An international comparison of efficiency of inpatient mental health care systems

Valerie Moran, Rowena Jacobs*

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

31 Citations (Scopus)


There is a fundamental gap in the evidence base on quantitative cross-country comparison of mental healthcare systems due to the challenges of comparative analysis in mental health including a paucity of good quality data. We explore whether existing limited data sources can potentially be exploited to examine technical efficiency of inpatient mental healthcare systems in 32 OECD countries in 2010. We use two analytical approaches: Data Envelopment Analysis (DEA) with bootstrapping to produce confidence intervals of efficiency scores and country rankings, and Cluster Analysis to group countries according to two broad efficiency groupings. We incorporate environmental variables using a two-stage truncated regression. We find slightly tighter confidence intervals for the less efficient countries which loosely corresponds with the 'inefficient' cluster grouping in the Cluster Analysis. However there is little stability in country rankings making it difficult with current data to draw any policy inferences. Environmental factors do not appear to significantly impact on efficiency scores. The most pressing pursuit remains the search for better national data in mental healthcare to underpin future analyses. Otherwise the use of any sophisticated analytic techniques will prove futile for establishing robust conclusions regarding international comparisons of the performance of mental healthcare systems.

Original languageEnglish
Pages (from-to)88-99
Number of pages12
JournalHealth Policy
Issue number1-2
Publication statusPublished - Sept 2013
Externally publishedYes


  • Bootstrapping
  • Cluster analysis
  • Cross-country comparisons
  • Data envelopment analyis
  • Inpatient mental health services


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