On evaluating health centers groups in Lisbon and Tagus Valley: efficiency, equity and quality

BMC Health Services Research

Paulo Nicola¹  Rui C Marques²  Cláudia Ferreira² 

[1]Faculty of Medicine, University of Lisbon, Lisbon, Portugal

[2]Instituto Superior Técnico, University of Lisbon, Lisbon, Portugal

关键词: Portugal;    Equity;    Quality;    Efficiency;    Data envelopment analysis;    Health center groups;   

Others  :  1134430
DOI  :  10.1186/1472-6963-13-529

 received in 2013-04-20, accepted in 2013-12-09,  发布年份 2013

【 摘 要 】

Background

Bearing in mind the increasing health expenses and their weight in the Portuguese gross domestic product, it is of the utmost importance to evaluate the performance of Primary Health Care providers taking into account both efficiency, quality and equity. This paper aims to contribute to a better understanding of the performance of Primary Health Care by measuring it in a Portuguese region (Lisbon and Tagus Valley) and identifying best practices. It also intends to evaluate the quality and equity provided.

Methods

For the purpose of measuring the efficiency of the health care centers (ACES) the non-parametric full frontier technique of data envelopment analysis (DEA) was adopted. The recent partial frontier method of order-m was also used to estimate the influence of exogenous variables on the efficiency of the ACES. The horizontal equity was investigated by applying the non-parametric Kruskal-Wallis test with multiple comparisons. Moreover, the quality of service was analyzed by using the ratio between the complaints and the total activity of the ACES.

Results

On the whole, a significant level of inefficiency was observed, although there was a general improvement in efficiency between 2009 and 2010. It was found that nursing was the service with the lowest scores. Concerning the horizontal equity, the analysis showed that there is no evidence of relevant disparities between the different subregions(NUTS III). Concerning the exogenous variables, the purchasing power, the percentage of patients aged 65 years old or older and the population size affect the efficiency negatively.

Conclusions

This research shows that better usage of the available resources and the creation of a learning network and dissemination of best practices will contribute to improvements in the efficiency of the ACES while maintaining or even improving quality and equity. It was also proved that the market structure does matter when efficiency measurement is addressed.

【 授权许可】

   
2013 Ferreira et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Nunes R: Regulação da saúde . Oporto: Vida Económic; 2009.
• [2]Fernandes AC, Costa FL, Barros PP, Ivo RS, Mello S: Saúde em análise: Uma visão para o Futuro . Lisbon: Delloite; 2011.
• [3]Biscaia A, Martins JN, Ferrinho P, Gonçalves I, Carreira M, Antunes AR: Cuidados de Saúde Primários em Portugal: Reformar para novos sucessos . Lisbon: Climepsi Editores PC; 2009.
• [4]Jacobs R, Smith PC, Street A: Measuring efficiency in health care: analytic techniques and health policy . New York: Cambridge University Press; 2006.
• [5]Nunamaker TR, Lewin AY: Measuring routine nursing service efficiency: a comparison of cost per patient day and data envelopment analysis models/comment. Health Serv Res 1983, 18:183-208.
• [6]Hollingsworth B: Non-parametric and parametric applications measuring efficiency in health care. Health Care Manage Sci 2003, 6:203-218.
• [7]Sexton TR, Leiken AM, Nolan AH, Liss S, Hogan A, Silkman RH: Evaluating managerial efficiency of veterans administration medical centers using data envelopment analysis. Med Care 1989, 27:1175-1188.
• [8]Huang YG, McLaughlin CP: Relative efficiency in rural primary health care: an application of data envelopment analysis. Health Serv Res 1989, 24:143-158.
• [9]Pinillos M, Antoñanzas F: La atención primaria de salud: descentralización y eficiencia. Gaceta Sanitaria 2002, 16:401-407.
• [10]Linna M, Nordblad A, Koivu M: Technical and cost efficiency of oral health care provision in Finnish health centres. Soc Sci Med 2003, 56:343-353.
• [11]Akazili J, Adjuik M, Jehu-Appiah C, Zere E: Using data envelopment analysis to measure the extent of technical efficiency of public health centres in Ghana. BMC Int Health Hum Rights 2008, 8:11. BioMed Central Full Text
• [12]Kirigia J, Emrouznejad A, Cassoma B, Asbu E, Barry S: A performance assessment method for hospitals: The case of municipal hospitals in Angola. J Med Syst 2008, 32:509-519.
• [13]Amado C, Santos S: Challenges for performance assessment and improvement in primary health care: the case of the Portuguese health centres. Health Policy 2010, 91:43-56.
• [14]Sebastian M, Lemma H: Efficiency of the health extension programme in Tigray, Ethiopia: a data envelopment analysis. BMC Int Health Hum Rights 2010, 10:16. BioMed Central Full Text
• [15]Halsteinli V, Kittelsen SA, Magnussen J: Productivity growth in outpatient child and adolescent mental health services: The impact of case-mix adjustment. Soc Sci Med 2010, 70:439-446.
• [16]Nuti S, Daraio C, Speroni C, Vainieri M: Relationships between technical efficiency and the quality and costs of health care in Italy. Int J Qual Health Care 2011, 23:324-330.
• [17]Helling DK, Nelson KM, Ramirez JE, Humphries TL: Kaiser permanente Colorado region pharmacy department: innovative leader in pharmacy practice. J Am Pharm Assoc 2006, 46:67-76.
• [18]Singaroyan R, Seed CA, Egdell RM: Is a target culture in health care always compatible with efficient use of resources? A cost-effectiveness analysis of an intervention to achieve thrombolysis targets. J Pub Health 2006, 28:31-34.
• [19]Kaplow L: Horizontal equity: measures in search of a principle. Nat Tax J 1989, 2:139-154.
• [20]Barros PP, Machado SR, Simoes JA: Portugal health system review. Health Syst Transit 2011, 13:1-156.
• [21]Starfield B: Primary Care: balancing health needs, services and technology . New York: Oxford University Press; 1998.
• [22]Declaration of Alma-Ata: International conference on primary health care . USSR: Alma-Ata; September 6–12. [http://www.who.int/publications/almaata_declaration_en.pdf webcite]
• [23]Pereira EA, Costa MM: Os centros de saúde em Portugal e o cuidado ao idoso no contexto domiciliário: Estudo de um centro de saúde. Texto contexto - enferm 2007, 16:408-416.
• [24]Branco AG, Ramos V: Cuidados de saúde primários em Portugal. Revista Portuguesa de Saúde Pública 2011, 2:5-12.
• [25]Charnes A, Cooper WW, Rhodes E: Measuring the efficiency of decision making units. Eur J Oper Res 1978, 2:429-444.
• [26]Charnes A, Cooper W, Lewin A, Seiford L: Data Envelopment Analysis: Theory, Methodology and Applications . Massachusetts: Kluwer Academic Press; 1994.
• [27]Ozcan Y: Health Care Benchmarking and Performance Evaluation: An Assessment using Data Envelopment Analysis (DEA) . New York: Springer; 2008.
• [28]Daraio C, Simar L: Introducing environmental variables in nonparametric frontier models: a probabilistic approach. J Prod Anal 2005, 24:93-121.
• [29]Chan Y, Walmsley RP: Learning and understanding the Kruskal-Wallis one-way analysis-of-variance-by-ranks test for differences among three or more independent groups. Phys Ther 1997, 77:1755-1761.
• [30]Norheim ET: Kruskal-Wallis test: BASIC computer program to perform nonparametric one-way analysis of variance and multiple comparisons on ranks of several independent samples. Comput Methods Programs Biomed 1986, 23:57-62.
• [31]Fornell C: Productivity, quality, and costumer satisfaction as strategic success indicators at firm and national level. Adv Strat Manag 1995, 11:217-29.
• [32]Santos P: Os centros de saúde da terceira geração. In Thesis . Universidade Fernando Pessoa: Departamento de Ciência Política e do Comportamento; 2008.
• [33]Alto Comissariado da Saúde: Estratégias para a Saúde . 2011. [http://pns.dgs.pt/files/2011/02/qs\_18-03-2011.pdf webcite]