Do Primary Care Physicians or Specialists Provide More Efficient Care?

Abstract

Sinusitis is a common health complaint and expenditures for its treatment are high; thus, it is necessary to promote efficient practice behaviours in managing patient care. This study compares resource utilization between primary care physicians and specialists in the treatment of Medicaid sinusitis patients in Virginia. Physician-level data from Virginia Medicaid claim files for 1993 were analysed. The efficiency frontier, representing the best achievable performance in the use of resources for treating sinusitis, is identified using Data Envelopment Analysis. Resource utilization (primary care physician visits, specialist visits, emergency room usage, prescriptions and laboratory tests) and corresponding costs are compared between generalists and otolaryngologists. It was concluded from this study that there are no discernible differences in technical efficiency between generalists and specialists in the treatment of sinusitis. Nevertheless, otolaryngologists are found to be more costly than generalists in treating sinusitis. Variation in both caseload and patient mix might explain variation in use of resources.

Primary Care Efficiency Measurement Using Data Envelopment Analysis: A Systematic Review

“…Only four authors [44,52,57,58] discussed the applicability of their findings to other PC settings (generalizability of results). A number of studies mentioned other important factors to be considered in the efficiency decision under consideration, such as equity [40,51], access [45,48], effectiveness [40] and financial incentives [26].…”

“…They discussed issues of implementation [31,40,48,51] or the feasibility of adopting efficiency changes given the existing operational constraints [29,37]. Kontodimopoulos et al (2007) identified that the theoretically possible efficiency improvements resulted from the analysis were plausible and desirable, but from a societal perspective, the reduction of resources needed to obtain efficiency improvements is undesirable for populations with limited health care options [29].…”

“…dental care) and treating specific diseases (e.g. diabetes) [37][38][39][40][41][42][43][44][45][46][47][48].…”

Scope and scale inefficiencies in physician practices

“…Ozcan [30], Ozcan et al [31] and Pai et al [32] used DEA to study the treatment of specific diseases. Although they found no difference in average efficiency between specialists and generalists, they found that inefficient physicians of each type were almost 30% less efficient than their fully efficient counterparts.…”

The measurement of relative efficiency of general practice and the implications for policy makers

“…A number of empirical analyses can be found that applied DEA within the context of PC [26][27][28][29][30][31][32][33][34][35][36][37] but only few studied general practice [38].…”