Department of Public Health, Population Medicine Unit, Catholic University "Sacro Cuore", Largo "F. Vito", n.1, Rome, Italy.
Health Policy. 2012 Oct;107(2-3):258-68. doi: 10.1016/j.healthpol.2012.05.005. Epub 2012 Jul 8.
This study aimed to compare technical efficiency of general practice (GP) delivered by the twenty Regions of Italy's decentralized healthcare system and to determine if it was affected by contextual factors.
First, we calculated the Regional efficiency scores by means of Data Envelopment Analysis. Then we carried out a regression analysis to investigate the influence of contextual factors on the efficiency in the provision of GP services.
Six Northern Regions were identified as efficient using the best combinations of general practitioners to deliver a given level of GP outcomes. Compared with peer benchmarks, inefficient Regions used more (on-call and regular) general practitioners with important underproductions of outputs (e.g. avoidable hospitalizations). The regression analysis showed a negative relationship between efficiency and the Regional total health care expenditures as percentage of its Gross Domestic Product.
Improving efficiency of GP services delivery is likely to result in reduced health expenditures. Since there is a general tendency in Europe to decentralize governmental systems of countries and Italy can be seen as an extreme example of this trend, we consider our findings of high relevance for international comparative studies on performance of primary care systems.
本研究旨在比较意大利分散式医疗体系的二十个大区的全科医疗服务的技术效率，并确定其是否受到环境因素的影响。
首先，我们通过数据包络分析（Data Envelopment Analysis）计算了区域效率得分。然后，我们进行了回归分析，以调查环境因素对提供全科医疗服务的效率的影响。
使用最佳的全科医生组合来提供特定水平的全科医疗服务，有六个北方大区被确定为有效。与同行基准相比，效率低下的大区使用了更多的（值班和常规）全科医生，产出量（如可避免的住院治疗）严重不足。回归分析表明，效率与区域内卫生保健总支出占国内生产总值的百分比呈负相关。
提高全科医疗服务的效率可能会降低卫生支出。由于欧洲各国政府系统的分权化趋势普遍存在，而意大利可以被视为这种趋势的极端例子，因此我们认为我们的研究结果对初级保健系统绩效的国际比较研究具有高度相关性。
