Research Unit for Health Economics and Management, Universitat Politècnica de València, Valencia, 46022, Spain.
BMC Health Serv Res. 2024 Aug 25;24(1):982. doi: 10.1186/s12913-024-11420-2.
Primary healthcare management efficiency conditions the functioning of specialized care and has a direct impact on the outcomes of the health system and its sustainability. The objective of this research is to develop models to evaluate the efficiency, including health outcomes, of the primary healthcare centres (PHC) of the Clínico - La Malvarrosa Health District in Valencia.
To evaluate efficiency, Data Envelopment Analysis (DEA) was used with output orientation and variable returns to scale, with panel data from the years 2015 to 2019. In rates per 10,000 inhabitants, the inputs are: medical and nursing staff and pharmacy cost. The outputs are: number of consultations, hospital emergencies, referrals, avoidable hospitalisations, avoidable mortality and pharmaceutical prescription efficiency. As exogenous variables: the percentage of population over 65 years old, over 80 and case-mix. Three models were developed, all of them with the same inputs and different combinations of outputs related to: healthcare activity, outcomes, and both, in order to study the influence of the different approaches on efficiency. Each model is analysed both without exogenous variables and with each of them.
The efficiency results vary depending on the model used, although certain PHCs are always on, or very close to, the efficient frontier, while others are always inefficient. When healthcare activity outputs are considered, efficiency scores improve and the number of efficient PHCs increases. However, in general, the PHC score decreases throughout the evaluated period. This decrease is more pronounced when only activity outputs are included.
DEA allows the inefficiencies of PHCs to be analysed and the efficient ones are clearly distinguished from the inefficient, although different efficiency scores are obtained depending on the model used. Evaluation can be according to healthcare activity, health outcomes or both, making it necessary to identify the expected objectives of the PHCs, as the perspective of the analysis influences the results.
基层医疗保健管理效率决定了专科医疗的运作，并直接影响卫生系统的结果及其可持续性。本研究的目的是开发模型来评估基层医疗保健中心（PHC）的效率，包括健康结果，该模型基于瓦伦西亚 Clínico-La Malvarrosa 卫生区的 2015 年至 2019 年的面板数据。
使用具有输出导向和可变规模报酬的数据包络分析（DEA）来评估效率。每 10000 居民的投入包括：医疗和护理人员以及药房成本。产出包括：就诊次数、医院急诊、转诊、可避免住院、可避免死亡和药物处方效率。作为外生变量：65 岁以上、80 岁以上和病例组合的人口百分比。开发了三个模型，所有模型都具有相同的投入和不同组合的产出，涉及：医疗保健活动、结果以及两者，以研究不同方法对效率的影响。每个模型都在没有外生变量和使用其中每个变量的情况下进行分析。
效率结果因使用的模型而异，尽管某些 PHC 始终处于或非常接近有效前沿，而其他 PHC 则始终效率低下。当考虑医疗保健活动产出时，效率得分提高，有效的 PHC 数量增加。然而，一般来说，整个评估期间 PHC 的得分都在下降。当仅包括活动产出时，下降更为明显。
DEA 允许分析 PHC 的效率低下，并清楚地区分有效的和无效的 PHC，尽管根据使用的模型获得不同的效率得分。评估可以根据医疗保健活动、健康结果或两者进行，这需要确定 PHC 的预期目标，因为分析的角度会影响结果。
