The efficiency of health care production in OECD countries: A systematic review and meta-analysis of cross-country comparisons

•We reviewed 22 studies of health care production efficiency in OECD countries.•We summarized these studies with view on their sample, variables, and methods.•Quality assessment revealed some methodological problems in the reviewed studies.•The meta-analysis of findings identified low correlations between country efficiency ratings.•Our review highlights the strengths and limitations of existing cross-country efficiency comparisons.

There has been an ongoing interest in the analysis and comparison of the efficiency of health care systems using nonparametric and parametric applications. The objective of this study was to review the current state of the literature and to synthesize the findings on health system efficiency in OECD countries. We systematically searched five electronic databases through August 2014 and identified 22 studies that analyzed the efficiency of health care production at the country level. We summarized these studies with view on their sample, methods, and utilized variables. We developed and applied a checklist of 14 items to assess the quality of the reviewed studies along four dimensions: reporting, external validity, bias, and power. Moreover, to examine the internal validity of findings we meta-analyzed the efficiency estimates reported in 35 models from ten studies. The qualitative synthesis of the literature indicated large differences in study designs and methods. The meta-analysis revealed low correlations between country rankings suggesting a lack of internal validity of the efficiency estimates. In conclusion, methodological problems of existing cross-country comparisons of the efficiency of health care systems draw into question the ability of these comparisons to provide meaningful guidance to policy-makers.