Evaluating the Financial Efficiency of the Healthcare System: A Three-Stage DEA Model Analysis

Aida S. Omir, Aksana Zh. Panzabekova, Azimkhan A. Satybaldin


Relevance. Public health effectiveness is crucial for population health, especially in the face of global challenges like the COVID-19 pandemic. The study applies the Data Envelopment Analysis (DEA) model to measure the efficiency of operating costs in the health care system across various regions of Kazakhstan from 2017 to 2021. Existing methods for assessing healthcare effectiveness often overlook the system's complexity, which turns DEA into a valuable tool to identify inequalities in healthcare availability and quality.

Research objective. This study aims to employ the DEA model to measure the efficiency of operating costs in the health care system across regions of Kazakhstan in 2017-2021.

Data and methods. The DEA model was chosen for its ability to analyze the efficiency of operating costs. Data were collected from the Agency for Strategic Planning and Reforms of the Republic of Kazakhstan.

Results. Our findings indicate the need for increased healthcare financing in specific regions, emphasizing the importance of transparent spending. The study concludes that the DEA model can regularly assess health financing, ensuring resources are directed where most needed. The novelty lies in establishing a link between financing and health outcomes.

Conclusions.  The study's results and methodology can be used by public health authorities in assessing operating costs' effectiveness, allocating resources judiciously, and making informed decisions to enhance the healthcare system.


Healthcare system, efficiency analysis, regions, regional economy, Data Envelopment Analysis, Kazakhstan

Full Text:



Ahmed, S., Hasan, Md., MacLennan, M. (2019). Measuring the efficiency of health systems in Asia: a data envelopment analysis. BMJ Open, 9 (22), 1-12. http://dx.doi.org/10.1136/bmjopen-2018-022155

Alexander, C. A., Gary B., & Karl S. (2003). Implementing and interpreting a data envelopment analysis model to assess the efficiency of health systems in developing countries. IMA Journal of Management Mathematics, 14(1), 49–63. https://doi.org/10.1093/imaman/14.1.49

Amagoh, F. (2021). Healthcare Policies in Kazakhstan. Palgrave Macmillan Singapore, VII, 110. https://doi.org/10.1007/978-981-16-2370-7

Anderson, G. F., Reinhardt, U. E., Hussey, P. S., & Petrosyan, V. (2003). It’s The Prices, Stupid: Why The United States Is So Different From Other Countries. Health Affairs, 22(3), 89–105. https://doi.org/10.1377/hlthaff.22.3.89

Cylus J, & Pearson M. (2016). Health System Efficiency: How to Make Measurement Matter for Policy and Management. London: World Health Organization; 139-166. https://pubmed.ncbi.nlm.nih.gov/28783269/

Doskeyeva, G. Zh., Rakhimbekova, A. E., Zhamkeyeva, M. K., Saudambekova, I. D., & Bekova, R. Zh. (2018). Health Care Financing System in the Republic of Kazakhstan. European Research Studies Journal, 21(2), 282–288. https://doi.org/10.35808/ersj/1002

Evans, D. B., Tandon, A., Murray, C. J. L., & Lauer, J. A. (2001). Comparative efficiency of national health systems: cross national econometric analysis. BMJ, 323(7308), 307–310. https://doi.org/10.1136/bmj.323.7308.307

Glynn, E. H. (2022). Corruption in the health sector: A problem in need of a systems-thinking approach. Frontiers in Public Health, 10, 1-13. https://doi.org/10.3389/fpubh.2022.910073

Gong, C., & Kang, H.-W. (2023). Resource Allocation Efficiency of Urban Medical and Health Financial Expenditure Under the Background of Employees’ Health. Risk Management and Healthcare Policy, 16, 1059–1074. https://doi.org/10.2147/rmhp.s412514

Greer, S. L., Bekker, M., de Leeuw, E., Wismar, M., Helderman, J.-K., Ribeiro, S., & Stuckler, D. (2017). Policy, politics and public health. European Journal of Public Health, 27 (4), 40–43. https://doi.org/10.1093/eurpub/ckx152

Hejduková, P., & Kureková, L. (2016). National Health Systems’ Performance: Evaluation WHO Indicators. Procedia - Social and Behavioral Sciences, 230, 240–248. https://doi.org/10.1016/j.sbspro.2016.09.031

Hollingsworth, B. (2008). The measurement of efficiency and productivity of health care delivery. Health Economics, 17(10), 1107–1128. https://doi.org/10.1002/hec.1391

Jovanovic, S. (2013). Prognostic value of tissue expression of matrix metalloproteinase. ESP Abstracts 2013. Virchows Archiv, 463(2), 101–352. https://doi.org/10.1007/s00428-013-1444-y

Kireyeva, A. A., Nurlanova, N. K., & Kredina, A. A. (2022). Assessment of the socio-economic performance of vulnerable and depressed territories in Kazakhstan. R-Economy, 8(1), 21–31. https://doi.org/10.15826/recon.2022.8.1.002

Kuhlmann, E., Batenburg, R., Wismar, M., Dussault, G., Maier, C. B., Glinos, I. A., Azzopardi-Muscat, N., Bond, C., Burau, V., Correia, T., Groenewegen, P. P., Hansen, J., Hunter, D. J., Khan, U., Kluge, H. H., Kroezen, M., Leone, C., Santric-Milicevic, M., Sermeus, W., & Ungureanu, M. (2018). Health Research Policy and Systems, 16(1), 1-8. https://doi.org/10.1186/s12961-018-0333-x

Liu, H., Wu, W., & Yao, P. (2021). Assessing the financial efficiency of healthcare services and its influencing factors of financial development: fresh evidences from three-stage DEA model based on Chinese provincial level data. Environmental Science and Pollution Research, 29(15), 21955–21967. https://doi.org/10.1007/s11356-021-17005-4

Onwujekwe, O., Ezumah, N., Mbachu, C. et al. (2019). Exploring effectiveness of different health financing mechanisms in Nigeria; what needs to change and how can it happen?. BMC Health Serv Res 19, 661-680. https://doi.org/10.1186/s12913-019-4512-4

Pecoraro, P., Gallè, F., Muscariello, E., Di Mauro, V., Daniele, O., Forte, S., Ricchiuti, R., Liguori, G., & Valerio, G. (2021). A telehealth intervention for ensuring continuity of care of pediatric obesity during the CoVid-19 lockdown in Italy. Nutrition, Metabolism and Cardiovascular Diseases, 31(12), 3502–3507. https://doi.org/10.1016/j.numecd.2021.09.026

Radojicic, M., Jeremic, V., & Savic, G. (2019). Going beyond health efficiency: What really matters? The International Journal of Health Planning and Management, 35(1), 318–338. https://doi.org/10.1002/hpm.2914

Servan-Mori, E., Avila-Burgos, L., Nigenda, G., & Lozano, R. (2016). A Performance Analysis of Public Expenditure on Maternal Health in Mexico. PLOS ONE, 11(4), e0152635. https://doi.org/10.1371/journal.pone.0152635

Squires, D. & Anderson, C. (2015). U.S. health care from a global perspective: spending, use of services, prices, and health in 13 countries. PubMed, 15. 1-15. https://pubmed.ncbi.nlm.nih.gov/26591905/

Stefko, R., Gavurova, B., & Kocisova, K. (2018). Healthcare efficiency assessment using DEA analysis in the Slovak Republic. Health Economics Review, 8(1), 1-12. https://doi.org/10.1186/s13561-018-0191-9

Varabyova Y, & Müller J-M. (2016). The efficiency of health care production in OECD countries: A systematic review and metaanalysis of cross-country comparisons [Review of The efficiency of health care production in OECD countries: A systematic review and metaanalysis of cross-country comparisons]. Health Policy (New York), 120(3), 252-263. https://pubmed.ncbi.nlm.nih.gov/26819140/

Ivankova, Viera & Rigelský, Martin & Kotulic, Rastislav & Gonos, Jaroslav. (2020). The governance of efficient healthcare financing system in OECD countries. Polish Journal of Management Studies. 21. 179-194. https://doi.org/10.17512/pjms.2020.21.2.13

Onwujekwe, O., Ezumah, N., Mbachu, C. et al. (2019). Exploring effectiveness of different health financing mechanisms in Nigeria; what needs to change and how can it happen?. BMC Health Serv Res 19, 661, 1-13. https://doi.org/10.1186/s12913-019-4512-4

Voskanyan, M. (2020). Economic impact of COVID-19 pandemic in Armenia. R-Economy, 6(3), 183–195. https://doi.org/10.15826/recon.2020.6.3.016

Yermukhanova, L., Buribayeva, Z., Abdikadirova, I., Tursynbekova, A., & Kurganbekova, M. (2022). SWOT Analysis and Expert Assessment of the Effectiveness of the Introduction of Healthcare Information Systems in Polyclinics in Aktobe, Kazakhstan. Journal of preventive medicine and public health, 55(6), 539–548. https://doi.org/10.3961/jpmph.22.360

Wallace, L. S. (2013). A View Of Health Care Around The World. The Annals of Family Medicine, 11(1), 84–84. Ncbi. https://doi.org/10.1370/afm.1484

Worthington, A. C. (2004). Frontier efficiency measurement in health care: a review of empirical techniques and selected applications. Med Care Res Rev., 61(2), 135–149. https://pubmed.ncbi.nlm.nih.gov/15155049/

Wranik, D. (2011). Healthcare policy tools as determinants of health-system efficiency: evidence from the OECD. Health Economics, Policy and Law, 7(2), 197–226. https://doi.org/10.1017/s1744133111000211

Wu, J.-S. (2023). Applying frontier approach to measure the financial efficiency of hospitals. Digital Health, 9, 1-13. https://doi.org/10.1177/20552076231162987

DOI: https://doi.org/10.15826/recon.2023.9.4.022

Copyright (c) 2024 Aida S. Omir, Aksana Zh. Panzabekova, Azimkhan A. Satybaldin

Сertificate of registration media Эл № ФС77-80764 от 28.04.2021
Online ISSN 2412-0731