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Healthcare Expenditure and Health System Efficiency in 25 European Countries: A Multidimensional Data Envelopment
Antonio Pinto1, Flavia Pennisi1,2, Carlo Signorelli1
1Faculty of Medicine, University Vita-Salute San Raffaele, 20132 Milan, Italy.
Epidemiologia (Basel, Switzerland)
|July 24, 2026
Summary
European health systems show varied efficiency, with higher spending not always equating to better outcomes. Resource conversion into measurable health and prevention is key for system performance.
Area of Science:
- Health Economics
- Public Health Policy
- Comparative Health Systems Analysis
Background:
- European health systems face increasing pressure from aging populations, post-pandemic backlogs, and budget constraints.
- Significant disparities in health outcomes exist across European countries despite similar healthcare spending levels.
- This study assesses European health system efficiency using a comprehensive framework integrating expenditure, prevention, and population health.
Purpose of the Study:
- To evaluate the relative efficiency of 25 European health systems.
- To analyze the relationship between healthcare expenditure, prevention efforts, and health outcomes.
- To identify factors influencing health system inefficiency.
Main Methods:
- Cross-sectional analysis of 25 European countries using 2022 data.
- Data Envelopment Analysis (DEA) model with healthcare expenditure as inputs and health outcomes/prevention coverage as outputs.
- Bootstrap bias correction and Simar-Wilson regression to assess robustness and contextual factors.
Main Results:
- In the baseline DEA, 8 countries achieved technical efficiency; others showed inefficiency scores up to 2.617.
- Germany, Austria, Belgium, Ireland, and France exhibited the highest inefficiency.
- Higher GDP per capita correlated with increased inefficiency, while aging, obesity, and tobacco use did not show significant associations.
Conclusions:
- Higher healthcare expenditure does not guarantee superior performance when health outcomes and prevention are considered.
- Results are sensitive to methodology (e.g., inclusion of physician density, bootstrap correction), highlighting DEA's exploratory nature.
- Effective conversion of financial and workforce resources into measurable health and prevention outputs is crucial for improving health system performance.
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