Factors affecting primary health care centers’ economic and production efficiency

Abstract

Little is known about the efficiency of health centers, despite their central role in primary health care strategy for several countries. This study evaluates the health centers in Greece, and identifies factors impeding the achievement of efficiency, with the aim of determining how their efficiency could be improved. Two alternative conceptual models are used to ensure the consistency of the efficiency results: one model is focusing on production efficiency and the other on economic efficiency. Subsequently a second stage analysis is performed to account for the impact of explanatory variables on efficiency. The use of DEA models alongside with bootstrap techniques allows calculating more accurately the efficiency scores that can reflect the performance of health centers more properly. The main drivers of health centers' technical efficiency for both conceptual models were the location characteristics, the population growth, the mortality rate and the competition. The scale efficiency of health centers in production model is reflected by the size of their respective covered populations, the location characteristics and the mortality rate while the economic model is affected by their size, the location characteristics and the percentage of population working in agriculture. Determining how these variables influence on efficiency is essential for determining performance improvement strategies.

Determinants of Technical Efficiency in Public Hospitals: The Case of Saudi Arabia

“…Also, it is essential to engage the primary health centres for supporting health service provisions, especially in terms of infectious disease control and follow up the chronic disease cases, e.g. diabetic and hypertensive patients, in the region [21]. Such policy and practice initiatives may make the efficient use of health resources to ensuring the maximum value for money, which should contribute significantly towards achieving universal health coverage in the KSA.…”

“…However, external variables, i.e. environmental and institutional factors, which were not under the control of the public hospital efficiency analysis, need to be considered in an additional evaluation since such factors are a potential source of inefficiency [21,25]. External variables are usually included in a second phase of the analysis in order to explain the reasons whether the public hospital is inefficient [26].…”

“…Efficiency literatures emphasized that the performance of public hospitals is influenced not only by the internal factors but also by external factors beyond the control of hospital management, which may have an impact on technical efficiency, for instance, Kontodimopoulos et al 2007;Mitropoulos et al 2016;Ahmed et al 2019 andCheng et al 2015 [14,[20][21][22]. Although these external factors are not used to construct the frontier analysis (e.g.…”

“…Although these external factors are not used to construct the frontier analysis (e.g. DEA analysis), their influence on efficiency measurement needs to be investigated [21]. More specifically, these external factors are represented by environmental variables that are related to management, demographic characteristics of the catchment area of the hospitals, and organizational structure [23].…”

Financial performance–efficiency nexus in public health services: A nonparametric evidence-based approach

“…Other units included in the analysis of healthcare efficiency include complete healthcare system at the national level (Asandului et al, 2015;Asandului et al, 2014;Adang & Borm, 2007), healthcare system at the level of individual regions within a country (Stefko et al, 2018;Carrillo & Jorge, 2017;De Nicola et al, 2011;Nuti et al, 2011) or specific healthcare units, for example intensive care units, dialysis centers, nursing homes, etc. (Mitropoulos et al, 2016;Garavaglia et al, 2011;Tsekouras et al, 2010;Nunamaker, 1983). According to CDCs (Centers for Disease Control & Prevention, 2014), public health consists of ten essential services crucial for the achievement of social determinants of health, including health literacy and access, community and social cohesion, environmental conditions and housing quality, etc.…”