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Measures of Performance in Primary Care - a Review of Efficiency Studies


  • Roberta Longo

    () (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds)

  • Claire Hulme

    (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds)

  • Andrew Smith

    (Institute for Transport Studies, University of Leeds, Leeds)


With the economic downturn inflicting austerity on the British National Health Service, the issue of efficiency is of paramount importance for health care policy makers who are called upon to identify where efficiency savings can be made without hindering the quality of care. Research exploring efficiency in health is still relatively new. The measurement of efficiency is made difficult by the multifaceted nature of the output of health care, particularly so in primary care. On the other hand simple measures of activity cannot be considered sufficient, particularly given the system of incentives introduced for primary care providers such as the Quality and Outcomes Framework (QOF) in UK. In this paper we review studies that have used stochastic frontier analysis to measure the efficiency of primary care providers and purchasers. We find that quality indicators are increasingly being used in explaining cost variation and relative efficiency differences. To our knowledge though, there are no UK based studies that have used data from the QOF. We argue that QOF is an invaluable source of information which should enable more accurate and insightful analysis of relative efficiency in primary care by incorporating appropriate measures of quality.

Suggested Citation

  • Roberta Longo & Claire Hulme & Andrew Smith, 2012. "Measures of Performance in Primary Care - a Review of Efficiency Studies," Working Papers 1203, Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds.
  • Handle: RePEc:lee:wpaper:1203

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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. 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.
    3. 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.
    4. Luis Murillo-Zamorano & Carmelo Petraglia, 2011. "Technical efficiency in primary health care: does quality matter?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(2), pages 115-125, April.
    5. Jaume Puig-Junoy & Vicente Ortún, 2004. "Cost efficiency in primary care contracting: a stochastic frontier cost function approach," Health Economics, John Wiley & Sons, Ltd., vol. 13(12), pages 1149-1165.
    6. 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.
    7. Gaynor, Martin & Pauly, Mark V, 1990. "Compensation and Productive Efficiency of Partnerships: Evidence from Medical Group Practice," Journal of Political Economy, University of Chicago Press, vol. 98(3), pages 544-573, June.
    8. Lisa C. DeFelice & W. David Bradford, 1997. "Relative inefficiencies in production between solo and group practice physicians," Health Economics, John Wiley & Sons, Ltd., vol. 6(5), pages 455-465.
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