IDEAS home Printed from https://ideas.repec.org/p/pra/mprapa/10725.html
   My bibliography  Save this paper

Technical efficiency in primary health care: does quality matter?

Author

Listed:
  • Murillo-Zamorano, Luis R.
  • Petraglia, C.

Abstract

The accuracy required in the measurement of output is an issue that has as yet still not been satisfactorily addressed in empirical research on efficiency in primary health care. We exploit information retrieved from a newly constructed database (APEX06) for the Spanish region of Extremadura. The richness of our dataset allows us to consider original synthetic measures of output that take into account both the quantity and the quality of services provided by 85 primary care centres (PCCs) in 2006. We provide evidence that neglecting the issue of properly accounting for the quality of health services can lead to misleading results. Our main finding is that adjusting output for quality influences efficiency analysis in three senses. First, inefficiency now explains relatively more of the deviation from the potential output. Second, the average technical efficiency in the sector is lower, while its dispersion among PCCs is significantly higher. And third, the efficiency ranking of the PCCs is also affected.

Suggested Citation

  • Murillo-Zamorano, Luis R. & Petraglia, C., 2008. "Technical efficiency in primary health care: does quality matter?," MPRA Paper 10725, University Library of Munich, Germany.
    • Handle: RePEc:pra:mprapa:10725
    as

    Download full text from publisher

    File URL: https://mpra.ub.uni-muenchen.de/10725/1/MPRA_paper_10725.pdf
    File Function: original version
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. 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.
    2. Robert Rosenman & Daniel Friesner, 2004. "Scope and scale inefficiencies in physician practices," Health Economics, John Wiley & Sons, Ltd., vol. 13(11), pages 1091-1116, November.
    3. Fried, Harold O. & Lovell, C. A. Knox & Schmidt, Shelton S. (ed.), 1993. "The Measurement of Productive Efficiency: Techniques and Applications," OUP Catalogue, Oxford University Press, number 9780195072181.
    4. 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.
    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, December.
    6. Yasar Ozcan, 1998. "Physician benchmarking: measuring variation in practice behavior in treatment of otitis media," Health Care Management Science, Springer, vol. 1(1), pages 5-17, September.
    7. Cervera, Juan Vega & Hernandez, Maria Isabel Sanchez & Mera, Antonio Chamorro & Miranda, Francisco Javier & Murillo, Luis Regino, 2010. "Adapting the Servqual Scale to Primary Health Care Services in Spain," Apas Papers 197, Academic Public Administration Studies Archive - APAS.
    8. Battese, George E. & Coelli, Tim J., 1988. "Prediction of firm-level technical efficiencies with a generalized frontier production function and panel data," Journal of Econometrics, Elsevier, vol. 38(3), pages 387-399, July.
    9. George E. Battese & Greg S. Corra, 1977. "Estimation Of A Production Frontier Model: With Application To The Pastoral Zone Of Eastern Australia," Australian Journal of Agricultural and Resource Economics, Australian Agricultural and Resource Economics Society, vol. 21(3), pages 169-179, December.
    10. 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.
    11. Jon Chilingerian & H. David Sherman, 1997. "DEA and primary care physician report cards: Deriving preferred practice cones from managed care service concepts and operating strategies," Annals of Operations Research, Springer, vol. 73(0), pages 35-66, October.
    12. 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.
    13. C A F Amado & R G Dyson, 2009. "Exploring the use of DEA for formative evaluation in primary diabetes care: An application to compare English practices," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 60(11), pages 1469-1482, November.
    14. Meeusen, Wim & van den Broeck, Julien, 1977. "Efficiency Estimation from Cobb-Douglas Production Functions with Composed Error," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 18(2), pages 435-444, June.
    15. Battese, George E. & Corra, Greg S., 1977. "Estimation Of A Production Frontier Model: With Application To The Pastoral Zone Of Eastern Australia," Australian Journal of Agricultural Economics, Australian Agricultural and Resource Economics Society, vol. 21(3), pages 1-11, December.
    16. Battese, G E & Coelli, T J, 1995. "A Model for Technical Inefficiency Effects in a Stochastic Frontier Production Function for Panel Data," Empirical Economics, Springer, vol. 20(2), pages 325-332.
    17. 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.
    18. Jondrow, James & Knox Lovell, C. A. & Materov, Ivan S. & Schmidt, Peter, 1982. "On the estimation of technical inefficiency in the stochastic frontier production function model," Journal of Econometrics, Elsevier, vol. 19(2-3), pages 233-238, August.
    19. Goni, Salome, 1999. "An analysis of the effectiveness of Spanish primary health care teams," Health Policy, Elsevier, vol. 48(2), pages 107-117, August.
    20. Luis R. Murillo‐Zamorano, 2004. "Economic Efficiency and Frontier Techniques," Journal of Economic Surveys, Wiley Blackwell, vol. 18(1), pages 33-77, February.
    21. Aigner, Dennis & Lovell, C. A. Knox & Schmidt, Peter, 1977. "Formulation and estimation of stochastic frontier production function models," Journal of Econometrics, Elsevier, vol. 6(1), pages 21-37, July.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Rita Bastião & Nuno de Sousa Pereira, 2020. "Performance in the Delivery of Primary Health Care Services: A Longitudinal Analysis," CEF.UP Working Papers 2002, Universidade do Porto, Faculdade de Economia do Porto.
    2. Justyna Kujawska, 2021. "Health System Efficiency in European Countries: Network Data Envelopment Analysis Approach," European Research Studies Journal, European Research Studies Journal, vol. 0(2), pages 1095-1117.
    3. Edson Serván-Mori & Carlos Chivardi & Fato Fene & Ileana Heredia-Pi & Miguel Ángel Mendoza & Gustavo Nigenda, 2020. "Tackling maternal mortality by improving technical efficiency in the production of primary health services: longitudinal evidence from the Mexican case," Health Care Management Science, Springer, vol. 23(4), pages 571-584, December.
    4. Maude Laberge & Walter P. Wodchis & Jan Barnsley & Audrey Laporte, 2016. "Efficiency of Ontario primary care physicians across payment models: a stochastic frontier analysis," Health Economics Review, Springer, vol. 6(1), pages 1-10, December.
    5. 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.
    6. Abate, Megersa & Lijesen, Mark & Pels, Eric & Roelevelt, Adriaan, 2013. "The impact of reliability on the productivity of railroad companies," Transportation Research Part E: Logistics and Transportation Review, Elsevier, vol. 51(C), pages 41-49.
    7. 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.
    8. J. Buckell & A. Smith & R. Longo & D. Holland, 2015. "Efficiency, heterogeneity and cost function analysis: empirical evidence from pathology services in the National Health Service in England," Applied Economics, Taylor & Francis Journals, vol. 47(31), pages 3311-3331, July.
    9. Carla Alexandra da Encarnação Filipe Amado & Olena Kalinichenko & Sérgio Pereira dos Santos, 2013. "Performance Assessment in Primary Health Care: A Systematic Literature Review," CEFAGE-UE Working Papers 2013_03, University of Evora, CEFAGE-UE (Portugal).
    10. Michiel Bijlsma & Pierre Koning & Victoria Shestalova, 2013. "The Effect of Competition on Process and Outcome Quality of Hospital Care in the Netherlands," De Economist, Springer, vol. 161(2), pages 121-155, June.
    11. Rajendra Dulal, 2017. "Cost efficiency of nursing homes: do five-star quality ratings matter?," Health Care Management Science, Springer, vol. 20(3), pages 316-325, September.
    12. Kim Olsen & Dorte Gyrd-Hansen & Torben Sørensen & Troels Kristensen & Peter Vedsted & Andrew Street, 2013. "Organisational determinants of production and efficiency in general practice: a population-based study," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(2), pages 267-276, April.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    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.
    2. Luis R. Murillo‐Zamorano, 2004. "Economic Efficiency and Frontier Techniques," Journal of Economic Surveys, Wiley Blackwell, vol. 18(1), pages 33-77, February.
    3. Coelli, Tim J., 1995. "Recent Developments In Frontier Modelling And Efficiency Measurement," Australian Journal of Agricultural Economics, Australian Agricultural and Resource Economics Society, vol. 39(3), pages 1-27, December.
    4. Salem Gheit, 2022. "A Stochastic Frontier Analysis of the Human Capital Effects on the Manufacturing Industries’ Technical Efficiency in the United States," Athens Journal of Business & Economics, Athens Institute for Education and Research (ATINER), vol. 8(3), pages 215-238, July.
    5. Martín Rossi, 2015. "The Econometrics Approach to the Measurement of Efficiency: A Survey," Working Papers 117, Universidad de San Andres, Departamento de Economia, revised Feb 2015.
    6. Abdul Wadud, 2013. "Impact of Microcredit on Agricultural Farm Performance and Food Security in Bangladesh," Working Papers 14, Institute of Microfinance (InM).
    7. Dairo Estrada & Poldy Osorio, 2004. "Effects of Financial Capital on Colombian Banking Efficiency," Revista ESPE - Ensayos sobre Política Económica, Banco de la Republica de Colombia, vol. 22(47), pages 162-201, December.
    8. Luis R. Murillo-Zamorano & Juan Vega-Cervera, "undated". "The Use of Parametric and Non Parametric Frontier Methods to Measure the Productive Efficiency in the Industrial Sector. A Comparative Study," Discussion Papers 00/17, Department of Economics, University of York.
    9. Massimo Del Gatto & Adriana Di Liberto & Carmelo Petraglia, 2011. "Measuring Productivity," Journal of Economic Surveys, Wiley Blackwell, vol. 25(5), pages 952-1008, December.
    10. Pavlos Almanidis & Robin C. Sickles, 2016. "Banking Crises, Early Warning Models, and Efficiency," International Series in Operations Research & Management Science, in: Juan Aparicio & C. A. Knox Lovell & Jesus T. Pastor (ed.), Advances in Efficiency and Productivity, chapter 0, pages 331-364, Springer.
    11. Amer Ait Sidhoum & K Hervé Dakpo & Laure Latruffe, 2022. "Trade-offs between economic, environmental and social sustainability on farms using a latent class frontier efficiency model: Evidence for Spanish crop farms," PLOS ONE, Public Library of Science, vol. 17(1), pages 1-17, January.
    12. Manlagnit, Maria Chelo V., 2015. "Basel regulations and banks’ efficiency: The case of the Philippines," Journal of Asian Economics, Elsevier, vol. 39(C), pages 72-85.
    13. Williams, Jonathan & Nguyen, Nghia, 2005. "Financial liberalisation, crisis, and restructuring: A comparative study of bank performance and bank governance in South East Asia," Journal of Banking & Finance, Elsevier, vol. 29(8-9), pages 2119-2154, August.
    14. García-Suárez, Federico & Pérez-Quesada, Gabriela & Molina, Carlos, 2022. "Rangeland cattle production in Uruguay: Single-output versus multi-output efficiency measures," Economia Agraria y Recursos Naturales, Spanish Association of Agricultural Economists, vol. 22(01), June.
    15. Althaler, Karl S. & Slavova, Tatjana, 2000. "DEA Problems under Geometrical or Probability Uncertainties of Sample Data," Economics Series 89, Institute for Advanced Studies.
    16. Roberto Colombi & Gianmaria Martini & Giorgio Vittadini, 2017. "Determinants of transient and persistent hospital efficiency: The case of Italy," Health Economics, John Wiley & Sons, Ltd., vol. 26(S2), pages 5-22, September.
    17. Rita Bastião & Nuno de Sousa Pereira, 2020. "Performance in the Delivery of Primary Health Care Services: A Longitudinal Analysis," CEF.UP Working Papers 2002, Universidade do Porto, Faculdade de Economia do Porto.
    18. Gauri Khanna, 2006. "Technical Efficiency in Production and Resource Use in Sugar Cane: A Stochastic Frontier Production Function Analysis," IHEID Working Papers 15-2006, Economics Section, The Graduate Institute of International Studies.
    19. Hayatullah Ahmadzai, 2017. "Crop Diversification and Technical Efficiency in Afghanistan: Stochastic Frontier Analysis," Discussion Papers 2017-04, University of Nottingham, CREDIT.
    20. Kuo, Jenn-Shyong & Ho, Yi-Cheng, 2008. "The cost efficiency impact of the university operation fund on public universities in Taiwan," Economics of Education Review, Elsevier, vol. 27(5), pages 603-612, October.

    More about this item

    Keywords

    Primary Health Care; Stochastic Frontier Analysis; Technical Efficiency; Quality;
    All these keywords.

    JEL classification:

    • C10 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - General
    • I10 - Health, Education, and Welfare - - Health - - - General

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:pra:mprapa:10725. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Joachim Winter (email available below). General contact details of provider: https://edirc.repec.org/data/vfmunde.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.