DEA ومنوذج Tobit قياس كفاءة الإنفاق العام على الصحة في منطقة الشرق الأوسط وشمال إفريقيا و تحليل أثر أنظمة الضمان الإجتماعي عليها باستخدام منهجية

Abstract

This study analyzes the technical efficiency of public health expenditure and the role of social health insurance across nine countries in the Middle East and North Africa (MENA) region, namely Algeria, Morocco, Tunisia, Egypt, Jordan, Lebanon, the United Arab Emirates, Saudi Arabia, and Kuwait, over the period 2018–2023. The study adopts a two-stage quantitative methodology. In the first stage, technical efficiency is measured using Data Envelopment Analysis (DEA), while in the second stage, Tobit regression models are employed to identify the determinants of efficiency. The results reveal a clear structural heterogeneity across countries, with an inverse relationship between health expenditure levels and technical efficiency. High-spending countries, particularly Gulf states, tend to exhibit lower efficiency scores. The findings also confirm the negative impact of the COVID-19 pandemic on the performance of health systems, followed by a gradual recovery beginning in 2022. The Tobit estimations indicate that population density enhances efficiency through economies of scale, whereas social health insurance shows a statistically significant negative effect on technical efficiency, suggesting the presence of organizational inefficiencies and moral hazard issues. The study concludes that improving health system efficiency in the MENA region requires comprehensive structural reforms focused on expenditure rationalization, governance improvement, and the restructuring of health insurance systems.