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An application of value-based DEA to identify the best practices in primary health care


  • M. C. Gouveia

    () (IPC-ISCAC, Quinta Agrícola
    INESC Coimbra)

  • L. C. Dias

    () (INESC Coimbra
    Universidade de Coimbra)

  • C. H. Antunes

    () (INESC Coimbra
    DEEC-FCT Universidade de Coimbra, Polo II)

  • M. A. Mota

    () (ACES Baixo Mondego I)

  • E. M. Duarte

    () (ACES Baixo Mondego I)

  • E. M. Tenreiro

    () (ACES Baixo Mondego I)


Abstract In 2005, a new phase for primary health care (PHC) in Portugal began, leading to the voluntary and independent creation of Family Health Units. The impact of this reform is now being witnessed, which justifies the need to evaluate its results as far as best practices in PHC are concerned. This work uses a value-based data envelopment analysis (DEA) method, which combines an additive DEA model with multi-criteria decision analysis concepts, to allow incorporating managerial preferences in the performance assessment of 12 health centres in a Portuguese region. Two models are presented for evaluating access to PHC, which resulted from discussions with a group of decision makers. This analysis helped the decision makers in the identification of best practices, sources of inefficiency and gaps relatively to the best practices, thus leading to shape opportunities for improvement.

Suggested Citation

  • M. C. Gouveia & L. C. Dias & C. H. Antunes & M. A. Mota & E. M. Duarte & E. M. Tenreiro, 2016. "An application of value-based DEA to identify the best practices in primary health care," OR Spectrum: Quantitative Approaches in Management, Springer;Gesellschaft für Operations Research e.V., vol. 38(3), pages 743-767, July.
  • Handle: RePEc:spr:orspec:v:38:y:2016:i:3:d:10.1007_s00291-015-0407-x
    DOI: 10.1007/s00291-015-0407-x

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    References listed on IDEAS

    1. Wagner, Janet M. & Shimshak, Daniel G. & Novak, Michael A., 2003. "Advances in physician profiling: the use of DEA," Socio-Economic Planning Sciences, Elsevier, vol. 37(2), pages 141-163, June.
    2. P N de Almeida & L C Dias, 2012. "Value-based DEA models: application-driven developments," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 63(1), pages 16-27, January.
    3. Tarja Joro & Pekka Korhonen & Jyrki Wallenius, 1998. "Structural Comparison of Data Envelopment Analysis and Multiple Objective Linear Programming," Management Science, INFORMS, vol. 44(7), pages 962-970, July.
    4. Ali, Agha Iqbal & Lerme, Catherine S. & Seiford, Lawrence M., 1995. "Components of efficiency evaluation in data envelopment analysis," European Journal of Operational Research, Elsevier, vol. 80(3), pages 462-473, February.
    5. 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.
    6. 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.
    7. Per Andersen & Niels Christian Petersen, 1993. "A Procedure for Ranking Efficient Units in Data Envelopment Analysis," Management Science, INFORMS, vol. 39(10), pages 1261-1264, October.
    8. Giuffrida, Antonio & Gravelle, Hugh & Sutton, Matthew, 2000. "Efficiency and administrative costs in primary care," Journal of Health Economics, Elsevier, vol. 19(6), pages 983-1006, November.
    9. Olga Milliken & Rose Anne Devlin & Vicky Barham & William Hogg & Simone Dahrouge & Grant Russell, 2008. "Comparative Efficiency Assessment of Primary Care Models Using Data Envelopment Analysis," Working Papers 0802E, University of Ottawa, Department of Economics.
    10. Merja Halme & Tarja Joro & Pekka Korhonen & Seppo Salo & Jyrki Wallenius, 1999. "A Value Efficiency Approach to Incorporating Preference Information in Data Envelopment Analysis," Management Science, INFORMS, vol. 45(1), pages 103-115, January.
    11. Robert Rosenman & Daniel Friesner, 2004. "Scope and scale inefficiencies in physician practices," Health Economics, John Wiley & Sons, Ltd., vol. 13(11), pages 1091-1116.
    12. 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.
    13. 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, vol. 221(2), pages 432-444.
    14. Robert Thrall, 2000. "Measures in DEA with an Application to the Malmquist Index," Journal of Productivity Analysis, Springer, vol. 13(2), pages 125-137, March.
    15. Olga Milliken & Rose Anne Devlin & Victoria Barham & William Hogg & Simone Dahrouge, 2011. "Comparative Efficiency Assessment of Primary Care Service Delivery Models Using Data Envelopment Analysis," Canadian Public Policy, University of Toronto Press, vol. 37(1), pages 85-109, March.
    16. Thanassoulis, E. & Boussofiane, A. & Dyson, R. G., 1996. "A comparison of data envelopment analysis and ratio analysis as tools for performance assessment," Omega, Elsevier, vol. 24(3), pages 229-244, June.
    17. Cook, Wade D. & Zhu, Joe, 2009. "Piecewise linear output measures in DEA (third revision)," European Journal of Operational Research, Elsevier, vol. 197(1), pages 312-319, August.
    18. M C Gouveia & L C Dias & C H Antunes, 2013. "Super-efficiency and stability intervals in additive DEA," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 64(1), pages 86-96, January.
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