The 'Healthcare Access and Quality Index' revisited: A fuzzy data envelopment analysis approach

Nowadays, health systems comprise a series of resources structured to provide healthcare services to meet our health needs. However, premature deaths still occur. To quantify and understand personal healthcare conditions affecting such amenable mortality, the Healthcare Access and Quality Index (HAQI) was put forward, evaluating 195 countries and territories since 1990. Nevertheless, the literature acknowledges a series of limitations of this framework, such as the drawbacks of using principal component analysis to aggregate individual indicators, the absence of control for financing and environmental conditions, and the presence of a substantial degree of data uncertainty. Accordingly, we propose a methodological alternative to the computation of the HAQI using a novel fuzzy Data Envelopment Analysis model to handle the aforementioned shortcomings. We also propose its extension towards the quantification of efficiency (E-HAQI) - in the sense of value for money - by incorporating financial aspects as modelling inputs. This way, we contribute with innovative modelling approaches that can also deal with the high degree of data uncertainty. Furthermore, in a second -stage analysis, the impact of key exogenous factors on healthcare access and quality is assessed via non -parametric hypothesis testing. Our results show positive and significant correlations of both the revisited HAQI and E-HAQI with the original HAQI 2016 dataset. They also reveal a better use of resources by European and Oceanian countries and territories than by Sub-Saharan African ones. Concerning contextual determinants, socio-demographic development, human development, and the type of health system were found to be statistically significant drivers of healthcare access and quality efficiency.