Efficiency—main concepts and significance in health system performance assessment

Efficiency, similar to many other dimensions of the healthcare system, is not unambiguously defined and this creates some difficulty in defining and measuring it. The World Health Organization and the Organization for Economic Cooperation and Development are developing international conceptual frameworks that provide a good basis for the development of national frameworks. In constructing these conceptual frameworks, one of the most complex interrelationships is represented by efficiency, which allows to evaluate what is achieved at the output in relation to what is placed at the input of the system. The aim of this study is to clarify the concepts and different approaches on efficiency and the significance of efficiency in health system performance assessment. Content analysis of scientific publications and international reports was conducted using PubMed, ScienceDirect, and Google Scholar with keywords in English. The main types of efficiency also considered in health care are technical and allocative. Technical efficiency refers to the physical dependency between resources used and a specific health outcome. Allocative efficiency refers to the choice between different technically efficient combinations of inputs used to obtain the maximum quantity of goods. To assess the relationship between inputs and outcomes in the healthcare system, the concept of efficiency is applied. When output-based indicators are used to measure efficiency, efficiency is equivalent to productivity. When outcome-based measures are used to measure efficiency, efficiency is equivalent to cost-effectiveness. Striving to achieve health system efficiency is a major issue for all health systems, made more urgent in many countries by adverse economic conditions and pressure on public finances