Challenges for performance assessment and improvement in primary health care: The case of the Portuguese health centres

Abstract

Primary care is currently at the heart of health service policy, both in Portugal and internationally. At the same time, interest in the measurement of efficiency of health care delivery has increased considerably. However, very few studies have focused specifically on performance assessment in primary health care provision. In this paper we aim to contribute to a discussion regarding appropriate ways to compare the performance of primary health care providers. Following a review of the literature, a conceptual framework for performance assessment of health centres is developed and tested using the Portuguese case. Our empirical analysis uses data from 2004 and 2005 for all the Portuguese health centres and compares the geographical equity of access to services, technical efficiency and quality of services across District Health Authorities. Data Envelopment Analysis is the technique used to measure technical efficiency. From our empirical analysis, we conclude that there is evidence of large variation in equity of access to services, in technical efficiency and quality of services across District Health Authorities. Our findings suggest that a better use of resources could lead to more and improved services. Whilst formative evaluation could contribute to this, the challenge is to engage health care professionals in the evaluation exercise.

Efficiency assessment of primary care providers: A conditional nonparametric approach

“…However, the concept of quality is difficult to define, since it encompasses technical aspects reflecting the capacity of medical staff to diagnose and treat medical problems, but also patients´ perceptions about the service delivered (Donabedian, 1980;Campbell et al, 2000). Therefore, in the short list of studies using a nonparametric framework to incorporate quality measures into the efficiency analysis it is possible to detect a variety of indicators as proxies to this concept (Salinas-Jiménez and Smith, 1996;García et al, 1999;Rosenman and Friesner, 2004;Amado and Santos, 2009). …”

An application of value-based DEA to identify the best practices in primary health care

“…These inputs and outputs have been widely discussed with the GDM, in accordance with the indicators established in the Performance Plan and are often considered in this type of DEA studies [40].…”

“…Amado and Santos [40] provide an empirical analysis of efficiency, equity and quality of the PHC in Portugal with the involvement of DMs. They discuss the results with health care professionals and their conviction is that engaging stakeholders in the evaluation process contributes to performance improvement in practice.…”

DEA Models with Production Trade-offs and Weight Restrictions

“…These include the assessment of efficiency of university departments (Podinovski 2007a), secondary schools (Khalili et al 2010), primary health care providers (Amado and Santos 2009), primary diabetes care providers (Amado and Dyson 2009), electricity distributors (Santos et al 2011) and agricultural farms (Atici 2012). The following are a few examples of production trade-offs employed in the above studies.…”

“…Primary health care provision: the hospital outputs should not deteriorate if the number of nurses is reduced by 1 and the number of doctors is increased by 1 (Amado and Santos 2009). This corresponds to the weight restriction stating that the weight attached to the number of doctors is at least as large as the weight attached to the number of nurses.…”