Papers by Corrado lo Storto
Cleaner Waste Systems, 2024
This paper adopts a meta-frontier non-parametric directional distance function framework to measu... more This paper adopts a meta-frontier non-parametric directional distance function framework to measure the ecoefficiency of municipal solid waste (MSW) services in 258 municipalities in the Apulia region from 2012 to 2016. Model specification includes the operating cost per quantity of waste as input and the per capita quantities of sorted and unsorted waste as the desirable and undesirable outputs. The heterogeneities due to the different governance systems implemented in the six areas in which the regional territory was partitioned to manage the MSW service were considered. A dynamic distributional analysis of MSW ecoefficiencies was performed, and determinants affecting their measure were investigated. The results show that the average MSW service meta-frontier ecoefficiency decreased from 0.631 to 0.546, while the technology gap ratio value diminished from 0.899 to 0.827. Findings relative to the impact on ecoefficiency of variables measuring either the size or density of MSW services remain inconclusive.
Utilities Policy, 2024
In the last decades, evaluating the performance of municipal solid waste (MSW) service has attrac... more In the last decades, evaluating the performance of municipal solid waste (MSW) service has attracted the interest of scholars and policymakers worldwide. This study adopts a generalized directional distance function (GDDF) data envelopment analysis (DEA) model to measure the eco-efficiency of 94 Apulian municipalities providing MSW service over 2019–2021. The model uses the α-cut method to handle missing data in a fuzzy DEA environment. During the period covered by the research, on average, the MSW eco-efficiency was between 0.825 and 0.879. The MSW separate collection rate is the only factor significantly affecting the MSW eco-efficiency.
A free copy of the article can be downloaded clicking on this link before February 22, 2024:
https://authors.elsevier.com/a/1iMuj3Peo9nMTB
Water, Sep 15, 2022
Data relative to the water services industry in Italy indicate that there is a serious infrastruc... more Data relative to the water services industry in Italy indicate that there is a serious infrastructure gap between the southern regions and isles and the rest of the country. In these geographical areas, water utilities are provided with substantial public grants from the central and local governments to support investments necessary to mitigate the infrastructure divide by increasing capacity and improve service quality. This paper implements a meta-frontier non-parametric approach based on a data envelopment analysis (DEA) to evaluate the efficiencies of 71 Italian water utilities, accounting for the differentiated contexts in which they operate. A short-term perspective was assumed to estimate efficiency, considering the production factors associated with the infrastructure assets as non-discretionary inputs in the specification of the meta-frontier model. The results showed that water utilities operating in the southern regions and isles suffer from an efficiency gap in compariso...
Water, 2022
Data relative to the water services industry in Italy indicate that there is a serious infrastruc... more Data relative to the water services industry in Italy indicate that there is a serious infrastructure gap between the southern regions and isles and the rest of the country. In these geographical areas, water utilities are provided with substantial public grants from the central and local governments to support investments necessary to mitigate the infrastructure divide by increasing capacity and improve service quality. This paper implements a meta-frontier non-parametric approach based on a data envelopment analysis (DEA) to evaluate the efficiencies of 71 Italian water utilities, accounting for the differentiated contexts in which they operate. A short-term perspective was assumed to estimate efficiency, considering the production factors associated with the infrastructure assets as non-discretionary inputs in the specification of the meta-frontier model. The results showed that water utilities operating in the southern regions and isles suffer from an efficiency gap in comparison to those in the northern and central regions. The average efficiency gap was 9.7%, achieving 24.9% in the worst case. Moreover, a more in-depth analysis focusing on the water utilities in the southern regions and isles indicated that scale inefficiencies might be an important determinant of such an efficiency gap. Indeed, slightly more than 69% of the water utilities operated at increasing returns to scale. Evidence from this study raises concern about the appropriate structure of the Italian water service industry and, particularly, the optimal size of the utilities and the financial sustainability of water services in the southern regions and isles.
Sustainability, 2020
In consideration of the three pillars of sustainability, alongside the environment, social and ec... more In consideration of the three pillars of sustainability, alongside the environment, social and economic dimensions interplay valuable insight into how society is molded and what key components should be considered. In terms of social sustainability, there are processes and framework objectives that promote wellbeing integral to the balance of people, planet, and profit. Economic practices consider the system of production, resource allocation, and distribution of goods and services with respect to demand and supply between economic agents. As a result, an economic system is a variant of the social system in which it exists. At present, the forefront of social sustainability research partially encompasses the impact economic practices have on people and society—with notable emphasis centered on the urban environment. Specific interdisciplinary analyses within the scope of sustainability, social development, competitiveness, and motivational management as well as decision making withi...
Sustainability, 2021
This paper presents a dynamic efficiency study of the solid waste management in the municipalitie... more This paper presents a dynamic efficiency study of the solid waste management in the municipalities of the Apulia region (Southern Italy). The study employs the non-parametric Global Malmquist Index to measure the change in productivity of the municipal solid waste service from 2010 to 2017. Three different DEA-based models are implemented to measure productivity. The first model computes the service productivity solely from the economic perspective, while the second and third models compute the service productivity from both the economic and environmental perspectives. Adopting two distinct perspectives provides a more comprehensive insight into the performance of the waste management service considering the productivity and the eco-productivity of service provision. The results from the productivity analysis show that, between 2010 and 2017, the municipal solid waste sector was still facing a transitional period characterized by low cost-efficiency and productivity growth measurements. Vice versa, the efficiency and productivity indicators improve when the analysis is performed accounting for the environmental impact. Indeed, both the
eco-efficiency and eco-productivity measures increase from 2010 to 2017. Findings demonstrate the critical importance to include environmental indicators in the efficiency and productivity analysis.
Ecological Indicators, 2021
The scope of this work is to present a comprehensive approach to analyze the effectiveness-effici... more The scope of this work is to present a comprehensive approach to analyze the effectiveness-efficiency nexus in the evaluation of the performance of municipal solid waste (MSW) management. The rate of separate MSW collection is used to measure service effectiveness. A multiple set of non-parametric indicators is employed to obtain measurements of technical, scale and congestion efficiencies of waste service provision. This approach was implemented to conduct an empirical study to evaluate the performance of MSW management in 258 municipalities in the Apulia region (Southern Italy) from 2010 to 2017. The study was organized in two phases. In the first phase, measures for the three efficiency indicators were calculated applying Data Envelopment Analysis (DEA) with an output-oriented model specification. In the second phase, Panel Tobit analysis with random parameters was employed to examine the effectiveness-efficiency one way nexus, considering both municipalities’ heterogeneities and context-specific variables. The efficiency analysis shows that several municipalities are still far from achieving acceptable performance scores. Between 2010 and 2017 the average rate of separate MSW collection increased only from 16.6% to 39.6%, while the average loss of technical efficiency ranged from 27% to 39%. On average, such inefficiency was due to an important extent to the low pure technical efficiency that ranged from about 69% to 81%, and to a lesser extent to scale and congestion inefficiencies. Indeed, scale efficiency was between 85.4% and 92.6%, whereas congestion efficiency was higher than 99%. The study also highlights that there is no trade-off between effectiveness and efficiency. For the largest part of the municipalities, high levels of effectiveness and efficiency can be achieved at the same time. For about 83% of the municipalities the decrease of the sorted waste collection rate is associated to a decrease of the pure technical efficiency. A drop of the output congestion efficiency due to a relatively high collection of the unsorted fraction of waste reduces the rate of the sorted waste collection for most of municipalities (77.3%). Results also indicate that for many municipalities (about 87%) improving the MSW service effectiveness necessarily requires reducing the average quantity of waste generated by people.
IOP Conf. Series: Earth and Environmental Science, 2021
This paper presents a productivity analysis of municipal solid waste collection in Italian provin... more This paper presents a productivity analysis of municipal solid waste collection in Italian provinces from 2010 to 2019. Particularly, the total factor productivity was measured by computing the non-parametric Global Malmquist Productivity Index implementing Slack Based Measure Data Envelopment Analysis (SBM-DEA). Findings show that the productivity of the sorted waste collection service slightly grew from 2010 to 2019. Such growth was due to an increase of the technical efficiency and an improvement of the service technology. However, in some years the efficiency changes and productivity increase were affected by the rise of the per capita production of waste.
Journal of Cleaner Production, 2020
In 1994 the Galli Law started an in-depth transformation of the Italian urban water industry in s... more In 1994 the Galli Law started an in-depth transformation of the Italian urban water industry in search for a better performance. However, after more than two decades, there is still much debate about the appropriateness of the regulatory framework. This paper contributes to this debate carrying out an efficiency analysis of the Italian urban water industry, employing data for fiscal years 2011 and 2017 and an extended parallel network DEA model that allows have a more comprehensive overview of the industry performance. The proposed DEA model addresses the inadequacies in the conventional DEA models because it takes into account the different nature of the three basic services provided by the urban water service utility (drinking water, sewerage, and wastewater treatment), and computes both the efficiencies of such individual basic services, and the global efficiency of the utility. Thus, it provides a more detailed picture and shed new light on the real performance of the Italian water industry. The efficiency analysis
indicates that the average global efficiency of the water utilities is still low, although it slightly increased from 2011 to 2017. Efficiency scores calculated using the proposed DEA model result reduced by about
32.6% in 2011 and 15.9% in 2017 in comparison to conventional DEA models. Additionally, the study shows that the efficiency measurements relative to the three basic water services differ largely for several utilities. Findings also suggest that size may support efficiency improvement.
Socio-Economic Planning Sciences
This paper employs Network Data Envelopment Analysis (NDEA) to measure the municipality performan... more This paper employs Network Data Envelopment Analysis (NDEA) to measure the municipality performance. The NDEA approach allows to have a more comprehensive evaluation of the municipality performance if compared to traditional DEA. The proposed NDEA model aims at shedding new light on the efficiency-effectiveness relationship in the provision of social services by municipalities. Municipal efficiency and effectiveness are combined to generate a single performance measure which can be considered as a proxy measure of the value for money of
municipality services. A sample including 103 major Italian municipalities is used as a case to implement the proposed model. Findings indicate that there is no trade-off between the efficiency and effectiveness components of the overall municipal performance score, but rather they appear to be preconditions of each other. Therefore,
higher level of performance can be achieved without conflicting one against the other. Furthermore, only 6 municipalities achieve the highest performance level, suggesting that there is still room for improving the performance of a great number of municipalities.
Data in Brief, 2019
The collection of urban waste is an important step of the waste management cycle, because the col... more The collection of urban waste is an important step of the waste management cycle, because the collection of sorted waste that soon separates different kind of materials makes their reusing, recovering, and recycling easier and more efficient, reducing the amount of landfilled waste. In Italy, municipalities have to meet specific targets relative to the yearly percentage of sorted waste collection. Collecting and analyzing data about waste collection and the proportion of sorted waste and the specific type of waste materials is a critical activity to measure the performance and monitor the effort of the municipalities to meet targets. Raw data relative to the yearly amounts of total and sorted waste collected from 2007 to 2017, and data relative to socio-economics in 258 municipalities of the Apulia region were retrieved from public databases and were used to calculate waste statistical indicators. Data about total and sorted waste collection in Italy at the regional and country level were retrieved and analysed to compare the Apulia region and specific groups of regions. The evolution of the per capita total and sorted waste amounts was also analysed over time for Apulia and the rest of Italy. The effects of the municipality surface area, the number of inhabitants and population density on the sorted waste collection rate were investigated by performing regression analysis. These data may help policy makers and stakeholders to evaluate total and sorted waste production over time, set and assess targets, and identify best policy practices.
Energies, 2019
This paper presents a framework to identify critical nodes of a gas pipeline network. This framew... more This paper presents a framework to identify critical nodes of a gas pipeline network. This framework calculates a set of metrics typical of the social network analysis considering the topological characteristics of the network. Such metrics are utilized as inputs and outputs of a (Data Envelopment Analysis) DEA model to generate a cross-efficiency index that identifies the most important nodes in the network. The framework was implemented to assess the US interstate gas network between 2013 and 2017 from both the demand and supply-side perspectives. Results emerging from the US gas network case suggest that different analysis perspectives should necessarily be considered to have a more in-depth and comprehensive view of the network capacity and performance.
This paper measures the efficiency of Italian airports using Data Envelopment Analysis (DEA). Par... more This paper measures the efficiency of Italian airports using Data Envelopment Analysis (DEA). Particularly, the efficiency of an airport is evaluated at three different stages of its cost-revenue production cycle, i.e. cost-operations-revenue stages, while network-slack based measure DEA (NSBM-DEA) is adopted to generate efficiency measurements for the airports at each stage. Results show that the suggested modeling approach has a better discrimination capability than the traditional black-box DEA model and provides important insights for policy makers and airport concessionaires useful for improving industry performance and airport management.
This paper presents a benchmarking study of the water and wastewater industry in Italy. A three-s... more This paper presents a benchmarking study of the water and wastewater industry in Italy. A three-stage modeling approach was implemented to measure the efficiency of 53 utility operators. This approach is based on the implementation of network and conventional data envelopment analysis (DEA) to model the production process of the water service utility operators. In comparison to the conventional black-box or one-stage production model generally adopted in previous studies, the proposed approach provides information relative to the different efficiency components of the stages and blocks of the water service production process and its overall efficiency. Further, by shifting the efficiency analysis to a two-dimensional performance space, i.e., resource and market-efficiency, it offers a more comprehensive view of the water service industry and allows accounting for different business goals at the same time and for an investigation of industry trade-offs. Results show that the operators' efficiencies in the Italian water service industry are generally variable and low. There are no water service utilities which are 100% efficient from the resource-efficiency perspective, and the maximum efficiency score is 0.545. Efficiency measurements suggest that there is a general orientation of the Italian water industry to not invest in upgrading and improving the infrastructure assets, and achieving an acceptable efficiency in the operations is critical to delivering water services to market in an efficient way. Only one utility operator is 100% efficient from the market-efficiency perspective. The low tariffs adopted by the water service operators do not allow the gaining of satisfactory service remuneration and the achievement of long-term business sustainability. The joint analysis of the resource and market efficiency scores indicates that there is a trade-off between the corresponding business goals. Recently, the sustainable management of water resources has become an important policy issue in Europe. The access to clean and good-quality drinking water and adequate sanitation service is of primary importance to ensure human well-being, protection of public health and ecosystems, energy production, industry and agriculture development, and economic growth. Hence, any disruption in the supply of water and wastewater services and scarcity of water resources have negative impacts on the quality of human life and economic activity [1]. The provision of water and wastewater services requires considerable investment to comply with the European Union Urban Waste Water Treatment and Drinking Water directives and the various national laws. Thus, in the near future, the main water management challenges in Europe will be the operations, maintenance, upgrading, and renovation of the infrastructure. This implies that water and wastewater services should be managed in an economically and environmentally sustainable fashion.
This paper presents a study aimed at measuring the efficiency of the transmission segment of the ... more This paper presents a study aimed at measuring the efficiency of the transmission segment of the US natural gas industry from an economic perspective. The gas transmission infrastructure is modeled as an economic production function and a multi-stage modeling approach based on the implementation of Data Envelopment Analysis is employed to obtain an efficiency measure in a two-dimension performance space, i.e., cost and revenue-efficiency. This approach allows taking into account conflicting business goals. The study also performs cluster analysis to uncover homogeneous efficiency profiles relative to the gas transmission systems to explore determinants of efficiency rates, and trade-off situations. A sample containing 80 US gas transmission systems is used in the analysis. Results indicate that the transmission segment of the US gas industry has considerable inefficiencies, while average cost and revenue-efficiency scores are 0.324 and 0.301, and only three transmission systems achieve high scores on both efficiency dimensions. Cluster analysis identified seven configurations. In three of them there are no trade-off situations between cost and revenue efficiencies. However, only in one of them gas transmission systems have high efficiencies. The remaining four configurations exhibit trade-off situations having different intensity. Such trade-offs can be determined by the gas transmission infrastructure size.
Management Decision, 2018
Purpose – The purpose of this paper is to propose a methodological framework that combines severa... more Purpose – The purpose of this paper is to propose a methodological framework that combines several data envelopment analysis (DEA) models to deal with the problem of evaluating and ranking advanced manufacturing technologies (AMTs) without introducing any subjectivity in the analysis.
Design/methodology/approach – The methodology follows a two-phase procedure. First, the relative efficiency of every technology is calculated by implementing different DEA cross-efficiency models generating the same number of high-order indicators as efficiency vectors. Second, high-order indicators are used as outputs in a SBM-DEA super-efficiency model to obtain a comprehensive DEA-like composite indicator.
Findings – The framework is implemented to evaluate a sample of flexible manufacturing systems. Comparing it to other methods, results show that the methodology provides reliable information for AMTs selection and effective support to management decision-making. Originality/value – This paper contributes to the body of knowledge about the utilization of DEA to select AMTs. The framework has several advantages: a discriminating power higher than the basic DEA models; no subjective judgment relative to weights necessary to aggregate single indicators and choice of aggregation function; no need to perform any transformation normalizing original data; independence from the unit of measurement of the DEA-like composite indicator; and great flexibility and adaptability allowing the introduction of further variables in the analysis.
Utilities Policy, 2018
A B S T R A C T This paper investigates the role of the different ownership types of operators in... more A B S T R A C T This paper investigates the role of the different ownership types of operators in the Italian airport sector. A meta-frontier conceptualization is utilized to consider ownership heterogeneity and compare airport efficiencies. Efficiencies are measured from multiple perspectives. Cluster analysis is adopted to uncover airport configurations with respect to inefficiencies. The results suggest that ownership heterogeneity may exert substantial influence on airport efficiency. However, while PPP airports have greater technical efficiency than airports operated by publicly owned operators, the meta-frontier analysis relative to cost and revenue efficiency does not provide evidence that PPP airports perform better. Indeed, publicly managed airports achieve comparable or better performance in terms of revenue efficiency. Findings also indicate that ownership is not the only factor affecting airport performance.
This paper illustrates a benchmarking study concerning the healthcare systems in 32 European coun... more This paper illustrates a benchmarking study concerning the healthcare systems in 32 European countries as of 2011 and 2014. Particularly, this study proposes a two-dimensional approach (efficiency/effectiveness models) to evaluate the performance of national healthcare systems. Data Envelopment Analysis has been adopted to compute two performance indices, measuring efficiency and effectiveness of these healthcare systems. The results of the study emphasize that the national healthcare systems achieve different efficiency and effectiveness levels. Their performance indices are uncorrelated and behave differently over time, suggesting that there might be no real trade-off between them. The healthcare systems' efficiencies remain generally stable, while the effectiveness values significantly improved from 2011 to 2014. However, comparing the efficiency and effectiveness scores, the authors identified a group of countries with the lowest performing healthcare systems that includes Ukraine, Bulgaria, Switzerland, Lithuania, and Romania. These countries need to implement healthcare reforms aimed at reducing resource intensity and increasing the quality of medical services. The results also showed the benefits of the proposed approach, which can help policy makers to identify shortcomings in national healthcare systems and justify the need for their reform.
Measuring efficiency in the utilization of public resources has become one major concern of natio... more Measuring efficiency in the utilization of public resources has become one major concern of national and regional governments, both in developed and underdeveloped countries. The objective of this paper is to present the results of a benchmarking study that measured efficiency of the national healthcare systems in 31 European countries, from 2011 to 2014.
Data were collected from the Eurostat dataset, while Data Envelopment Analysis (DEA) was used as a computational technique to generate an objective measurement of efficiency for the countries included in the sample.
Results show that there is a widespread inefficiency in the management of healthcare systems across Europe. Mean efficiency of the whole sample is between 75.7% and 76.6% and between 84.5% and 87.1% respectively under the assumption of constant and variable returns to scale. Efficiency appears associated to management and scale inefficiency, the ratios “number of medical doctors to number of beds in hospitals” and “number of beds to population size”.
In the last decade the renewable energy facilities have become very important for generating elec... more In the last decade the renewable energy facilities have become very important for generating electricity in Europe. Estimating the production efficiency of renewable energy industry is thus a major concern of governments. This paper implements Data Envelopment Analysis (DEA) to measure efficiency in the generation of electricity from renewable sources during 2002-2011 in 31 European countries. As input congestion may introduce bias in the efficiency analysis, an improved DEA model is used to correct and avoid efficiency underestimation.
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Papers by Corrado lo Storto
A free copy of the article can be downloaded clicking on this link before February 22, 2024:
https://authors.elsevier.com/a/1iMuj3Peo9nMTB
eco-efficiency and eco-productivity measures increase from 2010 to 2017. Findings demonstrate the critical importance to include environmental indicators in the efficiency and productivity analysis.
indicates that the average global efficiency of the water utilities is still low, although it slightly increased from 2011 to 2017. Efficiency scores calculated using the proposed DEA model result reduced by about
32.6% in 2011 and 15.9% in 2017 in comparison to conventional DEA models. Additionally, the study shows that the efficiency measurements relative to the three basic water services differ largely for several utilities. Findings also suggest that size may support efficiency improvement.
municipality services. A sample including 103 major Italian municipalities is used as a case to implement the proposed model. Findings indicate that there is no trade-off between the efficiency and effectiveness components of the overall municipal performance score, but rather they appear to be preconditions of each other. Therefore,
higher level of performance can be achieved without conflicting one against the other. Furthermore, only 6 municipalities achieve the highest performance level, suggesting that there is still room for improving the performance of a great number of municipalities.
Design/methodology/approach – The methodology follows a two-phase procedure. First, the relative efficiency of every technology is calculated by implementing different DEA cross-efficiency models generating the same number of high-order indicators as efficiency vectors. Second, high-order indicators are used as outputs in a SBM-DEA super-efficiency model to obtain a comprehensive DEA-like composite indicator.
Findings – The framework is implemented to evaluate a sample of flexible manufacturing systems. Comparing it to other methods, results show that the methodology provides reliable information for AMTs selection and effective support to management decision-making. Originality/value – This paper contributes to the body of knowledge about the utilization of DEA to select AMTs. The framework has several advantages: a discriminating power higher than the basic DEA models; no subjective judgment relative to weights necessary to aggregate single indicators and choice of aggregation function; no need to perform any transformation normalizing original data; independence from the unit of measurement of the DEA-like composite indicator; and great flexibility and adaptability allowing the introduction of further variables in the analysis.
Data were collected from the Eurostat dataset, while Data Envelopment Analysis (DEA) was used as a computational technique to generate an objective measurement of efficiency for the countries included in the sample.
Results show that there is a widespread inefficiency in the management of healthcare systems across Europe. Mean efficiency of the whole sample is between 75.7% and 76.6% and between 84.5% and 87.1% respectively under the assumption of constant and variable returns to scale. Efficiency appears associated to management and scale inefficiency, the ratios “number of medical doctors to number of beds in hospitals” and “number of beds to population size”.
A free copy of the article can be downloaded clicking on this link before February 22, 2024:
https://authors.elsevier.com/a/1iMuj3Peo9nMTB
eco-efficiency and eco-productivity measures increase from 2010 to 2017. Findings demonstrate the critical importance to include environmental indicators in the efficiency and productivity analysis.
indicates that the average global efficiency of the water utilities is still low, although it slightly increased from 2011 to 2017. Efficiency scores calculated using the proposed DEA model result reduced by about
32.6% in 2011 and 15.9% in 2017 in comparison to conventional DEA models. Additionally, the study shows that the efficiency measurements relative to the three basic water services differ largely for several utilities. Findings also suggest that size may support efficiency improvement.
municipality services. A sample including 103 major Italian municipalities is used as a case to implement the proposed model. Findings indicate that there is no trade-off between the efficiency and effectiveness components of the overall municipal performance score, but rather they appear to be preconditions of each other. Therefore,
higher level of performance can be achieved without conflicting one against the other. Furthermore, only 6 municipalities achieve the highest performance level, suggesting that there is still room for improving the performance of a great number of municipalities.
Design/methodology/approach – The methodology follows a two-phase procedure. First, the relative efficiency of every technology is calculated by implementing different DEA cross-efficiency models generating the same number of high-order indicators as efficiency vectors. Second, high-order indicators are used as outputs in a SBM-DEA super-efficiency model to obtain a comprehensive DEA-like composite indicator.
Findings – The framework is implemented to evaluate a sample of flexible manufacturing systems. Comparing it to other methods, results show that the methodology provides reliable information for AMTs selection and effective support to management decision-making. Originality/value – This paper contributes to the body of knowledge about the utilization of DEA to select AMTs. The framework has several advantages: a discriminating power higher than the basic DEA models; no subjective judgment relative to weights necessary to aggregate single indicators and choice of aggregation function; no need to perform any transformation normalizing original data; independence from the unit of measurement of the DEA-like composite indicator; and great flexibility and adaptability allowing the introduction of further variables in the analysis.
Data were collected from the Eurostat dataset, while Data Envelopment Analysis (DEA) was used as a computational technique to generate an objective measurement of efficiency for the countries included in the sample.
Results show that there is a widespread inefficiency in the management of healthcare systems across Europe. Mean efficiency of the whole sample is between 75.7% and 76.6% and between 84.5% and 87.1% respectively under the assumption of constant and variable returns to scale. Efficiency appears associated to management and scale inefficiency, the ratios “number of medical doctors to number of beds in hospitals” and “number of beds to population size”.