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Measuring the efficiency of the Greek rural primary health care using a restricted DEA model; the case of southern and western Greece

Author

Listed:
  • Nikolaos Oikonomou

    (Health Centre of Gennadi
    Greek Union of General Practitioners)

  • Yannis Tountas

    (University of Athens)

  • Argiris Mariolis

    (Health Centre of Areopolis
    Greek Union of General Practitioners)

  • Kyriakos Souliotis

    (University of Athens
    University of Peloponnese)

  • Kostas Athanasakis

    (National School of Public Health)

  • John Kyriopoulos

    (National School of Public Health)

Abstract

This is a study to measure the efficiency of the rural Health Centres (HCs) and their Regional Surgeries (RSs) of the 6th Health Prefecture (HP) of Greece, which covers Southern and Western Greece. Data Envelopment Analysis (DEA) was applied under Constant and Variable Returns to Scale, using a weight-restricted, output-oriented model, to calculate pure technical efficiency (PΤΕ), scale efficiency (SE) and total technical efficiency (TE). The selection of inputs, outputs and their relative weights in the model was based on two consecutive consensus panels of experts on Primary Health Care (PHC). Medical personnel, nursing personnel and technological equipment were chosen as inputs and were attributed appropriate weight restrictions. Acute, chronic and preventive consultations where chosen as outputs; each output was constructed by smaller subcategories of different relative importance. Data were collected through a questionnaire sent to all HCs of the covered area. From the 42 HCs which provided complete data, the study identified 9 as technical efficient, 5 as scale efficient and 2 as total efficient. The mean TE, PTE and SE scores of the HCs of the 6th Health Prefecture were 0.57, 0.67 and 0.87, respectively. The results demonstrate noteworthy variation in efficiency in the productive process of the HCs of Southern and Western Greece. The dominant form of inefficiency was technical inefficiency. The HCs of the 6th HP can theoretically produce 33 % more output on average, using their current production factors. These results indicated potential for considerable efficiency improvement in most rural health care units. Emphasis on prevention and chronic disease management, as well as wider structural and organisational reforms, are discussed from the viewpoint of how to increase efficiency.

Suggested Citation

  • Nikolaos Oikonomou & Yannis Tountas & Argiris Mariolis & Kyriakos Souliotis & Kostas Athanasakis & John Kyriopoulos, 2016. "Measuring the efficiency of the Greek rural primary health care using a restricted DEA model; the case of southern and western Greece," Health Care Management Science, Springer, vol. 19(4), pages 313-325, December.
    • Handle: RePEc:kap:hcarem:v:19:y:2016:i:4:d:10.1007_s10729-015-9324-4
    DOI: 10.1007/s10729-015-9324-4
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    1. William W. Cooper & Lawrence M. Seiford & Joe Zhu (ed.), 2011. "Handbook on Data Envelopment Analysis," International Series in Operations Research and Management Science, Springer, number 978-1-4419-6151-8, September.
    2. Filipe Amado, Carla Alexandra & Dyson, Robert G., 2008. "On comparing the performance of primary care providers," European Journal of Operational Research, Elsevier, vol. 185(3), pages 915-932, March.
    3. Amado, Carla Alexandra da Encarnação Filipe & Santos, Sérgio Pereira dos, 2009. "Challenges for performance assessment and improvement in primary health care: The case of the Portuguese health centres," Health Policy, Elsevier, vol. 91(1), pages 43-56, June.
    4. Tountas, Yannis & Karnaki, Panagiota & Pavi, Elpida, 2002. "Reforming the reform: the greek national health system in transition," Health Policy, Elsevier, vol. 62(1), pages 15-29, October.
    5. Bruce Hollingsworth, 2008. "The measurement of efficiency and productivity of health care delivery," Health Economics, John Wiley & Sons, Ltd., vol. 17(10), pages 1107-1128, October.
    6. Elias Mossialos & Sara Allin & Konstantina Davaki, 2005. "Analysing the Greek health system: a tale of fragmentation and inertia," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 151-168, September.
    7. Tountas, Yannis & Karnaki, Panagiota & Pavi, Elpida & Souliotis, Kyriakos, 2005. "The "unexpected" growth of the private health sector in Greece," Health Policy, Elsevier, vol. 74(2), pages 167-180, October.
    8. Kyriopoulos, John E. & Tsalikis, George, 1993. "Public and private imperatives of Greek health policies," Health Policy, Elsevier, vol. 26(2), pages 105-117, December.
    9. Fried, Harold O. & Lovell, C. A. Knox & Schmidt, Shelton S. (ed.), 1993. "The Measurement of Productive Efficiency: Techniques and Applications," OUP Catalogue, Oxford University Press, number 9780195072181.
    10. Charnes, A. & Cooper, W. W. & Rhodes, E., 1978. "Measuring the efficiency of decision making units," European Journal of Operational Research, Elsevier, vol. 2(6), pages 429-444, November.
    11. Kontodimopoulos, Nick & Nanos, Panagiotis & Niakas, Dimitris, 2006. "Balancing efficiency of health services and equity of access in remote areas in Greece," Health Policy, Elsevier, vol. 76(1), pages 49-57, March.
    12. R. Allen & A. Athanassopoulos & R.G. Dyson & E. Thanassoulis, 1997. "Weights restrictions and value judgements in Data Envelopment Analysis: Evolution, development and future directions," Annals of Operations Research, Springer, vol. 73(0), pages 13-34, October.
    13. Charalampos Economou & Claude Giorno, 2009. "Improving the Performance of the Public Health Care System in Greece," OECD Economics Department Working Papers 722, OECD Publishing.
    14. Paul Marschall & Steffen Flessa, 2011. "Efficiency of primary care in rural Burkina Faso. A two-stage DEA analysis," Health Economics Review, Springer, vol. 1(1), pages 1-15, December.
    15. Yasar A. Ozcan, 2014. "Evaluation of Performance in Health Care," International Series in Operations Research & Management Science, in: Health Care Benchmarking and Performance Evaluation, edition 2, chapter 0, pages 3-14, Springer.
    16. Nikolaos Oikonomou & Yannis Tountas & John Kyriopoulos, 2012. "The need for measurement of efficiency in Greek primary healthcare," Applied Health Economics and Health Policy, Springer, vol. 10(2), pages 143-144, March.
    17. Linna, Miika & Nordblad, Anne & Koivu, Matti, 2003. "Technical and cost efficiency of oral health care provision in Finnish health centres," Social Science & Medicine, Elsevier, vol. 56(2), pages 343-353, January.
    18. Roll, Y & Golany, B., 1993. "Alternate methods of treating factor weights in DEA," Omega, Elsevier, vol. 21(1), pages 99-109, January.
    19. Cordero, José Manuel & Alonso-Morán, Edurne & Nuño-Solinis, Roberto & Orueta, Juan F. & Arce, Regina Sauto, 2015. "Efficiency assessment of primary care providers: A conditional nonparametric approach," European Journal of Operational Research, Elsevier, vol. 240(1), pages 235-244.
    20. Luis R. Murillo‐Zamorano, 2004. "Economic Efficiency and Frontier Techniques," Journal of Economic Surveys, Wiley Blackwell, vol. 18(1), pages 33-77, February.
    21. R. D. Banker & A. Charnes & W. W. Cooper, 1984. "Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis," Management Science, INFORMS, vol. 30(9), pages 1078-1092, September.
    22. Thompson, Russell G. & Langemeier, Larry N. & Lee, Chih-Tah & Lee, Euntaik & Thrall, Robert M., 1990. "The role of multiplier bounds in efficiency analysis with application to Kansas farming," Journal of Econometrics, Elsevier, vol. 46(1-2), pages 93-108.
    23. Francisco Pedraja-Chaparro & Javier Salinas-Jimenez & Peter Smith, 1997. "On the Role of Weight Restrictions in Data Envelopment Analysis," Journal of Productivity Analysis, Springer, vol. 8(2), pages 215-230, May.
    24. Kazley, Abby Swanson & Ozcan, Yasar A., 2009. "Electronic medical record use and efficiency: A DEA and windows analysis of hospitals," Socio-Economic Planning Sciences, Elsevier, vol. 43(3), pages 209-216, September.
    25. William W. Cooper & Lawrence M. Seiford & Kaoru Tone, 2006. "Introduction to Data Envelopment Analysis and Its Uses," Springer Books, Springer, number 978-0-387-29122-2, September.
    26. Yasar A. Ozcan, 2014. "Health Care Benchmarking and Performance Evaluation," International Series in Operations Research and Management Science, Springer, edition 2, number 978-1-4899-7472-3, September.
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