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Exploring the use of DEA for formative evaluation in primary diabetes care: An application to compare English practices


  • C A F Amado

    () (University of Algarve, Campus de Gambelas)

  • R G Dyson

    (University of Warwick)


Primary care is currently at the heart of the UK National Health Service policy. Primary care trusts have the crucial role of improving the efficiency and equity in primary care delivery. However, few studies have focused on performance assessment in primary care provision. In this paper, we examine the role of data envelopment analysis (DEA) in helping decision makers to understand and improve the performance of primary care practices. We discuss the results from a study of 14 practices in England in terms of their delivery of diabetes services. In order to take into account the multiple values that underlie public services provision, we have considered several different perspectives for evaluation. These were: technical, allocative and cost efficiency, clinical and patient-focused effectiveness, and equity. The approach adopted involved a deep engagement with the practices. The purpose was to understand the structures and processes supporting effective practice using DEA in a formative role rather than the more usual summative role with a large data set. This approach is in the tradition of the developmental engagement approach of operational research.

Suggested Citation

  • C A F Amado & R G Dyson, 2009. "Exploring the use of DEA for formative evaluation in primary diabetes care: An application to compare English practices," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 60(11), pages 1469-1482, November.
  • Handle: RePEc:pal:jorsoc:v:60:y:2009:i:11:d:10.1057_jors.2008.160
    DOI: 10.1057/jors.2008.160

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    References listed on IDEAS

    1. 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.
    2. 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.
    3. Antonio Giuffrida & Hugh Gravelle, 2001. "Measuring performance in primary care: econometric analysis and DEA," Applied Economics, Taylor & Francis Journals, vol. 33(2), pages 163-175.
    4. Robert Rosenman & Daniel Friesner, 2004. "Scope and scale inefficiencies in physician practices," Health Economics, John Wiley & Sons, Ltd., vol. 13(11), pages 1091-1116, November.
    5. 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.
    6. 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.
    7. Yasar Ozcan, 1998. "Physician benchmarking: measuring variation in practice behavior in treatment of otitis media," Health Care Management Science, Springer, vol. 1(1), pages 5-17, September.
    8. Jon Chilingerian & H. David Sherman, 1997. "DEA and primary care physician report cards: Deriving preferred practice cones from managed care service concepts and operating strategies," Annals of Operations Research, Springer, vol. 73(0), pages 35-66, October.
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    Cited by:

    1. Panagiotis Mitropoulos & Kostas Kounetas & Ioannis Mitropoulos, 2016. "Factors affecting primary health care centers’ economic and production efficiency," Annals of Operations Research, Springer, vol. 247(2), pages 807-822, December.
    2. Victor V. Podinovski & Wan Rohaida Wan Husain, 2017. "The hybrid returns-to-scale model and its extension by production trade-offs: an application to the efficiency assessment of public universities in Malaysia," Annals of Operations Research, Springer, vol. 250(1), pages 65-84, March.
    3. Førsund, Finn R., 2017. "Measuring effectiveness of production in the public sector," Omega, Elsevier, vol. 73(C), pages 93-103.
    4. R G Dyson & E A Shale, 2010. "Data envelopment analysis, operational research and uncertainty," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 61(1), pages 25-34, January.
    5. Marcos Pereira Estellita Lins & Sergio Orlando Antoun Netto & Maria Stella Castro Lobo, 2019. "Multimethodology applied to the evaluation of Healthcare in Brazilian municipalities," Health Care Management Science, Springer, vol. 22(2), pages 197-214, June.
    6. Thorsen, Maggie & McGarvey, Ronald & Thorsen, Andreas, 2020. "Diabetes management at community health centers: Examining associations with patient and regional characteristics, efficiency, and staffing patterns," Social Science & Medicine, Elsevier, vol. 255(C).


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