IDEAS home Printed from https://ideas.repec.org/a/kap/hcarem/v28y2025i2d10.1007_s10729-025-09702-0.html
   My bibliography  Save this article

Visualisation of Data Envelopment Analysis in primary health services

Author

Listed:
  • Ane Elixabete Ripoll-Zarraga

    (Universitat Autònoma de Barcelona)

  • José Luis Franco Miguel

    (Universidad Pontificia Comillas)

  • Carmen Fullana Belda

    (Universidad Pontificia Comillas)

Abstract

Benchmark efficiency analysis in public health typically focuses on hospitals rather than primary care providers. Data Envelopment Analysis (DEA) is widely used to assess resource efficiency among decision-making units (DMUs). However, traditional DEA struggles to differentiate between efficient units and is sensitive to the selection of inputs and outputs. Methods like super-efficiency and cross-efficiency address some of these limitations but often exclude outliers and may overlook efficiency related to specialisation. DEA Visualisation integrates DEA with multivariate statistical methods allowing for the identification of inefficiency sources and specialisation patterns without losing discriminatory power or removing extreme cases from the sample. This study analyses 82 public primary health centres in Madrid serving senior citizens in 2018. The findings reveal inefficiencies such as a preference for prescribing specific rather than generic drugs, increasing public health costs. Additionally, two extreme cases (outliers or mavericks) were identified as having high infrastructure costs and disproportionate staffing. Redistributing patients from overcrowded centres could enhance efficiency, while centres focused on preventive care showed greater cost-effectiveness, particularly in reducing prescription costs.

Suggested Citation

  • Ane Elixabete Ripoll-Zarraga & José Luis Franco Miguel & Carmen Fullana Belda, 2025. "Visualisation of Data Envelopment Analysis in primary health services," Health Care Management Science, Springer, vol. 28(2), pages 207-233, June.
    • Handle: RePEc:kap:hcarem:v:28:y:2025:i:2:d:10.1007_s10729-025-09702-0
    DOI: 10.1007/s10729-025-09702-0
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s10729-025-09702-0
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s10729-025-09702-0?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Gutiérrez-Nieto, Begoña & Serrano-Cinca, Carlos & Mar Molinero, Cecilio, 2007. "Microfinance institutions and efficiency," Omega, Elsevier, vol. 35(2), pages 131-142, April.
    2. Léopold Simar & Paul W. Wilson, 1998. "Sensitivity Analysis of Efficiency Scores: How to Bootstrap in Nonparametric Frontier Models," Management Science, INFORMS, vol. 44(1), pages 49-61, January.
    3. 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.
    4. Daraio, Cinzia & Bonaccorsi, Andrea & Simar, Léopold, 2015. "Efficiency and economies of scale and specialization in European universities: A directional distance approach," Journal of Informetrics, Elsevier, vol. 9(3), pages 430-448.
    5. Wilson, Paul W., 2018. "Dimension reduction in nonparametric models of production," European Journal of Operational Research, Elsevier, vol. 267(1), pages 349-367.
    6. 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.
    7. Berger, Allen N. & Humphrey, David B., 1997. "Efficiency of financial institutions: International survey and directions for future research," European Journal of Operational Research, Elsevier, vol. 98(2), pages 175-212, April.
    8. Lee, Chia-Yen & Cai, Jia-Ying, 2020. "LASSO variable selection in data envelopment analysis with small datasets," Omega, Elsevier, vol. 91(C).
    9. C Serrano Cinca & C Mar Molinero, 2004. "Selecting DEA specifications and ranking units via PCA," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 55(5), pages 521-528, May.
    10. 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.
    11. Ripoll-Zarraga, Ane Elixabete & Mar-Molinero, Cecilio, 2020. "Exploring the reasons for efficiency in Spanish airports," Transport Policy, Elsevier, vol. 99(C), pages 186-202.
    12. Russell, R. Robert, 1985. "On the Axiomatic Approach to the Measurement of Technical Efficiency," Working Papers 85-33, C.V. Starr Center for Applied Economics, New York University.
    13. Olesen, O. B. & Petersen, N. C., 1995. "Incorporating quality into data envelopment analysis: a stochastic dominance approach," International Journal of Production Economics, Elsevier, vol. 39(1-2), pages 117-135, April.
    14. Ripoll-Zarraga, Ane Elixabete & Huderek-Glapska, Sonia, 2021. "Airports’ managerial human capital, ownership, and efficiency," Journal of Air Transport Management, Elsevier, vol. 92(C).
    15. repec:hal:journl:peer-00796744 is not listed on IDEAS
    16. José Cordero Ferrera & Eva Cebada & Luis Murillo Zamorano, 2014. "The effect of quality and socio-demographic variables on efficiency measures in primary health care," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(3), pages 289-302, April.
    17. Sebastian Kohl & Jan Schoenfelder & Andreas Fügener & Jens O. Brunner, 2019. "The use of Data Envelopment Analysis (DEA) in healthcare with a focus on hospitals," Health Care Management Science, Springer, vol. 22(2), pages 245-286, June.
    18. Podinovski, Victor V. & Wu, Junlin & Argyris, Nikolaos, 2024. "Production trade-offs in models of data envelopment analysis with ratio inputs and outputs: An application to schools in England," European Journal of Operational Research, Elsevier, vol. 313(1), pages 359-372.
    19. 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.
    20. Cinzia Daraio & Léopold Simar, 2007. "Conditional nonparametric frontier models for convex and nonconvex technologies: a unifying approach," Journal of Productivity Analysis, Springer, vol. 28(1), pages 13-32, October.
    21. Daouia, Abdelaati & Gijbels, Irène, 2011. "Robustness and inference in nonparametric partial frontier modeling," Journal of Econometrics, Elsevier, vol. 161(2), pages 147-165, April.
    22. Liu, John S. & Lu, Louis Y.Y. & Lu, Wen-Min & Lin, Bruce J.Y., 2013. "A survey of DEA applications," Omega, Elsevier, vol. 41(5), pages 893-902.
    23. Toru Hattori, 2002. "Relative Performance of U.S. and Japanese Electricity Distribution: An Application of Stochastic Frontier Analysis," Journal of Productivity Analysis, Springer, vol. 18(3), pages 269-284, November.
    24. 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.
    25. Robert Russell, R., 1985. "Measures of technical efficiency," Journal of Economic Theory, Elsevier, vol. 35(1), pages 109-126, February.
    26. Abdelaati Daouia & Irène Gijbels, 2011. "Robustness and inference in nonparametric partial-frontier modeling," Post-Print hal-00796744, HAL.
    27. Mansour Zarrin, 2023. "A mixed-integer slacks-based measure data envelopment analysis for efficiency measuring of German university hospitals," Health Care Management Science, Springer, vol. 26(1), pages 138-160, March.
    28. I. T. Jolliffe, 1972. "Discarding Variables in a Principal Component Analysis. I: Artificial Data," Journal of the Royal Statistical Society Series C, Royal Statistical Society, vol. 21(2), pages 160-173, June.
    29. Marianela Carrillo & Jesús M. Jorge, 2017. "DEA-Like Efficiency Ranking of Regional Health Systems in Spain," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 133(3), pages 1133-1149, September.
    30. Peter Smith, 1990. "The Use of Performance Indicators in the Public Sector," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 153(1), pages 53-72, January.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Diogo Cunha Ferreira & Rui Cunha Marques, 2020. "A step forward on order-α robust nonparametric method: inclusion of weight restrictions, convexity and non-variable returns to scale," Operational Research, Springer, vol. 20(2), pages 1011-1046, June.
    2. Mai, Nhat Chi, 2015. "Efficiency of the banking system in Vietnam under financial liberalization," OSF Preprints qsf6d, Center for Open Science.
    3. Sebastian Kohl & Jan Schoenfelder & Andreas Fügener & Jens O. Brunner, 2019. "The use of Data Envelopment Analysis (DEA) in healthcare with a focus on hospitals," Health Care Management Science, Springer, vol. 22(2), pages 245-286, June.
    4. Rita Bastião & Nuno de Sousa Pereira, 2020. "Performance in the Delivery of Primary Health Care Services: A Longitudinal Analysis," CEF.UP Working Papers 2002, Universidade do Porto, Faculdade de Economia do Porto.
    5. Liu, John S. & Lu, Louis Y.Y. & Lu, Wen-Min, 2016. "Research fronts in data envelopment analysis," Omega, Elsevier, vol. 58(C), pages 33-45.
    6. José Manuel Cordero & Carlos Díaz Caro & Francisco Pedraja Chaparro & Cristina Polo Fernández, 2020. "Tributos cedidos y eficiencia en la gestión tributaria de las Comunidades Autónomas," Hacienda Pública Española / Review of Public Economics, IEF, vol. 232(1), pages 75-112, March.
    7. Lampe, Hannes W. & Hilgers, Dennis, 2015. "Trajectories of efficiency measurement: A bibliometric analysis of DEA and SFA," European Journal of Operational Research, Elsevier, vol. 240(1), pages 1-21.
    8. Daraio, Cinzia & Simar, Leopold & Wilson, Paul, 2019. "Quality and its impact on efficiency," LIDAM Discussion Papers ISBA 2019004, Université catholique de Louvain, Institute of Statistics, Biostatistics and Actuarial Sciences (ISBA).
    9. Halkos, George & Tzeremes, Nickolaos, 2008. "Measuring regional public health provision," MPRA Paper 23762, University Library of Munich, Germany.
    10. Wijesiri, Mahinda & Yaron, Jacob & Meoli, Michele, 2017. "Assessing the financial and outreach efficiency of microfinance institutions: Do age and size matter?," Journal of Multinational Financial Management, Elsevier, vol. 40(C), pages 63-76.
    11. Kaffash, Sepideh & Azizi, Roza & Huang, Ying & Zhu, Joe, 2020. "A survey of data envelopment analysis applications in the insurance industry 1993–2018," European Journal of Operational Research, Elsevier, vol. 284(3), pages 801-813.
    12. Alexandre Marinho & Claudia Affonso Silva Araújo, 2021. "Using data envelopment analysis and the bootstrap method to evaluate organ transplantation efficiency in Brazil," Health Care Management Science, Springer, vol. 24(3), pages 569-581, September.
    13. Amir Moradi-Motlagh & Ali Emrouznejad, 2022. "The origins and development of statistical approaches in non-parametric frontier models: a survey of the first two decades of scholarly literature (1998–2020)," Annals of Operations Research, Springer, vol. 318(1), pages 713-741, November.
    14. Chiang Kao & Shiang-Tai Liu, 2022. "Stochastic efficiencies of network production systems with correlated stochastic data: the case of Taiwanese commercial banks," Annals of Operations Research, Springer, vol. 315(2), pages 1151-1174, August.
    15. 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.
    16. Bao Hoang Nguyen & Valentin Zelenyuk, 2021. "Aggregation of Outputs and Inputs for DEA Analysis of Hospital Efficiency: Economics, Operations Research and Data Science Perspectives," International Series in Operations Research & Management Science, in: Joe Zhu & Vincent Charles (ed.), Data-Enabled Analytics, pages 123-158, Springer.
    17. Krüger, Jens J., 2012. "A Monte Carlo study of old and new frontier methods for efficiency measurement," European Journal of Operational Research, Elsevier, vol. 222(1), pages 137-148.
    18. Sandrine A. Kablan & Jean-phillipe Boussemart, 2015. "Bootstrapping efficiency scores of microfinance institutions in West African economic and monetary union," Economics Bulletin, AccessEcon, vol. 35(4), pages 2220-2232.
    19. 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.
    20. Ripoll-Zarraga, Ane Elixabete & Mar-Molinero, Cecilio, 2020. "Exploring the reasons for efficiency in Spanish airports," Transport Policy, Elsevier, vol. 99(C), pages 186-202.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:kap:hcarem:v:28:y:2025:i:2:d:10.1007_s10729-025-09702-0. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.