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Data Envelopment Analysis Applications on Primary Health Care Using Exogenous Variables and Health Outcomes

Author

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  • Silvia González-de-Julián

    (Research Unit for Health Economics and Management, Universitat Politècnica de València, 46022 Valencia, Spain)

  • Isabel Barrachina-Martínez

    (Research Unit for Health Economics and Management, Universitat Politècnica de València, 46022 Valencia, Spain)

  • David Vivas-Consuelo

    (Research Unit for Health Economics and Management, Universitat Politècnica de València, 46022 Valencia, Spain)

  • Álvaro Bonet-Pla

    (Departamento de Salud Valencia Clínico–La Malvarrosa, Generalitat Valenciana, 46010 Valencia, Spain)

  • Ruth Usó-Talamantes

    (Conselleria de Sanitat i Salut Pública, Generalitat Valenciana, 46010 Valencia, Spain)

Abstract

A data envelopment analysis was used to evaluate the efficiency of 18 primary healthcare centres in a health district of the Valencian Community, Spain. Factor analysis was used as a first step in order to identify the most explanatory variables to be incorporated in the models. Included as variable inputs were the ratios of general practitioners, nurses, and costs; as output variables, those included were consultations, emergencies, avoidable hospitalisations, and prescription efficiency; as exogenous variables, those included were the percentage of population over 65 and a multimorbidity index. Confidence intervals were calculated using bootstrapping to correct possible biases. Efficient organisations within the set were identified, although the results depend on the models used and the introduction of exogenous variables. Pharmaceutical expenditure showed the greatest slack and room for improvement in its management. Data envelopment analysis allows an evaluation of efficiency that is focussed on achieving better results and a proper distribution and use of healthcare resources, although it needs the desired goals of the healthcare managers to be clearly identified, as the perspective of the analysis influences the results, as does including variables that measure the achievements and outcomes of the healthcare services.

Suggested Citation

  • Silvia González-de-Julián & Isabel Barrachina-Martínez & David Vivas-Consuelo & Álvaro Bonet-Pla & Ruth Usó-Talamantes, 2021. "Data Envelopment Analysis Applications on Primary Health Care Using Exogenous Variables and Health Outcomes," Sustainability, MDPI, vol. 13(3), pages 1-17, January.
    • Handle: RePEc:gam:jsusta:v:13:y:2021:i:3:p:1337-:d:488149
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    References listed on IDEAS

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    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. Nikolaos Oikonomou & Yannis Tountas & Argiris Mariolis & Kyriakos Souliotis & Kostas Athanasakis & John Kyriopoulos, 2016. "Measuring the efficiency of the Greek rural primary health care using a restricted DEA model; the case of southern and western Greece," Health Care Management Science, Springer, vol. 19(4), pages 313-325, December.
    3. 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.
    4. Choonjoo Lee, 2010. "An Efficient Data Envelopment Analysis with Large Data Set in Stata," BOS10 Stata Conference 3, Stata Users Group.
    5. María del Rocío Moreno‐Enguix & Juan Cándido Gómez‐Gallego & María Gómez Gallego, 2018. "Analysis and determination the efficiency of the European health systems," International Journal of Health Planning and Management, Wiley Blackwell, vol. 33(1), pages 136-154, January.
    6. Wynn, A. & Moore, K.M., 2012. "Integration of primary health care and public health during a public health emergency," American Journal of Public Health, American Public Health Association, vol. 102(11), pages 9-12.
    7. 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.
    8. M C Gouveia & L C Dias & C H Antunes, 2008. "Additive DEA based on MCDA with imprecise information," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 59(1), pages 54-63, January.
    9. Caballer-Tarazona, Vicent & Guadalajara-Olmeda, Natividad & Vivas-Consuelo, David, 2019. "Predicting healthcare expenditure by multimorbidity groups," Health Policy, Elsevier, vol. 123(4), pages 427-434.
    10. Simar, Leopold & Wilson, Paul W., 2007. "Estimation and inference in two-stage, semi-parametric models of production processes," Journal of Econometrics, Elsevier, vol. 136(1), pages 31-64, January.
    11. Sandiford, P. & Vivas Consuelo, D. & Rouse, P. & Bramley, D., 2018. "The trade-off between equity and efficiency in population health gain: Making it real," Social Science & Medicine, Elsevier, vol. 212(C), pages 136-144.
    12. Paolo Mancuso & Vivian Grace Valdmanis, 2016. "Care Appropriateness and Health Productivity Evolution: A Non-Parametric Analysis of the Italian Regional Health Systems," Applied Health Economics and Health Policy, Springer, vol. 14(5), pages 595-607, October.
    13. Léopold Simar & Paul W. Wilson, 1998. "Sensitivity Analysis of Efficiency Scores: How to Bootstrap in Nonparametric Frontier Models," Management Science, INFORMS, vol. 44(1), pages 49-61, January.
    14. H. David Sherman & Joe Zhu, 2006. "Service Productivity Management," Springer Books, Springer, number 978-0-387-33231-4, March.
    15. Yong-bae Ji & Choonjoo Lee, 2010. "Data envelopment analysis," Stata Journal, StataCorp LP, vol. 10(2), pages 267-280, June.
    16. Cordero, José Manuel & Alonso-Morán, Edurne & Nuño-Solinis, Roberto & Orueta, Juan F. & Arce, Regina Sauto, 2015. "Efficiency assessment of primary care providers: A conditional nonparametric approach," European Journal of Operational Research, Elsevier, vol. 240(1), pages 235-244.
    17. José Cordero Ferrera & Eva Cebada & Luis Murillo Zamorano, 2014. "The effect of quality and socio-demographic variables on efficiency measures in primary health care," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(3), pages 289-302, April.
    18. Dyson, R. G. & Allen, R. & Camanho, A. S. & Podinovski, V. V. & Sarrico, C. S. & Shale, E. A., 2001. "Pitfalls and protocols in DEA," European Journal of Operational Research, Elsevier, vol. 132(2), pages 245-259, July.
    19. Scheel, Holger, 2001. "Undesirable outputs in efficiency valuations," European Journal of Operational Research, Elsevier, vol. 132(2), pages 400-410, July.
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    1. Fang Wu & Wei Chen & Lingling Lin & Xu Ren & Yingna Qu, 2022. "The Balanced Allocation of Medical and Health Resources in Urban Areas of China from the Perspective of Sustainable Development: A Case Study of Nanjing," Sustainability, MDPI, vol. 14(11), pages 1-28, May.

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