Modeling European Health Regional Systems through a Directional Distance Function Metafrontier Framework. Are There Any Differences?

The current and future performance of regional health systems is responsible for increasing health costs and it depends on a wide range of contextual factors. Studies on regional health productive performance and on different health systems are scarce. This paper focuses on the efficiency of European healthcare systems at regional level across Europe, taking into account undesirable outcomes. Our analysis is based on data for a 14-year period (2000-2013) from a unique balanced panel comprising 185 European regions in 17 EU countries. Adopting a metafrontier directional distance function we investigate whether there is an actual difference in terms of efficiency performance among European regions considering the health system under which they operate. It is found that there are no great differences in terms of convergence among the groups, irrespective of the health system types. When the whole sample is considered, there is a convergence toward two levels of efficiency. Focusing on the distribution of technological gap over time, we found that the three systems did not allow its reduction homogeneously among the regions. The 2008 crisis may have played a crucial role in determining a different process of polarization among groups