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Performance indicators for primary care management in the NHS


  • Antonio Giuffrida
  • Hugh Gravelle
  • Martin Rowland


There is increased emphasis on the measurement of performance in the NHS. Following the White Paper, additional high level indicators for measuring primary care performance at Health Authority level have been proposed by the NHS Executive. These include measures based on prescribing and on hospital admission rates for certain acute and chronic conditions. It is suggested that higher hospital admission rates for some conditions may indicate deficiencies in their management in primary care. In this paper we argue that there are difficulties with some of the proposed measures. The difficulties arise because individual single indicators are used to attempt to reflect more than one aspect of performance, may have large year to year variation and be subject to confounding. Using data on Family Health Services Authorities (FHSAs) from 1989/90 to 1994/5 we investigate how admission rates, and the ranking of FHSAs by admission rates, vary as socio-economic and secondary and primary care supply conditions are allowed for. The impact of socio-economic factors on admission rates and rankings is at least as large as the impact of the age and sex structure of FHSA populations. Allowing also for secondary care supply conditions has a smaller, but still noticeable, effect. We suggest that if admission rates are used as performance indicators in primary care they should be standardised for socio-economic and supply conditions, as well as for demographic factors. We also make a number of other suggestions for improving the indicators. Length: 34 pages

Suggested Citation

  • Antonio Giuffrida & Hugh Gravelle & Martin Rowland, 1998. "Performance indicators for primary care management in the NHS," Working Papers 160chedp, Centre for Health Economics, University of York.
  • Handle: RePEc:chy:respap:160chedp

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    References listed on IDEAS

    1. Wu, De-Min, 1973. "Alternative Tests of Independence Between Stochastic Regressors and Disturbances," Econometrica, Econometric Society, vol. 41(4), pages 733-750, July.
    2. Hausman, Jerry, 2015. "Specification tests in econometrics," Applied Econometrics, Publishing House "SINERGIA PRESS", vol. 38(2), pages 112-134.
    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. Godfrey, L. G. & Hutton, J. P., 1994. "Discriminating between errors-in- variables/simultaneity and misspecification in linear regression models," Economics Letters, Elsevier, vol. 44(4), pages 359-364, April.
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    1. 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.


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