Is the quest for efficiency harmful to health equity? An examination of the health efficiency-equity nexus in OECD countries over the past two decades

Has the quest for efficiency in OECD health systems impacted the social gradient of health? We examined the cross-dynamics of the health system equity-efficiency nexus among OECD countries in the past two decades. We used a three-step methodology based on annual macro-level data from 36 OECD countri...

Celý popis

Uloženo v:

Podrobná bibliografie
Vydáno v:	Social science & medicine (1982) Ročník 383; s. 118379
Hlavní autoři:	Bousmah, Marwân-al-Qays, Abu-Zaineh, Mohammad, Combes, Simon, Ventelou, Bruno
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	England Elsevier Ltd 01.10.2025
Témata:	Efficiency, Organizational - standards Equity-efficiency tradeoff Granger causality Health Equity - standards Health Equity - statistics & numerical data Health Equity - trends Health system Humans Organisation for Economic Co-Operation and Development - organization & administration Organisation for Economic Co-Operation and Development - statistics & numerical data Reverse causality Socioeconomic Factors Stochastic frontier analysis Health system Reverse causality Equity-efficiency tradeoff Stochastic frontier analysis Granger causality
ISSN:	0277-9536, 1873-5347, 1873-5347
On-line přístup:	Získat plný text
Tagy:	Přidat tag Žádné tagy, Buďte první, kdo vytvoří štítek k tomuto záznamu!

Abstract	Has the quest for efficiency in OECD health systems impacted the social gradient of health? We examined the cross-dynamics of the health system equity-efficiency nexus among OECD countries in the past two decades. We used a three-step methodology based on annual macro-level data from 36 OECD countries for the period 2004–2021. First, we estimated the efficiency of health systems using a stochastic frontier analysis. We then assessed the equity of health systems using simple measures of income-related inequality in self-assessed health. Lastly, we estimated the dynamic relationship between health system efficiency and equity using a panel Granger causality analysis. We also stratified the analysis by type of health system: viz. publicly- vs. privately-dominated health service provision. We find evidence for a bidirectional causality between health system efficiency and equity. An increase in health system efficiency leads to an increase in socioeconomic inequalities in health; a result particularly salient in countries with predominantly private health service provision. Interestingly, decreases in socio-economic inequalities in health are likely to lead to higher health system efficiency, especially in countries where the health system relies predominantly on public provision. The pursuit of efficiency gains in OECD health systems has not been a precondition for socioeconomic equity in health. Adverse effects of efficiency-seeking interventions on health equity are particularly apparent in the private provision of healthcare. However, addressing health inequalities provides a plausible route to enhance efficiency. •There is a long-standing debate on the equity-efficiency nexus within health systems.•We analyse the bidirectional efficiency-equity relationship in OECD health systems.•Efficiency gains jeopardize equity, especially when health service provision is mainly private.•However, reducing health inequality may lead to higher health system efficiency.
AbstractList	Has the quest for efficiency in OECD health systems impacted the social gradient of health? We examined the cross-dynamics of the health system equity-efficiency nexus among OECD countries in the past two decades.BACKGROUNDHas the quest for efficiency in OECD health systems impacted the social gradient of health? We examined the cross-dynamics of the health system equity-efficiency nexus among OECD countries in the past two decades.We used a three-step methodology based on annual macro-level data from 36 OECD countries for the period 2004-2021. First, we estimated the efficiency of health systems using a stochastic frontier analysis. We then assessed the equity of health systems using simple measures of income-related inequality in self-assessed health. Lastly, we estimated the dynamic relationship between health system efficiency and equity using a panel Granger causality analysis. We also stratified the analysis by type of health system: viz. publicly- vs. privately-dominated health service provision.METHODSWe used a three-step methodology based on annual macro-level data from 36 OECD countries for the period 2004-2021. First, we estimated the efficiency of health systems using a stochastic frontier analysis. We then assessed the equity of health systems using simple measures of income-related inequality in self-assessed health. Lastly, we estimated the dynamic relationship between health system efficiency and equity using a panel Granger causality analysis. We also stratified the analysis by type of health system: viz. publicly- vs. privately-dominated health service provision.We find evidence for a bidirectional causality between health system efficiency and equity. An increase in health system efficiency leads to an increase in socioeconomic inequalities in health; a result particularly salient in countries with predominantly private health service provision. Interestingly, decreases in socio-economic inequalities in health are likely to lead to higher health system efficiency, especially in countries where the health system relies predominantly on public provision.FINDINGSWe find evidence for a bidirectional causality between health system efficiency and equity. An increase in health system efficiency leads to an increase in socioeconomic inequalities in health; a result particularly salient in countries with predominantly private health service provision. Interestingly, decreases in socio-economic inequalities in health are likely to lead to higher health system efficiency, especially in countries where the health system relies predominantly on public provision.The pursuit of efficiency gains in OECD health systems has not been a precondition for socioeconomic equity in health. Adverse effects of efficiency-seeking interventions on health equity are particularly apparent in the private provision of healthcare. However, addressing health inequalities provides a plausible route to enhance efficiency.INTERPRETATIONThe pursuit of efficiency gains in OECD health systems has not been a precondition for socioeconomic equity in health. Adverse effects of efficiency-seeking interventions on health equity are particularly apparent in the private provision of healthcare. However, addressing health inequalities provides a plausible route to enhance efficiency. Has the quest for efficiency in OECD health systems impacted the social gradient of health? We examined the cross-dynamics of the health system equity-efficiency nexus among OECD countries in the past two decades. We used a three-step methodology based on annual macro-level data from 36 OECD countries for the period 2004-2021. First, we estimated the efficiency of health systems using a stochastic frontier analysis. We then assessed the equity of health systems using simple measures of income-related inequality in self-assessed health. Lastly, we estimated the dynamic relationship between health system efficiency and equity using a panel Granger causality analysis. We also stratified the analysis by type of health system: viz. publicly- vs. privately-dominated health service provision. We find evidence for a bidirectional causality between health system efficiency and equity. An increase in health system efficiency leads to an increase in socioeconomic inequalities in health; a result particularly salient in countries with predominantly private health service provision. Interestingly, decreases in socio-economic inequalities in health are likely to lead to higher health system efficiency, especially in countries where the health system relies predominantly on public provision. The pursuit of efficiency gains in OECD health systems has not been a precondition for socioeconomic equity in health. Adverse effects of efficiency-seeking interventions on health equity are particularly apparent in the private provision of healthcare. However, addressing health inequalities provides a plausible route to enhance efficiency. Has the quest for efficiency in OECD health systems impacted the social gradient of health? We examined the cross-dynamics of the health system equity-efficiency nexus among OECD countries in the past two decades. We used a three-step methodology based on annual macro-level data from 36 OECD countries for the period 2004–2021. First, we estimated the efficiency of health systems using a stochastic frontier analysis. We then assessed the equity of health systems using simple measures of income-related inequality in self-assessed health. Lastly, we estimated the dynamic relationship between health system efficiency and equity using a panel Granger causality analysis. We also stratified the analysis by type of health system: viz. publicly- vs. privately-dominated health service provision. We find evidence for a bidirectional causality between health system efficiency and equity. An increase in health system efficiency leads to an increase in socioeconomic inequalities in health; a result particularly salient in countries with predominantly private health service provision. Interestingly, decreases in socio-economic inequalities in health are likely to lead to higher health system efficiency, especially in countries where the health system relies predominantly on public provision. The pursuit of efficiency gains in OECD health systems has not been a precondition for socioeconomic equity in health. Adverse effects of efficiency-seeking interventions on health equity are particularly apparent in the private provision of healthcare. However, addressing health inequalities provides a plausible route to enhance efficiency. •There is a long-standing debate on the equity-efficiency nexus within health systems.•We analyse the bidirectional efficiency-equity relationship in OECD health systems.•Efficiency gains jeopardize equity, especially when health service provision is mainly private.•However, reducing health inequality may lead to higher health system efficiency.
ArticleNumber	118379
Author	Ventelou, Bruno Bousmah, Marwân-al-Qays Combes, Simon Abu-Zaineh, Mohammad
Author_xml	– sequence: 1 givenname: Marwân-al-Qays orcidid: 0000-0001-5346-5184 surname: Bousmah fullname: Bousmah, Marwân-al-Qays email: marwan-al-qays.bousmah@ined.fr organization: Ined, National Institute for Demographic Studies, Aubervilliers, France – sequence: 2 givenname: Mohammad surname: Abu-Zaineh fullname: Abu-Zaineh, Mohammad email: mohammad.abu-zaineh@univ-amu.fr organization: Aix-Marseille Univ, CNRS, AMSE, Marseille, France – sequence: 3 givenname: Simon orcidid: 0000-0001-6594-8458 surname: Combes fullname: Combes, Simon email: simon.combes@ucl.ac.uk organization: Global Business School for Health, University College London, London, UK – sequence: 4 givenname: Bruno orcidid: 0000-0003-0774-1525 surname: Ventelou fullname: Ventelou, Bruno email: bruno.ventelou@univ-amu.fr organization: Aix-Marseille Univ, CNRS, AMSE, Marseille, France
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/40683104$$D View this record in MEDLINE/PubMed
BookMark	eNqFkcFO4zAURa0Ro6F05hcGL9mk2LEbJytUFQaQkNiwtxz7WXWV2MV2gP4I3zuhgW5ZeXPutd65Z-jEBw8InVOyoIRWl9tFCjpp14NZlKRcLiitmWh-oBmtBSuWjIsTNCOlEEWzZNUpOktpSwihpGa_0CknVc0o4TP0fp9w3gB-HiBlbEPEYK3TDrze442KvR06nAPegOryBsPz4PL-Cq88hjfVO6-yCx4Heyj5go4NxcRjD29Dws7jx5v1NdZh8Dk6SDi8QDwkd2r8Pb8GbEArA-k3-mlVl-DP5ztHT_9untZ3xcPj7f169VBoTspcMFK140mW6aUxVBleGsuNaGpKrTKKE9MwsLXQJRMlVK2hrGaa21Y3bWs5m6OLqXYXw8GA7F3S0HXKQxiSZCWjFa_J6HSO_n6iQztal7voehX38kvlCIgJ0DGkFMEeEUrkx2hyK4-jyY_R5DTamFxNSRgvfXEQZTroA-Mi6CxNcN92_Ac3p6Zt
Cites_doi	10.1016/j.healthpol.2013.09.003 10.1093/qje/qjy020 10.1016/j.ahj.2007.10.043 10.1007/BF01205442 10.1186/s12961-023-01005-6 10.1016/0304-4076(88)90045-0 10.1016/S0277-9536(96)00073-1 10.1016/j.healthpol.2016.08.009 10.1377/hlthaff.28.5.1260 10.1177/1536867X231162034 10.1086/293210 10.1016/S0140-6736(16)00580-8 10.1007/s00181-020-01970-9 10.1111/1756-2171.12270 10.1016/S0140-6736(71)92410-X 10.1057/s41599-022-01271-9 10.2307/1912791 10.1093/fampra/cmae017 10.1111/maq.12555 10.1377/hlthaff.2014.1059 10.1016/S2468-2667(22)00133-5 10.1016/j.socscimed.2006.07.003 10.1016/j.socscimed.2019.04.028
ContentType	Journal Article
Copyright	2025 The Authors Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.
Copyright_xml	– notice: 2025 The Authors – notice: Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.
DBID	6I. AAFTH AAYXX CITATION CGR CUY CVF ECM EIF NPM 7X8
DOI	10.1016/j.socscimed.2025.118379
DatabaseName	ScienceDirect Open Access Titles Elsevier:ScienceDirect:Open Access CrossRef Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed MEDLINE - Academic
DatabaseTitle	CrossRef MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) MEDLINE - Academic
DatabaseTitleList	MEDLINE - Academic MEDLINE
Database_xml	– sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database
DeliveryMethod	fulltext_linktorsrc
Discipline	Medicine Public Health Social Sciences (General)
EISSN	1873-5347
ExternalDocumentID	40683104 10_1016_j_socscimed_2025_118379 S0277953625007105
Genre	Journal Article
GroupedDBID	--- --K --M -DZ -~X .GJ .~1 07C 0R~ 123 1B1 1~. 1~5 4.4 457 4G. 53G 5RE 5VS 6I. 6PF 7-5 71M 85S 8P~ 9JM 9JO AABNK AADFP AAEDT AAEDW AAFJI AAFTH AAGJA AAGUQ AAIKJ AAKOC AALRI AAOAW AAQFI AAQQT AATTM AAWTL AAXKI AAXUO AAYWO ABBQC ABFNM ABIVO ABJNI ABMAC ABMMH ABMZM ABOCM ABOYX ABPPZ ABXDB ACDAQ ACGFO ACGFS ACHQT ACIEU ACLOT ACRLP ACVFH ACXNI ADBBV ADCNI ADEZE ADXHL AEBSH AEIPS AEKER AENEX AEUPX AFFNX AFJKZ AFPUW AFTJW AFXIZ AGHFR AGUBO AGYEJ AHHHB AHMBA AIEXJ AIGII AIIUN AIKHN AITUG AJRQY AKBMS AKRWK AKYEP ALMA_UNASSIGNED_HOLDINGS AMRAJ ANKPU ANZVX AOMHK APXCP ASPBG AVARZ AVWKF AXJTR AZFZN BKOJK BKOMP BLXMC BNPGV CS3 DU5 EBS EFJIC EFKBS EFLBG EJD EO8 EO9 EP2 EP3 F5P FDB FEDTE FGOYB FIRID FNPLU FYGXN G-2 G-Q GBLVA HEH HMK HMO HMY HVGLF HZ~ IH2 IHE J1W K-O KOM L7B M29 M3W M3Y M41 MO0 MVM N9A NHB O-L O9- OAUVE OHT OKEIE OZT P-8 P-9 P2P PC. PQQKQ PRBVW Q38 R2- ROL RPZ RXW SAE SCC SDF SDG SDP SES SEW SPCBC SSB SSH SSO SSS SSY SSZ T5K TAE TN5 UHB UQL WH7 WUQ X7L XJT XPP YHZ ZCA ZGI ZY4 ~G- ~HD 9DU AAYXX CITATION CGR CUY CVF ECM EIF NPM 7X8
ID	FETCH-LOGICAL-c402t-306b108f3c5dd1ad42df4d79811fada40d93ef87c2372e6bd1383c4fbc9bbf43
ISICitedReferencesCount	0
ISICitedReferencesURI	http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=001573667200001&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D
ISSN	0277-9536 1873-5347
IngestDate	Thu Oct 02 22:22:42 EDT 2025 Wed Oct 01 06:56:55 EDT 2025 Sat Nov 29 06:52:58 EST 2025 Sat Oct 25 17:08:54 EDT 2025
IsDoiOpenAccess	true
IsOpenAccess	true
IsPeerReviewed	true
IsScholarly	true
Keywords	Health system Reverse causality Equity-efficiency tradeoff Stochastic frontier analysis Granger causality
Language	English
License	This is an open access article under the CC BY license. Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.
LinkModel	OpenURL
MergedId	FETCHMERGED-LOGICAL-c402t-306b108f3c5dd1ad42df4d79811fada40d93ef87c2372e6bd1383c4fbc9bbf43
Notes	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ORCID	0000-0001-6594-8458 0000-0001-5346-5184 0000-0003-0774-1525
OpenAccessLink	https://dx.doi.org/10.1016/j.socscimed.2025.118379
PMID	40683104
PQID	3231648087
PQPubID	23479
ParticipantIDs	proquest_miscellaneous_3231648087 pubmed_primary_40683104 crossref_primary_10_1016_j_socscimed_2025_118379 elsevier_sciencedirect_doi_10_1016_j_socscimed_2025_118379
PublicationCentury	2000
PublicationDate	2025-10-01
PublicationDateYYYYMMDD	2025-10-01
PublicationDate_xml	– month: 10 year: 2025 text: 2025-10-01 day: 01
PublicationDecade	2020
PublicationPlace	England
PublicationPlace_xml	– name: England
PublicationTitle	Social science & medicine (1982)
PublicationTitleAlternate	Soc Sci Med
PublicationYear	2025
Publisher	Elsevier Ltd
Publisher_xml	– name: Elsevier Ltd
References	Dumesnil, Lutaud, Bellon-Curutchet, Deffontaines, Verger (bib6) 2024 Mackenbach, Kunst (bib17) 1997; 44 Aaron, Ginsburg (bib1) 2009; 28 Kumbhakar, Lovell (bib15) 2000 Oster (bib24) 1995 Morel (bib19) 2019; 232 Granger (bib10) 1988; 39 Okun (bib22) 2015 Battese, Coelli (bib2) 1995; 20 Granger (bib11) 1969; 37 Horton (bib12) 2006; 63 Tudor Hart (bib26) 1971; 1 Dafny, Ho, Lee (bib5) 2019; 50 (bib23) 2023 Böhm, Schmid, Götze, Landwehr, Rothgang (bib3) 2013; 113 Milstein, Schreyoegg (bib18) 2016; 120 Xiao, Karavias, Juodis, Sarafidis, Ditzen (bib27) 2023; 23 Cooper, Craig, Gaynor, Van Reenen (bib4) 2019; 134 Ngami, Ventelou (bib21) 2023; 21 Nay, Béjean, Benamouzig, Bergeron, Castel, Ventelou (bib20) 2016; 387 Karve, Ou, Lytle, Peterson (bib14) 2008; 155 González-Agüero, Chenhall, Basnayake, Vaughan (bib8) 2020; 34 Gilman, Adams, Hockenberry, Milstein, Wilson, Becker (bib7) 2015; 34 Le Grand (bib16) 1990; 100 Paul, Nguemdjo, Ngami, Kovtun, Ventelou (bib25) 2022; 9 Juodis, Karavias, Sarafidis (bib13) 2021; 60 Goodair, Reeves (bib9) 2022; 7 Aaron (10.1016/j.socscimed.2025.118379_bib1) 2009; 28 Xiao (10.1016/j.socscimed.2025.118379_bib27) 2023; 23 González-Agüero (10.1016/j.socscimed.2025.118379_bib8) 2020; 34 Goodair (10.1016/j.socscimed.2025.118379_bib9) 2022; 7 Paul (10.1016/j.socscimed.2025.118379_bib25) 2022; 9 Okun (10.1016/j.socscimed.2025.118379_bib22) 2015 Tudor Hart (10.1016/j.socscimed.2025.118379_bib26) 1971; 1 Milstein (10.1016/j.socscimed.2025.118379_bib18) 2016; 120 Böhm (10.1016/j.socscimed.2025.118379_bib3) 2013; 113 Ngami (10.1016/j.socscimed.2025.118379_bib21) 2023; 21 Le Grand (10.1016/j.socscimed.2025.118379_bib16) 1990; 100 Granger (10.1016/j.socscimed.2025.118379_bib11) 1969; 37 Gilman (10.1016/j.socscimed.2025.118379_bib7) 2015; 34 Kumbhakar (10.1016/j.socscimed.2025.118379_bib15) 2000 Granger (10.1016/j.socscimed.2025.118379_bib10) 1988; 39 Morel (10.1016/j.socscimed.2025.118379_bib19) 2019; 232 Dafny (10.1016/j.socscimed.2025.118379_bib5) 2019; 50 Battese (10.1016/j.socscimed.2025.118379_bib2) 1995; 20 Dumesnil (10.1016/j.socscimed.2025.118379_bib6) 2024 Cooper (10.1016/j.socscimed.2025.118379_bib4) 2019; 134 (10.1016/j.socscimed.2025.118379_bib23) 2023 Juodis (10.1016/j.socscimed.2025.118379_bib13) 2021; 60 Mackenbach (10.1016/j.socscimed.2025.118379_bib17) 1997; 44 Oster (10.1016/j.socscimed.2025.118379_bib24) 1995 Nay (10.1016/j.socscimed.2025.118379_bib20) 2016; 387 Horton (10.1016/j.socscimed.2025.118379_bib12) 2006; 63 Karve (10.1016/j.socscimed.2025.118379_bib14) 2008; 155
References_xml	– volume: 60 start-page: 93 year: 2021 end-page: 112 ident: bib13 article-title: A homogeneous approach to testing for granger non-causality in heterogeneous panels publication-title: Empir. Econ. – volume: 1 start-page: 405 year: 1971 end-page: 412 ident: bib26 article-title: The inverse care law publication-title: Lancet – year: 2024 ident: bib6 article-title: Dealing with the doctor shortage: a qualitative study exploring French general practitioners' lived experiences, difficulties, and adaptive behaviours publication-title: Fam Pract cmae017 – volume: 120 start-page: 1125 year: 2016 end-page: 1140 ident: bib18 article-title: Pay for performance in the inpatient sector: a review of 34 P4P programs in 14 OECD countries publication-title: Health Policy – volume: 20 start-page: 325 year: 1995 end-page: 332 ident: bib2 article-title: A model for technical inefficiency effects in a stochastic frontier production function for panel data publication-title: Empir. Econ. – volume: 63 start-page: 2702 year: 2006 end-page: 2714 ident: bib12 article-title: The double burden on safety net providers: placing health disparities in the context of the privatization of health care in the US publication-title: Soc. Sci. Med. – year: 2015 ident: bib22 article-title: Equality and Efficiency: the Big Tradeoff – volume: 50 start-page: 286 year: 2019 end-page: 325 ident: bib5 article-title: The price effects of cross-market mergers: theory and evidence from the hospital industry publication-title: Rand J. Econ. – volume: 28 start-page: 1260 year: 2009 end-page: 1275 ident: bib1 article-title: Is health spending excessive? If so, what can we do about it? publication-title: Health Aff. – volume: 44 start-page: 757 year: 1997 end-page: 771 ident: bib17 article-title: Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe publication-title: Soc. Sci. Med. – volume: 34 start-page: 210 year: 2020 end-page: 226 ident: bib8 article-title: Inequalities in the age of universal health coverage: young Chileans with diabetes negotiating for their right to health publication-title: Med. Anthropol. Q. – volume: 113 start-page: 258 year: 2013 end-page: 269 ident: bib3 article-title: Five types of OECD healthcare systems: empirical results of a deductive classification publication-title: Health Policy – year: 1995 ident: bib24 article-title: Strategic Management for Nonprofit Organizations: Theory and Cases – volume: 37 start-page: 424 year: 1969 end-page: 438 ident: bib11 article-title: Investigating causal relations by econometric models and cross-spectral methods publication-title: Econometrica – volume: 21 start-page: 57 year: 2023 ident: bib21 article-title: Respective healthcare system performances taking into account environmental quality: what are the re-rankings for OECD countries? publication-title: Health Res. Pol. Syst. – volume: 9 start-page: 1 year: 2022 end-page: 8 ident: bib25 article-title: Do efficiency and equity move together? cross-dynamics of health system performance and universal health coverage publication-title: Humanit. Soc. Sci. Commun. – volume: 232 start-page: 25 year: 2019 end-page: 32 ident: bib19 article-title: Inequality and discrimination in access to urgent care in France ethnographies of three healthcare structures and their audiences publication-title: Soc. Sci. Med. – year: 2000 ident: bib15 article-title: Stochastic Frontier Analysis – volume: 23 start-page: 230 year: 2023 end-page: 242 ident: bib27 article-title: Improved tests for granger noncasuality in panel data publication-title: STATA J. – volume: 387 start-page: 2236 year: 2016 end-page: 2249 ident: bib20 article-title: Achieving universal health coverage in France: policy reforms and the challenge of inequalities publication-title: Lancet – volume: 134 start-page: 51 year: 2019 end-page: 107 ident: bib4 article-title: The price ain't right? Hospital prices and health spending on the privately insured publication-title: Q. J. Econ. – volume: 34 start-page: 398 year: 2015 end-page: 405 ident: bib7 article-title: Safety-net hospitals more likely than other hospitals to fare poorly under Medicare's value-based purchasing publication-title: Health Aff. – volume: 155 start-page: 571 year: 2008 end-page: 576 ident: bib14 article-title: Potential unintended financial consequences of pay-for-performance on the quality of care for minority patients publication-title: Am. Heart J. – volume: 100 start-page: 554 year: 1990 end-page: 568 ident: bib16 article-title: Equity versus efficiency: the elusive trade-off publication-title: Ethics – year: 2023 ident: bib23 article-title: OECD Country Health Profiles 2023 – volume: 7 start-page: e638 year: 2022 end-page: e646 ident: bib9 article-title: Outsourcing health-care services to the private sector and treatable mortality rates in England, 2013-20: an observational study of NHS privatisation publication-title: Lancet Public Health – volume: 39 start-page: 199 year: 1988 end-page: 211 ident: bib10 article-title: Some recent development in a concept of causality publication-title: J. Econom. – year: 2015 ident: 10.1016/j.socscimed.2025.118379_bib22 – volume: 113 start-page: 258 year: 2013 ident: 10.1016/j.socscimed.2025.118379_bib3 article-title: Five types of OECD healthcare systems: empirical results of a deductive classification publication-title: Health Policy doi: 10.1016/j.healthpol.2013.09.003 – volume: 134 start-page: 51 year: 2019 ident: 10.1016/j.socscimed.2025.118379_bib4 article-title: The price ain't right? Hospital prices and health spending on the privately insured publication-title: Q. J. Econ. doi: 10.1093/qje/qjy020 – volume: 155 start-page: 571 year: 2008 ident: 10.1016/j.socscimed.2025.118379_bib14 article-title: Potential unintended financial consequences of pay-for-performance on the quality of care for minority patients publication-title: Am. Heart J. doi: 10.1016/j.ahj.2007.10.043 – volume: 20 start-page: 325 year: 1995 ident: 10.1016/j.socscimed.2025.118379_bib2 article-title: A model for technical inefficiency effects in a stochastic frontier production function for panel data publication-title: Empir. Econ. doi: 10.1007/BF01205442 – volume: 21 start-page: 57 year: 2023 ident: 10.1016/j.socscimed.2025.118379_bib21 article-title: Respective healthcare system performances taking into account environmental quality: what are the re-rankings for OECD countries? publication-title: Health Res. Pol. Syst. doi: 10.1186/s12961-023-01005-6 – volume: 39 start-page: 199 year: 1988 ident: 10.1016/j.socscimed.2025.118379_bib10 article-title: Some recent development in a concept of causality publication-title: J. Econom. doi: 10.1016/0304-4076(88)90045-0 – year: 2000 ident: 10.1016/j.socscimed.2025.118379_bib15 – volume: 44 start-page: 757 year: 1997 ident: 10.1016/j.socscimed.2025.118379_bib17 article-title: Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe publication-title: Soc. Sci. Med. doi: 10.1016/S0277-9536(96)00073-1 – volume: 120 start-page: 1125 year: 2016 ident: 10.1016/j.socscimed.2025.118379_bib18 article-title: Pay for performance in the inpatient sector: a review of 34 P4P programs in 14 OECD countries publication-title: Health Policy doi: 10.1016/j.healthpol.2016.08.009 – volume: 28 start-page: 1260 year: 2009 ident: 10.1016/j.socscimed.2025.118379_bib1 article-title: Is health spending excessive? If so, what can we do about it? publication-title: Health Aff. doi: 10.1377/hlthaff.28.5.1260 – volume: 23 start-page: 230 year: 2023 ident: 10.1016/j.socscimed.2025.118379_bib27 article-title: Improved tests for granger noncasuality in panel data publication-title: STATA J. doi: 10.1177/1536867X231162034 – year: 2023 ident: 10.1016/j.socscimed.2025.118379_bib23 – volume: 100 start-page: 554 year: 1990 ident: 10.1016/j.socscimed.2025.118379_bib16 article-title: Equity versus efficiency: the elusive trade-off publication-title: Ethics doi: 10.1086/293210 – volume: 387 start-page: 2236 year: 2016 ident: 10.1016/j.socscimed.2025.118379_bib20 article-title: Achieving universal health coverage in France: policy reforms and the challenge of inequalities publication-title: Lancet doi: 10.1016/S0140-6736(16)00580-8 – volume: 60 start-page: 93 year: 2021 ident: 10.1016/j.socscimed.2025.118379_bib13 article-title: A homogeneous approach to testing for granger non-causality in heterogeneous panels publication-title: Empir. Econ. doi: 10.1007/s00181-020-01970-9 – volume: 50 start-page: 286 year: 2019 ident: 10.1016/j.socscimed.2025.118379_bib5 article-title: The price effects of cross-market mergers: theory and evidence from the hospital industry publication-title: Rand J. Econ. doi: 10.1111/1756-2171.12270 – volume: 1 start-page: 405 year: 1971 ident: 10.1016/j.socscimed.2025.118379_bib26 article-title: The inverse care law publication-title: Lancet doi: 10.1016/S0140-6736(71)92410-X – volume: 9 start-page: 1 year: 2022 ident: 10.1016/j.socscimed.2025.118379_bib25 article-title: Do efficiency and equity move together? cross-dynamics of health system performance and universal health coverage publication-title: Humanit. Soc. Sci. Commun. doi: 10.1057/s41599-022-01271-9 – volume: 37 start-page: 424 year: 1969 ident: 10.1016/j.socscimed.2025.118379_bib11 article-title: Investigating causal relations by econometric models and cross-spectral methods publication-title: Econometrica doi: 10.2307/1912791 – year: 2024 ident: 10.1016/j.socscimed.2025.118379_bib6 article-title: Dealing with the doctor shortage: a qualitative study exploring French general practitioners' lived experiences, difficulties, and adaptive behaviours publication-title: Fam Pract cmae017 doi: 10.1093/fampra/cmae017 – volume: 34 start-page: 210 year: 2020 ident: 10.1016/j.socscimed.2025.118379_bib8 article-title: Inequalities in the age of universal health coverage: young Chileans with diabetes negotiating for their right to health publication-title: Med. Anthropol. Q. doi: 10.1111/maq.12555 – volume: 34 start-page: 398 year: 2015 ident: 10.1016/j.socscimed.2025.118379_bib7 article-title: Safety-net hospitals more likely than other hospitals to fare poorly under Medicare's value-based purchasing publication-title: Health Aff. doi: 10.1377/hlthaff.2014.1059 – volume: 7 start-page: e638 year: 2022 ident: 10.1016/j.socscimed.2025.118379_bib9 article-title: Outsourcing health-care services to the private sector and treatable mortality rates in England, 2013-20: an observational study of NHS privatisation publication-title: Lancet Public Health doi: 10.1016/S2468-2667(22)00133-5 – volume: 63 start-page: 2702 year: 2006 ident: 10.1016/j.socscimed.2025.118379_bib12 article-title: The double burden on safety net providers: placing health disparities in the context of the privatization of health care in the US publication-title: Soc. Sci. Med. doi: 10.1016/j.socscimed.2006.07.003 – year: 1995 ident: 10.1016/j.socscimed.2025.118379_bib24 – volume: 232 start-page: 25 year: 2019 ident: 10.1016/j.socscimed.2025.118379_bib19 article-title: Inequality and discrimination in access to urgent care in France ethnographies of three healthcare structures and their audiences publication-title: Soc. Sci. Med. doi: 10.1016/j.socscimed.2019.04.028
SSID	ssj0001083
Score	2.4868805
Snippet	Has the quest for efficiency in OECD health systems impacted the social gradient of health? We examined the cross-dynamics of the health system...
SourceID	proquest pubmed crossref elsevier
SourceType	Aggregation Database Index Database Publisher
StartPage	118379
SubjectTerms	Efficiency, Organizational - standards Equity-efficiency tradeoff Granger causality Health Equity - standards Health Equity - statistics & numerical data Health Equity - trends Health system Humans Organisation for Economic Co-Operation and Development - organization & administration Organisation for Economic Co-Operation and Development - statistics & numerical data Reverse causality Socioeconomic Factors Stochastic frontier analysis
Title	Is the quest for efficiency harmful to health equity? An examination of the health efficiency-equity nexus in OECD countries over the past two decades
URI	https://dx.doi.org/10.1016/j.socscimed.2025.118379 https://www.ncbi.nlm.nih.gov/pubmed/40683104 https://www.proquest.com/docview/3231648087
Volume	383
WOSCitedRecordID	wos001573667200001&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D
hasFullText	1
inHoldings	1
isFullTextHit
isPrint
journalDatabaseRights	– providerCode: PRVESC databaseName: Elsevier SD Freedom Collection Journals 2021 customDbUrl: eissn: 1873-5347 dateEnd: 99991231 omitProxy: false ssIdentifier: ssj0001083 issn: 0277-9536 databaseCode: AIEXJ dateStart: 19950101 isFulltext: true titleUrlDefault: https://www.sciencedirect.com providerName: Elsevier
link	http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtV1bb9MwFLZ2QQgJIRi3cpmMBBKoctXEbp3wgsrWiqHRgSio4iVyYlvrtCbb2m7lj_AL-SEcX5J2sInxwEsURb5E_j7b59jngtBzLQKaKU2J1qkiLG1LEimhiTJen7A_SiVTm2yC9_vRcBh_XFn5WfrCnB7yPI_m8_jov0IN3wBs4zr7D3BXjcIHeAfQ4Qmww_NKwO9MrDBp13sX0NtGibAuliZOtTFKBoHTOUDW1fHM5AWgPXM8qObCWMaUQqRppixWtUFcjXqu5jNrS7vX3dqu25QTRuuuG5NQ538loP_pWVGXytjgT5bFYO8UXPoUGfqVl_w2clQchUtHFG-L2WQs9r1r0Zm92w9z0jkkn8T3SifopDPyTUALrmCxL8ZjIas7lmKcuhXx82i8MD34akOSFjNP87xYPgUJW5U9XblwR5ySFnXROxvqgm9-tacRXVqvQb2iLpnNH1uJO9U4aMAkgdGAQWiYfhuLGueDd_f3kt6X3d1k0B0OYNSOjonJbGYsAF7QbceyVbQe8lYMa-96Z6c7fF9JDEHThout_vecHeKF_V8mRV2mJVlpaXAb3fJqDu44et5BKyrfQNc_eIw30E13XIydF9wGqjlGYL_VTPBLHw_91V30Y2eCgVDY9oiB0XjBRuwZjacFdlTFjp9vcCfHS3zGhbaNlIV-5zO2fMajHBs-44rP2PDZ1jR8xsBn7Pl8Dw163cHWO-LTiZCMNcMpAeU4hZHWNGtJGQjJQqmZ5HEUBFpIwZoypkpHPAspD1U7lQFwJWM6zeI01YzeR2t5kauHCGsVtRRXjKuMsUyGIuaU6ywOqAhZGrRrqFmikxy5oDFJaU15kFSAJgbQxAFaQ69LFBM_-ZxMmwAf_175WYl7AruDufITuYK5mVBQ39osaka8hh44QlR_BKK8yTLIHl2h9mN0YzHrnqC16clMPUXXstPpaHKyiVb5MNr0rP4FVHzqMw
linkProvider	Elsevier
openUrl	ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Is+the+quest+for+efficiency+harmful+to+health+equity%3F+An+examination+of+the+health+efficiency-equity+nexus+in+OECD+countries+over+the+past+two+decades&rft.jtitle=Social+science+%26+medicine+%281982%29&rft.au=Bousmah%2C+Marw%C3%A2n-Al-Qays&rft.au=Abu-Zaineh%2C+Mohammad&rft.au=Combes%2C+Simon&rft.au=Ventelou%2C+Bruno&rft.date=2025-10-01&rft.issn=1873-5347&rft.eissn=1873-5347&rft.volume=383&rft.spage=118379&rft_id=info:doi/10.1016%2Fj.socscimed.2025.118379&rft.externalDBID=NO_FULL_TEXT
thumbnail_l	http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0277-9536&client=summon
thumbnail_m	http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0277-9536&client=summon
thumbnail_s	http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0277-9536&client=summon