Swedish Health Care Performance – Quantity versus Quality

This paper investigates the relative efficiency of 21 Swedish county councils through two efficiency models; one focusing on a traditional productivity measure (activity model) in terms of the production of intermediate outputs, and the other on quality outputs in the form of health-related outcomes (outcome model). Efficiency is estimated using Data Envelopment Analysis (DEA) and the two models are used to test whether there are significantly different efficiency estimates among the councils. The efficiency concept used consists of technical efficiency, here measured as cost efficiency, where the relationship between inputs and outputs for each council is compared to a “best practice” consisting of a production frontier. A weak positive correlation is found between the two models, indicating that cost efficiency regarding activities and outcomes may foremost be seen as complements in the production process. In a second stage, the efficiency scores in both models are used as dependent variables in multiple regressions with several independent structural factors that may be used to explain differences in efficiency. The paper finds that councils which are net receivers in the equalization grant system have lower efficiency scores in both models.Productive efficiency; quality indicators; data envelopment analysis; Tobit regression; Sweden