Production and quality performance of healthcare services in EU countries during the economic crisis

Healthcare systems are facing tremendous pressure to reduce costs while providing better services without lowering their quality. By utilizing a two-stage network DEA approach we explore whether there is a trade-off between service production and service quality in the healthcare delivery process at a country level. While the first stage deals with production performance of the healthcare systems, the second stage deals with service quality using patient reported safety and satisfaction measures. A critical aspect in this evaluation process is to examine how well the health systems perform from the perspective of the people they are intended to benefit, especially under the current surge of economic crisis. The health systems performance of the European Union member states is assessed, using cross-sectional data from the Eurobarometer survey and Eurostat from 2009 to 2013. In order to dynamically analyze the productivity changes during the economic crisis the corresponding Malmquist index was also developed. The results revealed that the overall technical efficiency increased during the study period. However, the inherent trade-off between health production and service quality was significantly raised indicating that the efficiency gains of several countries were achieved either by sacrificing production or quality. Results also indicate that the economic crisis provided improvement in the technical efficiency, although the technological frontier has presented a negative shift.