGlynn, E.A. (2009) A systematic review of health care efficiency measures. Health Services Research, Vol. 44, Issue 3, 784–805. https://doi.org/10.1111/j.1475-6773.2008.00942.x
13. Charnes, A., Cooper, W., Rhodes, E. (1978). Measuring the efficiency of decision-making units. European Journal of Operational Research, Vol. 2, Issue 6, 429–444. https://doi.org/10.1016/0377-2217(78)90138-8
14. Charnes, A., Cooper, W., Lewin, A.Y., Seiford, L. (1994). Data Envelopment Analysis. Theory, Methodology and Applications. London, Kluwer Academic Publishers, 513 р. https://doi.org/10.1057/palgrave.jors.2600342
15. Birman, S.V., Pirondi, E., Rodin, E.Y. (2003). Application of DEA to medical clinics. Mathematical and Computer Modelling, Vol. 37, Issues 9-10, 923–936. https://doi.org/10.1016/S0895-7177(03)00108-0
16. Zere, E., Mbeeli, T., Shangula, K., Mandlhate, C., Mutirua, K., Tjivambi, B., Kapenambili, W. (2006). Technical efficiency of district hospitals: Evidence from Namibia using Data Envelopment Analysis. Сost Effectiveness and Resource Allocation, Vol. 4, 5. https://doi.org/10.1186/1478-7547-4-5
17. Banker, R.D., Charnes, A., Cooper, W. (1984). Some models for estimating technical and scale inefficiencies in data envelopment analysis. Management Science, Vol. 30, No. 9, 1078–1092. https://doi.org/10.1287/mnsc.30.9.1078
18. Jung, S, Son, J, Kim, C, Chung, K. (2023). Efficiency Measurement Using Data Envelopment Analysis (DEA) in Public Healthcare: Research Trends from 2017 to 2022. Processes, Vol. 11, Issue 3, 811. https://doi.org/10.3390/pr11030811
19. Cantor, V.J.M., Poh, K.L. (2017). Integrated Analysis of Healthcare Efficiency: A Systematic Review. Journal of Medical Systems, Vol. 42, 8. https://doi.org/10.1007/s10916-017-0848-7
20. Oikonomou, N., Tountas, Y., Mariolis, A., Souliotis, K., Athanasakis, K., Kyriopoulos, J. (2016). Measuring the efficiency of the Greek rural primary health care using a restricted DEA model; the case of southern and western Greece. Health Care Management Science, Vol. 19, 313–325. https://doi.org/10.1007/s10729-015-9324-4
21. Behr, A., Theune, K. (2017). Health System Efficiency: A Fragmented Picture Based on OECD Data. PharmacoEconomics Open, Vol. 1, 203–221. https://doi.org/10.1007/s41669-017-0010-y
22. Estellita Lins, M.P., Netto, S.O.A., de Castro Lobo, M.S. (2019). Multimethodology applied to the evaluation of Healthcare in Brazilian municipalities. Health Care Management Science, Vol. 22, 197–214. https://doi.org/10.1007/s10729-018-9432-z
23. Zhou, M. (2025). Equity and efficiency of public health resource allocation in China. BMC Public Health, Vol. 25, 283. https://doi.org/10.1186/s12889-025-21447-7
24. Cordero Ferrera, J.M., Cebada, E.C., Murillo Zamorano, L.R. (2014). The effect of quality and socio-demographic variables on efficiency measures in primary health care. The European Journal of Health Economics, Vol. 15, 289–302. https://doi.org/10.1007/s10198-013-0476-1
25. Sokolov, I.A., Filippova, I.N. (2020). Effectiveness of reforming the budget network in the health sector in the 2010s. World of New Economy, Vol. 14, No. 1, 108–122. (In Russ.). https://doi.org/10.26794/2220-6469-2020-14-1-108-122
26. Stefko, R., Gavurova, B., Kocisova, K. (2018). Healthcare efficiency assessment using DEA analysis in the Slovak Republic. Health Economics Review, Vol. 8, 6. https://doi.org/10.1186/s13561-018-0191-9
27. Miszczynska, K., Miszczyński, P.M. (2021). Measuring the efficiency of the healthcare sector in Poland – a window-DEA evaluation. International Journal of Productivity and Performance Management, Vol. 71, Issue 7, 2743–2770. https://doi.org/10.1108/IJPPM-06-2020-0276
28. Neradovskaya, Yu.V. (2023). A study of DEA-assessments sustainability of functioning of regional healthcare systems effectiveness. Economics and Management: Scientific and Practical Journal, No. 1, 109–114. (In Russ.). https://doi.org/10.34773/EU.2023.1.18
29. Frants, M.V., Shmakova, M.V. (2023). Effectiveness of healthcare expenditures in the Republic of Bashkortostan: assessment based on the DEA approach. Vestnik of Altai Academy of Economics and Law, No. 10-2, 267–273. (In Russ.). https://doi.org/10.17513/vaael.3022
30. Omir, A.S., Panzabekova, A.Zh., Satybaldin, A.A. (2023). Evaluating the Financial Efficiency of the Healthcare System: A Three-Stage DEA Model Analysis. R-Economy, Vol. 9, No. 4, 353–365. https://doi.org/10.15826/recon.2023.9.4.022
31. Kutyshkin, A.V., Shulgin, O.V. (2023). Use of nonparametric data analysis for assessing the efficiency of municipal medical institutions of the region. Bulletin of the South Ural State University. Series Computer Technology, Automatic Control, Radio Electronics, Vol. 23, No. 1, 57–66. (In Russ.). https://doi.org/10.14529/ctcr230105
32. Kutyshkin, A.V., Shulgin, O.V. (2022). Evaluation of the efficiency of district medical institutions by the method of data envelopment analysis (DEA). Fundamental Research, No. 5, 61–65. (In Russ.). https://doi.org/10.17513/fr.43255
33. Kohl, S., Schoenfelder, J., Fügener, A., Brunner, J.O. (2019). The use of Data Envelopment Analysis (DEA) in healthcare with a focus on hospitals. Health Care Management Science, Vol. 22, 245–286. https://doi.org/10.1007/s10729-018-9436-8
34. Murray, C.J., Frenk, J. (2008). Health metrics and evaluation: Strengthening the science. Lancet, Vol. 371, Issue 9619, 1191–1199. https://doi.org/10.1016/S0140-6736(08)60526-7
35. Avxentyev, N.A., Baydin, V.M., Zarubina, O.A., Sisigina, N.N., Kulkova, S.A. (2015). Healthcare spending efficiency in Russian regions. Farmakoekonomika. Modern Pharmacoeconomics and Pharmacoepidemiology, Vol. 8, No. 4, 10–20. https://doi.org/10.17749/2070-4909.2015.8.4.010-020
About Authors
Svetlana Viktorovna Begicheva
Candidate of Economic Sciences, Associate Professor, Department of Business Informatics, Ural State University of Economics, Yekaterinburg, Russia (620144, Yekaterinburg, 8 Marta/Narodnoy Voli street, 62/45); ORCID https://orcid.org/0000-0002-0551-1622 e-mail: begichevas@mail.ru
Elena Georgievna Kalabina
Doctor of Economics, Professor, Department of Enterprise Economics, Ural State University of Economics, Yekaterinburg, Russia (620144, Yekaterinburg, 8 Marta/Narodnoj Voli street, 62/45); ORCID https://orcid.org/0000-0002-3952-7665 e-mail: kalabina@mail.ru
Dmitry Mikhailovich Nazarov
Doctor of Economics, Professor Department of Business Informatics, Ural State University of Economics, Yekaterinburg, Russia (620144, Yekaterinburg, 8 Marta/Narodnoj Voli street, 62/45); ORCID https://orcid.org/0000-0002-5847-9718 e-mail: slup2005@mail.ru
For citation
Begicheva, S.V., Kalabina, E.G., Nazarov, D.M. (2025). Comparative Analysis of Municipal Healthcare Efficiency Using the DEA Method: The Case of Sverdlovsk Region. Journal of Applied Economic Research, Vol. 24, No. 2, 491-527. https://doi.org/10.15826/vestnik.2025.24.2.017
Article info
Received January 12, 2025; Revised February 24, 2025; Accepted March 4, 2025.
DOI: https://doi.org/10.15826/vestnik.2025.24.2.017
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