Does happiness matter to health system efficiency? A performance analysis

BACKGROUND: The main objective of this study is to assess the performance of the global health system, emphasising the contribution of people’s happiness to health system efficiency across countries. Technical efficiency (TE) scores are estimated using the output-oriented variable returns to scale (VRS) data envelopment analysis (DEA) model based on the input measures: health expenditure, labour, hospital beds and education, and the output measures: healthy life expectancy and inverse mortality index. The efficiency scores are regressed against three explanatory variables: happiness index, population density, and healthcare share of gross domestic product (GDP). The analysis involved 121 selected countries using double bootstrap DEA as proposed by Simar, L., Wilson, P.W J Econ 136:1‑34, 2007. RESULTS: The bootstrap truncated regression indicates that happiness is one of the factors that contributes significantly to health system efficiency. The study also revealed that the selected health systems perform well, on average, in terms of population density and healthcare share of GDP. CONCLUSIONS: In addition to improving the economic standard of living, policy-makers should also consider ways to increase the happiness and well-being of society. Policies focusing on well-being and happiness can lead to improved well-being and improved health outcomes, which may ultimately reduce the healthcare burden and enhance healthcare performance. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13561-018-0214-6) contains supplementary material, which is available to authorized users.