Journals / Dumlupınar Üniversitesi Sosyal Bilimler Dergisi / 2026 / Sayı: 91

Efficiency in Transforming Economic Resources into Healthy Life Expectancy and Sex-Specific Differences: A DEA and Malmquist Analysis of 27 European Countries

Ekonomik Kaynakların Sağlıklı Yaşam Süresine Dönüşüm Etkinliği ve Cinsiyete Göre Farklılaşması: 27 Avrupa Ülkesi için VZA ve Malmquist Analizi

Bilge Meydan(DUMLUPINAR ÜNİVERSİTESİ)0000-0003-1478-5999
Pages
558–581
Publication Date
2026-10-27
DOI
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

The findings indicate that static efficiency, productivity change, and sex-specific relative performance yield different country patterns.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:This study examines how efficiently 27 European countries transformed constant-PPP GDP per capita into healthy life years at birth for women and men during 2015-2023.
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Key Findings & Data:The analysis uses a balanced panel of 243 country-year observations.
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Conclusion & Impact:The findings indicate that static efficiency, productivity change, and sex-specific relative performance yield different country patterns.
🔬Design:Modeling & Simulation
📍Scope:2015-2023 Verileri
⚙️Variables:Doğuşta sağlıklı yaşam süresi · Dönüşüm etkinliği · Cinsiyet farklılıkları

Abstract

This study examines how efficiently 27 European countries transformed constant-PPP GDP per capita into healthy life years at birth for women and men during 2015-2023. The analysis uses a balanced panel of 243 country-year observations. Output-oriented CCR and BCC Data Envelopment Analysis models estimate technical and scale efficiency, while the Malmquist index measures total factor productivity change. Sex-specific outcomes are examined through separate models and a common BCC frontier. Bulgaria was CCR- and BCC-efficient throughout the nine-year period. Average annual total factor productivity declined by 2.1% because improvement in efficiency change did not offset technological regress. Türkiye ranked tenth in average BCC efficiency and second in average CCR efficiency but recorded a cumulative productivity loss of 25.3%. Under the common frontier, male BCC scores exceeded female scores most in the Netherlands and Türkiye, whereas female scores exceeded male scores most in Bulgaria and Lithuania. The price-level coefficient was positive and statistically significant in the country and period fixed-effects model, although its magnitude varied across specifications. The findings indicate that static efficiency, productivity change, and sex-specific relative performance yield different country patterns.

Özet

Bu çalışma, 27 Avrupa ülkesinde sabit PPP kişi başına GSYH’nin kadın ve erkeklerin doğuşta sağlıklı yaşam süresine dönüşüm etkinliğini ve bu etkinliğin 2015-2023 dönemindeki değişimini incelemektedir. Analiz, 243 ülke-yıl gözleminden oluşan dengeli panele dayanmaktadır. Çıktı yönelimli CCR ve BCC Veri Zarflama Analiziyle teknik ve ölçek etkinliği, Malmquist endeksiyle toplam faktör verimliliği değişimi ve bileşenleri hesaplanmıştır. Cinsiyete özgü dönüşüm, ayrı tek çıktılı modellerin yanı sıra kadın ve erkek gözlemlerini aynı referans kümesinde değerlendiren ortak BCC sınırıyla incelenmiştir. Fiyat düzeyi ile toplam faktör verimliliği değişimi arasındaki ilişki panel modelleriyle tahmin edilmiştir. Bulgaristan dokuz yıl boyunca CCR ve BCC etkin bulunmuştur. Dönem genelinde toplam faktör verimliliği yıllık ortalama %2,1 azalmış; etkinlik değişimindeki artış teknolojik gerilemeyi karşılayamamıştır. Türkiye, ortalama BCC skorunda onuncu ve CCR skorunda ikinci sırada yer alırken kümülatif toplam faktör verimliliği kaybı %25,3 olmuştur. Ortak sınırda erkek BCC skorunun kadın skorundan en fazla yüksek olduğu ülkeler Hollanda (0,0493) ve Türkiye (0,0448); kadın skorunun erkek skorundan en fazla yüksek olduğu ülkeler Bulgaristan (0,0570) ve Litvanya’dır (0,0527). Fiyat düzeyi katsayısı ülke ve dönem sabit etkili modelde pozitif ve istatistiksel olarak anlamlı bulunmuş, ancak katsayının büyüklüğü model tanımına göre değişmiştir.

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Cite This Article

Meydan, B. (2026). Efficiency in Transforming Economic Resources into Healthy Life Expectancy and Sex-Specific Differences: A DEA and Malmquist Analysis of 27 European Countries. Dumlupınar Üniversitesi Sosyal Bilimler Dergisi, Sayı: 91, 558–581. https://ajindex.com/articles/1667687

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References (47)

  1. Afonso, A., & St. Aubyn, M. (2011). Assessing health efficiency across countries with a two-step and bootstrap analysis. Applied Economics Letters, 18(15), 1427-1430. doi: 10.1080/13504851.2010.541149
  2. Alaimo, L. S., & Nigri, A. (2024). The gender gap in life expectancy and lifespan disparity as social risk indicators for international countries: A fuzzy clustering approach. Socio-Economic Planning Sciences, 91, 101712. doi: 10.1016/j.seps.2023.101712
  3. Asandului, L., Roman, M., & Fatulescu, P. (2014). The efficiency of healthcare systems in Europe: A data envelopment analysis approach. Procedia Economics and Finance, 10, 261-268. doi: 10.1016/S2212-5671(14)00301-3
  4. Aydın, A. (2022). Benchmarking healthcare systems of OECD countries: A DEA-based Malmquist productivity index approach. Alphanumeric Journal, 10(1), 25-40. doi: 10.17093/alphanumeric.1057559
  5. Banker, R. D., Charnes, A., & Cooper, W. W. (1984). Some models for estimating technical and scale inefficiencies in data envelopment analysis. Management Science, 30(9), 1078-1092. doi: 10.1287/mnsc.30.9.1078
  6. Barthold, D., Nandi, A., Mendoza Rodríguez, J. M., & Heymann, J. (2014). Analyzing whether countries are equally efficient at improving longevity for men and women. American Journal of Public Health, 104(11), 2163-2169. doi: 10.2105/AJPH.2013.301494
  7. Cameron, A. C., & Miller, D. L. (2015). A practitioner’s guide to cluster-robust inference. Journal of Human Resources, 50(2), 317-372. doi: 10.3368/jhr.50.2.317
  8. Caves, D. W., Christensen, L. R., & Diewert, W. E. (1982). The economic theory of index numbers and the measurement of input, output, and productivity. Econometrica, 50(6), 1393-1414. doi: 10.2307/1913388
  9. Charnes, A., Cooper, W. W., & Rhodes, E. (1978). Measuring the efficiency of decision making units. European Journal of Operational Research, 2(6), 429-444. doi: 10.1016/0377-2217(78)90138-8
  10. Cooper, W. W., Seiford, L. M., & Tone, K. (2007). Data envelopment analysis: A comprehensive text with models, applications, references and DEA-Solver software (2nd ed.). Springer. doi: 10.1007/978-0-387-45283-8
  11. Di Lego, V., Nepomuceno, M. R., & Turra, C. M. (2025). Gender gaps in healthy life expectancy as indicators of inequality for disability and chronic disease: Cross-sectional evidence from 24 countries, years 2014-2019. BMJ Open, 15(11), e096968. doi: 10.1136/bmjopen-2024-096968
  12. Dlouhý, M., & Havlík, P. (2024). Efficiency evaluation of 28 health systems by MCDA and DEA. Health Economics Review, 14, 59. doi: 10.1186/s13561-024-00538-y
  13. Eurostat. (2026a). Healthy life years by sex (from 2004 onwards) [Data set]. doi: 10.2908/hlth_hlye
  14. Eurostat. (2026b). Healthy life years: Reference metadata. 28 Temmuz 2026 tarihinde https://ec.europa.eu/eurostat/cache/metadata/en/hlth_hlye_esms.htm adresinden erişildi.
  15. Färe, R., Grosskopf, S., Norris, M., & Zhang, Z. (1994). Productivity growth, technical progress, and efficiency change in industrialized countries. American Economic Review, 84(1), 66-83.
  16. Farrell, M. J. (1957). The measurement of productive efficiency. Journal of the Royal Statistical Society: Series A (General), 120(3), 253-290. doi: 10.2307/2343100
  17. GBD 2016 DALYs and HALE Collaborators. (2017). Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: A systematic analysis for the global burden of disease study 2016. The Lancet, 390(10100), 1260-1344. doi: 10.1016/S0140-6736(17)32130-X
  18. Hadad, S., Hadad, Y., & Simon-Tuval, T. (2013). Determinants of healthcare system’s efficiency in OECD countries. The European Journal of Health Economics, 14(2), 253-265. doi: 10.1007/s10198-011-0366-3
  19. Kaya Samut, P., & Cafrı, R. (2016). Analysis of the efficiency determinants of health systems in OECD countries by DEA and panel Tobit. Social Indicators Research, 129(1), 113-132. doi: 10.1007/s11205-015-1094-3
  20. Kujawska, J. (2018). Efficiency of healthcare systems in European countries—The DEA network approach. Metody Ilościowe w Badaniach Ekonomicznych, 19(1), 60-70. doi: 10.22630/MIBE.2018.19.1.6
  21. Lacko, R., Hajduová, Z., Bakalár, T., & Pavolová, H. (2023). Efficiency and productivity differences in healthcare systems: The case of the European Union. International Journal of Environmental Research and Public Health, 20(1), 178. doi: 10.3390/ijerph20010178
  22. Mackenbach, J. P., Rubio Valverde, J., Artnik, B., Bopp, M., Brønnum-Hansen, H., Deboosere, P., Kalediene, R., Kovács, K., Leinsalu, M., Martikainen, P., Menvielle, G., Regidor, E., Rychtaríková, J., Rodriguez-Sanz, M., Vineis, P., White, C., Wojtyniak, B., Hu, Y., & Nusselder, W. J. (2018). Trends in health inequalities in 27 European countries. Proceedings of the National Academy of Sciences of the United States of America, 115(25), 6440-6445. doi: 10.1073/pnas.1800028115
  23. Mackenbach, J. P., Rubio Valverde, J., Bopp, M., Brønnum-Hansen, H., Deboosere, P., Kalediene, R., Kovács, K., Leinsalu, M., Martikainen, P., Menvielle, G., Regidor, E., & Nusselder, W. J. (2019). Determinants of inequalities in life expectancy: An international comparative study of eight risk factors. The Lancet Public Health, 4(10), e529-e537. doi: 10.1016/S2468-2667(19)30147-1
  24. Malmquist, S. (1953). Index numbers and indifference surfaces. Trabajos de Estadística, 4(2), 209-242. doi: 10.1007/BF03006863
  25. Moutinho, V., & Madaleno, M. (2021). A two-stage DEA model to evaluate the technical eco-efficiency indicator in the EU countries. International Journal of Environmental Research and Public Health, 18(6), 3038. doi: 10.3390/ijerph18063038
  26. OECD. (2026). Annual GDP and consumption per capita, US dollars, volume, constant PPPs, reference year 2020 [Data set]. OECD Data Explorer. 28 Ağustos 2026 tarhinde https://data-explorer.oecd.org/vis?df%5Bag%5D=OECD.SDD.NAD&df%5Bds%5D=dsDisseminateFinalDMZ&df%5Bid%5D=DSD_NAMAIN10%40DF_TABLE1_EXPENDITURE_HVPVOB adresinden erişildi
  27. Puertas, R., Marti, L., & Guaita-Martinez, J. M. (2020). Innovation, lifestyle, policy and socioeconomic factors: An analysis of European quality of life. Technological Forecasting and Social Change, 160, 120209. doi: 10.1016/j.techfore.2020.120209
  28. Ray, S. C., & Desli, E. (1997). Productivity growth, technical progress, and efficiency change in industrialized countries: Comment. American Economic Review, 87(5), 1033-1039.
  29. Retzlaff-Roberts, D., Chang, C. F., & Rubin, R. M. (2004). Technical efficiency in the use of health care resources: A comparison of OECD countries. Health Policy, 69(1), 55-72. doi: 10.1016/j.healthpol.2003.12.002
  30. Rubio Valverde, J. R., Mackenbach, J. P., & Nusselder, W. J. (2021). Trends in inequalities in disability in Europe between 2002 and 2017. Journal of Epidemiology and Community Health, 75(8), 712-720. doi: 10.1136/jech-2020-216141
  31. Sart, G., Bayar, Y., & Danilina, M. (2024). Impact of education and income inequalities on life expectancy: Insights from the new EU members. Frontiers in Public Health, 12, 1397585. doi: 10.3389/fpubh.2024.1397585
  32. Schnabel, S. K., & Eilers, P. H. C. (2009). An analysis of life expectancy and economic production using expectile frontier zones. Demographic Research, 21, 109-134. doi: 10.4054/DemRes.2009.21.5
  33. Seddighi, H., Nosrati Nejad, F., & Basakha, M. (2020). Health systems efficiency in Eastern Mediterranean Region: A data envelopment analysis. Cost Effectiveness and Resource Allocation, 18, 22. doi: 10.1186/s12962-020-00217-9
  34. Simar, L., & Wilson, P. W. (1999). Estimating and bootstrapping Malmquist indices. European Journal of Operational Research, 115(3), 459-471. doi: 10.1016/S0377-2217(97)00450-5
  35. Simar, L., & Wilson, P. W. (2007). Estimation and inference in two-stage, semi-parametric models of production processes. Journal of Econometrics, 136(1), 31-64. doi: 10.1016/j.jeconom.2005.07.009
  36. Simar, L., & Wilson, P. W. (2011). Two-stage DEA: Caveat emptor. Journal of Productivity Analysis, 36(2), 205-218. doi: 10.1007/s11123-011-0230-6
  37. Stanciu, S. M., Rusu, E., Jinga, M., Ursu, C. G., Stanciu, R. I., Miricescu, D., Antohi, V. M., & Barbu, E. (2024). Multivariate analysis of the determinants of total mortality in the European Union with focus on fat intake, diabetes, myocardial infarction, life expectancy, and preventable mortality: A panel data fixed-effects panel data model approach. Journal of Cardiovascular Development and Disease, 11(10), 328. doi: 10.3390/jcdd11100328
  38. Straka, J., Šídlo, L., & Kulhánová, I. (2024). Trends in healthy life years between 2005 and 2019 in 31 European countries: The compression or expansion of morbidity? International Journal of Public Health, 69, 1607574. doi: 10.3389/ijph.2024.1607574
  39. Tavares, A. I. (2022). Life expectancy at 65, associated factors for women and men in Europe. European Journal of Ageing, 19(4), 1213-1227. doi: 10.1007/s10433-022-00695-1
  40. Țarcă, V., Țarcă, E., & Moscalu, M. (2024, June). Social and economic determinants of life expectancy at birth in Eastern Europe. In Healthcare (Vol. 12, No. 11, p. 1148). MDPI. doi: 10.3390/healthcare12111148
  41. Türkiye İstatistik Kurumu. (2025a). Avrupa ülkelerinde cinsiyete göre doğuşta sağlıklı yaşam süreleri, 2015-2023 [Veri tablosu]. 27 Aralık 2025 tarihinde https://data.tuik.gov.tr/ adresinden erişildi
  42. Türkiye İstatistik Kurumu. (2025b). Ülkeler itibarıyla fiyat düzeyi endeksleri, 2013-2024 (AB27=100) [Veri tablosu]. 27 Aralık 2025 tarihinde https://data.tuik.gov.tr/ adresinden erişildi
  43. Van Oyen, H., Nusselder, W., Jagger, C., Kolip, P., Cambois, E., & Robine, J.-M. (2013). Gender differences in healthy life years within the EU: An exploration of the “health-survival” paradox. International Journal of Public Health, 58(1), 143-155. doi: 10.1007/s00038-012-0361-1
  44. Varabyova, Y., & Schreyögg, J. (2013). International comparisons of the technical efficiency of the hospital sector: Panel data analysis of OECD countries using parametric and non-parametric approaches. Health Policy, 112(1-2), 70-79. doi: 10.1016/j.healthpol.2013.03.003
  45. Varbanova, V., Hens, N., & Beutels, P. (2023). Determinants of life-expectancy and disability-adjusted life years (DALYs) in European and Organisation for Economic Co-operation and Development (OECD) countries: A longitudinal analysis (1990-2019). SSM—Population Health, 24, 101484. doi: 10.1016/j.ssmph.2023.101484
  46. Yeşilaydın, G., & Saraç, B. (2025). The efficiency of health systems in European Union (EU) countries with undesirable output: A DEA-slack-based model approach. Verimlilik Dergisi, 59(4), 893-908. doi: 10.51551/verimlilik.1638688
  47. country study. PLOS ONE, 16(7), e0253450. doi: 10.1371/journal.pone.0253450