On evaluating health centers groups in Lisbon and Tagus Valley: efficiency, equity and quality

Abstract

BackgroundBearing in mind the increasing health expenses and their weight in the Portuguese gross domestic product, it is of the utmost importance to evaluate the performance of Primary Health Care providers taking into account both efficiency, quality and equity. This paper aims to contribute to a better understanding of the performance of Primary Health Care by measuring it in a Portuguese region (Lisbon and Tagus Valley) and identifying best practices. It also intends to evaluate the quality and equity provided.MethodsFor the purpose of measuring the efficiency of the health care centers (ACES) the non-parametric full frontier technique of data envelopment analysis (DEA) was adopted. The recent partial frontier method of order-m was also used to estimate the influence of exogenous variables on the efficiency of the ACES. The horizontal equity was investigated by applying the non-parametric Kruskal-Wallis test with multiple comparisons. Moreover, the quality of service was analyzed by using the ratio between the complaints and the total activity of the ACES.ResultsOn the whole, a significant level of inefficiency was observed, although there was a general improvement in efficiency between 2009 and 2010. It was found that nursing was the service with the lowest scores. Concerning the horizontal equity, the analysis showed that there is no evidence of relevant disparities between the different subregions(NUTS III). Concerning the exogenous variables, the purchasing power, the percentage of patients aged 65 years old or older and the population size affect the efficiency negatively.ConclusionsThis research shows that better usage of the available resources and the creation of a learning network and dissemination of best practices will contribute to improvements in the efficiency of the ACES while maintaining or even improving quality and equity. It was also proved that the market structure does matter when efficiency measurement is addressed.

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

“…expenditure, operating costs-has been opted by six studies [23,27,28,35,54,55]; while the most common approach was to consider a disaggregated combination of inputs -i.e. mix of labour or capital resources; five DEA models considered both single and disaggregated measures of inputs (see additional file 1).…”

“…Eleven included DEA applications focused on measuring scale (in)efficiency, using both a CRS and a VRS DEA model on the same dataset [23,26,27,29,34,35,44,37,38,46,52].…”

“…Three out of thirtynine included analyses ran both an input-oriented and an output-oriented DEA model, to know simultaneously the proportional reduction in input usage possible for a given level of output and the proportional expansion in output levels possible keeping the input fixed [23,44,55].…”

“…Largely, DEA has been used to measure the relative efficiency of a wide range of activities provided by different PC centers or districts within national/regional PC systems [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. In a large number of studies DEA has also been used to compare PC providers in delivering specific activities (e.g.…”

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

“…More recently, Ferreira et al [41] also evaluate the performance of PHC providers of a Portuguese region, taking into account both efficiency, equity and quality. In this study the DMUs are the 22 ACES belonging to Lisbon and Tagus Valley region and the authors show that by establishing a learning network the efficiency of ACES is likely to improve, with a better usage of the available resources while keeping quality and equity.…”