Amado Carla Alexandra da Encarnação Filipe, Santos Sérgio Pereira Dos
Centre for Advanced Studies in Economics and Econometrics, Faculty of Economics, University of Algarve, Portugal.
Health Policy. 2009 Jun;91(1):43-56. doi: 10.1016/j.healthpol.2008.11.008. Epub 2008 Dec 31.
Primary care is currently at the heart of health service policy, both in Portugal and internationally. At the same time, interest in the measurement of efficiency of health care delivery has increased considerably. However, very few studies have focused specifically on performance assessment in primary health care provision. In this paper we aim to contribute to a discussion regarding appropriate ways to compare the performance of primary health care providers. Following a review of the literature, a conceptual framework for performance assessment of health centres is developed and tested using the Portuguese case. Our empirical analysis uses data from 2004 and 2005 for all the Portuguese health centres and compares the geographical equity of access to services, technical efficiency and quality of services across district health authorities. Data envelopment analysis is the technique used to measure technical efficiency. From our empirical analysis, we conclude that there is evidence of large variation in equity of access to services, in technical efficiency and quality of services across district health authorities. Our findings suggest that a better use of resources could lead to more and improved services. Whilst formative evaluation could contribute to this, the challenge is to engage health care professionals in the evaluation exercise.
在葡萄牙及国际上，初级保健目前都是卫生服务政策的核心。与此同时，对医疗服务提供效率衡量的关注度大幅提高。然而，极少有研究专门聚焦于初级卫生保健服务中的绩效评估。在本文中，我们旨在推动关于比较初级卫生保健提供者绩效的适当方法的讨论。在对文献进行综述之后，我们构建了一个卫生中心绩效评估的概念框架，并以葡萄牙的情况进行了检验。我们的实证分析使用了2004年和2005年葡萄牙所有卫生中心的数据，比较了各地区卫生当局在服务可及性的地理公平性、技术效率和服务质量方面的情况。数据包络分析是用于衡量技术效率的方法。从我们的实证分析中，我们得出结论，各地区卫生当局在服务可及性公平性、技术效率和服务质量方面存在很大差异。我们的研究结果表明，更好地利用资源可以带来更多且质量更高的服务。虽然形成性评估有助于此，但挑战在于让医疗保健专业人员参与评估工作。
