Using data envelopment analysis to address the challenges of comparing health system efficiency

Efficiency is one of the most potent measures of health system performance and is of particular interest to policy makers because it seeks to assess the valued outcomes of a health system in relation to the resources that are sacrificed to achieve those outcomes. However, the production process of the health care system is a complex sequence, and most indicators are only able to capture part of that process; these indicators offer limited scope for analysis. While researchers have previously constructed composite indicators which combine partial measures into a single number, the weights used for aggregating data can be contentious and may not be universally applicable across systems. Data envelopment analysis (DEA) is most often used to compare the productivity of different producing entities, including health systems. In this article, we instead propose a method that relies on DEA to construct composite health system efficiency indicators from several partial efficiency measures. Among other noted benefits, this enables the construction of composite indicators where different weights are attached to partial indicators for each country, allowing countries to be viewed according to the weights that cast each in the best light. Our application of this method suggests that there is reasonable consistency among the countries that are found to be efficient

Cultivating the Installed Base: The Introduction of e-Prescription in Greece

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Mapping the Future: Policy Applications of Climate Vulnerability Mapping in West Africa

We describe the development of climate vulnerability maps for three Sahelian countries – Mali, Burkina Faso, and Niger – and for coastal West Africa, with a focus on the way the maps were designed to meet decision-making needs and their ultimate influence and use in policy contexts. The paper provides a review of the literature on indicators and maps in the science-policy interface. We then assess the credibility, salience, and legitimacy of the maps as tools for decision-making. Results suggest that vulnerability maps are a useful boundary object for generating discussions among stakeholders with different objectives and technical backgrounds, and that they can provide useful input for targeting development assistance. We conclude with a discussion of the power of maps to capture policy maker attention, and how this increases the onus on map developers to communicate clearly uncertainties and limitations. The assessment of policy uptake in this paper is admittedly subjective; the article includes a discussion of ways to conduct more objective and rigorous assessments of policy impact so as to better evaluate the value and use of vulnerability mapping in decision-making processes