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

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  • Amado, Carla Alexandra da Encarnação Filipe
  • Santos, Sérgio Pereira dos

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.

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Bibliographic Info

Article provided by Elsevier in its journal Health Policy.

Volume (Year): 91 (2009)
Issue (Month): 1 (June)
Pages: 43-56

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Handle: RePEc:eee:hepoli:v:91:y:2009:i:1:p:43-56

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Web page: http://www.elsevier.com/locate/healthpol

Related research

Keywords: Efficiency Equity of access Quality Data envelopment analysis Primary health care;

References

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  1. Robert Rosenman & Daniel Friesner, 2004. "Scope and scale inefficiencies in physician practices," Health Economics, John Wiley & Sons, Ltd., vol. 13(11), pages 1091-1116.
  2. Jamieson, Anne & van der Geest, Sjaak & Pereira, João, 1990. "Equity objectives in Portuguese health policy," Social Science & Medicine, Elsevier, Elsevier, vol. 31(1), pages 91-94, January.
  3. Thanassoulis, E. & Boussofiane, A. & Dyson, R. G., 1995. "Exploring output quality targets in the provision of perinatal care in England using data envelopment analysis," European Journal of Operational Research, Elsevier, Elsevier, vol. 80(3), pages 588-607, February.
  4. Bruce Hollingsworth & P.J. Dawson & N. Maniadakis, 1999. "Efficiency measurement of health care: a review of non‐parametric methods and applications," Health Care Management Science, Springer, Springer, vol. 2(3), pages 161-172, July.
  5. R. D. Banker & A. Charnes & W. W. Cooper, 1984. "Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis," Management Science, INFORMS, INFORMS, vol. 30(9), pages 1078-1092, September.
  6. Mónica Duarte Oliveira & Carlos Gouveia Pinto, 2005. "Health care reform in Portugal: an evaluation of the NHS experience," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages S203-S220.
  7. Charnes, A. & Cooper, W. W. & Rhodes, E., 1978. "Measuring the efficiency of decision making units," European Journal of Operational Research, Elsevier, Elsevier, vol. 2(6), pages 429-444, November.
  8. Antonio Giuffrida & Hugh Gravelle, 2001. "Measuring performance in primary care: econometric analysis and DEA," Applied Economics, Taylor & Francis Journals, Taylor & Francis Journals, vol. 33(2), pages 163-175.
  9. Filipe Amado, Carla Alexandra & Dyson, Robert G., 2008. "On comparing the performance of primary care providers," European Journal of Operational Research, Elsevier, Elsevier, vol. 185(3), pages 915-932, March.
  10. Jakob Bj�rner & Hans Keiding, 2004. "Cost-effectiveness with multiple outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 13(12), pages 1181-1190.
  11. Oliveira, Monica Duarte & Bevan, Gwyn, 2003. "Measuring geographic inequities in the Portuguese health care system: an estimation of hospital care needs," Health Policy, Elsevier, Elsevier, vol. 66(3), pages 277-293, December.
  12. Boussofiane, A. & Dyson, R. G. & Thanassoulis, E., 1991. "Applied data envelopment analysis," European Journal of Operational Research, Elsevier, Elsevier, vol. 52(1), pages 1-15, May.
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Cited by:
  1. Luis Murillo-Zamorano & Carmelo Petraglia, 2011. "Technical efficiency in primary health care: does quality matter?," The European Journal of Health Economics, Springer, Springer, vol. 12(2), pages 115-125, April.
  2. Cordero Ferrera, Jose Manuel & Alonso Morán, Edurne & Nuño Solís, Roberto & Orueta, Juan F. & Souto Arce, Regina, 2013. "Efficiency assessment of primary care providers: A conditional nonparametric approach," MPRA Paper 51926, University Library of Munich, Germany.
  3. Pelone, Ferruccio & Kringos, Dionne Sofia & Valerio, Luca & Romaniello, Alessandro & Lazzari, Agnese & Ricciardi, Walter & de Belvis, Antonio Giulio, 2012. "The measurement of relative efficiency of general practice and the implications for policy makers," Health Policy, Elsevier, Elsevier, vol. 107(2), pages 258-268.
  4. Thanassoulis, Emmanuel & Silva Portela, Maria C.A. & Graveney, Mike, 2014. "Using DEA to estimate potential savings at GP units at medical specialty level," Socio-Economic Planning Sciences, Elsevier, Elsevier, vol. 48(1), pages 38-48.
  5. Thanassoulis, Emmanuel & Silva Portela, Maria C.A. & Graveney, Mike, 2012. "Estimating the scope for savings in referrals and drug prescription costs in the general Practice units of a UK primary care trust," European Journal of Operational Research, Elsevier, Elsevier, vol. 221(2), pages 432-444.
  6. John Buckell & Andrew Smith & Roberta Longo & David Holland, 2013. "Health inefficiency and unobservable heterogeneity - empirical evidence from pathology services in the UK National Health Service," Working Papers, Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds 1307, Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds.

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