RESUMEN
This paper aims to extend the literature on measuring efficiency in primary health care by considering the influence of quality indicators and environmental variables conjointly in a case study. In particular, environmental variables are represented by patients' characteristics and quality indicators are based on technical aspects. In order to deal with both aspects, different extensions of data envelopment analysis (DEA) methodology are applied. Specifically, we use weight restrictions to ensure that the efficiency scores assigned to the evaluated units take quality data into account, and a four-stage model to identify which exogenous variables have impact on performance as well as to compute efficiency scores that incorporate this information explicitly. The results provide evidence in support of the importance of including information about both aspects in the analysis so that the efficiency measures obtained can be interpreted as an accurate reflection of performance.
Asunto(s)
Eficiencia Organizacional , Ambiente , Atención Primaria de Salud/organización & administración , Calidad de la Atención de Salud/organización & administración , Humanos , Atención Primaria de Salud/normas , Indicadores de Calidad de la Atención de Salud , Calidad de la Atención de Salud/normas , Factores SocioeconómicosRESUMEN
The aim of this paper is to extend the existing literature about efficiency measurement in primary health care with the application of a recently developed method to deal with exogenous variables. In this context, these variables are represented by the main characteristics of the covered population. The use of this technique allows calculating more accurate efficiency scores that can reflect the performance of units more properly. Our results show that the inclusion of these variables in the evaluation has a great impact on both the values of efficiency scores and the rank of units. This analysis has been carried out using a great amount of data available about primary health care centers in the Spanish region of Extremadura.
Asunto(s)
Eficiencia Organizacional , Atención Primaria de Salud/organización & administración , Prescripciones de Medicamentos/estadística & datos numéricos , Personal de Salud/estadística & datos numéricos , Humanos , Visita a Consultorio Médico/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Factores Socioeconómicos , España , Estadísticas VitalesRESUMEN
The accuracy required in the measurement of output is an issue that has as yet still not been satisfactorily addressed in empirical research on efficiency in primary health care. We exploit information retrieved from a newly constructed database (APEX06) for the Spanish region of Extremadura. The richness of our dataset allows us to consider original synthetic measures of output that take into account both the quantity and the quality of services provided by 85 primary care centers (PCCs) in 2006. We provide evidence that neglecting the issue of properly accounting for the quality of health services can lead to misleading results. Our main finding is that adjusting output for quality has a three-fold effect on efficiency analysis. Firstly, inefficiency explains relatively more of the deviation from potential output. Secondly, the average technical efficiency in the sector is lower, while its dispersion among PCCs is significantly higher. Thirdly, the efficiency ranking of the PCCs is affected.