Evaluation of Urban Health Efficiency in Japanese Cities Using Network Data Envelopment Analysis

Urban health efficiency is influenced by both urban planning decisions and the functioning of the public health system. However, there is currently a lack of effective methods to simultaneously examine urban planning and public health when assessing urban health efficiency. This study proposes a two-stage network data envelopment analysis (DEA) model for evaluating urban health efficiency. The urban planning and public health sectors act as interconnected stages where the public facilities and living quality are mediating variables. The urban health efficiencies of 303 Japanese cities are examined using the proposed model, showing that most Japanese cities still have room for urban planning improvement with pure technical efficiency ranging between 0.7 and 0.9. At the same time, most public health sectors of Japanese cities reach pure technical efficiencies larger than 0.95 but are limited by the scale efficiency. Further analysis points out that public health sectors are in decreasing-return-to-scale, meaning that excessive urban scale adversely affects urban health efficiency. Furthermore, cities that joined the Alliance for Healthy Cities (AFHC) performed better on average, suggesting that information sharing and national and international networking can boost urban health. The study shows that the proposed two-stage network DEA model can be applied to analyze urban health efficiency and identify the impact of technology and urban scale in different stages.