Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Journal of Medical Systems
Published in: Journal of Medical Systems 5/2011

01-10-2011 | Original Paper

A Multiple Stage Approach for Performance Improvement of Primary Healthcare Practice

Authors: Martha T. Ramírez-Valdivia, Sergio Maturana, Sonia Salvo-Garrido

Published in: Journal of Medical Systems | Issue 5/2011

Login to get access

Abstract

Chilean primary healthcare practice is analyzed using a Data Envelopment Analysis (DEA) multiple stage approach. We estimate the efficiency level of 259 municipalities nationwide. Since the efficiency score by itself is of limited value for decision making, we use a multivariate tool to help explain the effect of relevant factors. First, we use a cluster analysis to homogenize the units under study. Second, we use DEA to estimate the efficiency levels, which varies from 61% to 71% for urban municipalities, and from 51% to 56% in rural ones. Third, we use bootstrap to estimate confidence intervals for the efficiency scores, and a Biplot method to identify adequate variables to include in the Tobit Model, which is our last stage. We identify six factors associated with rural municipalities’ operational efficiency, and two with urban ones. Knowing the efficiency level of municipalities can help determine ways to improve their efficiency.
Footnotes
1
Rates are estimated using different sources. Datasets available at: http://​www.​ine.​cl and htpp://​www.​sinim.​cl
 
3
Do not confuse the variables rur and urb with the variable used for urban and rural location in “Cluster analysis”. Any urban or rural municipality might have a mix of urban and/or rural health centers associated.
 
4
ipobre and denpob were included in the cluster analysis of “Cluster analysis”. However, since those variables were disregarded to form cluster groups we decided to include them in the Tobit analysis.
 
5
We do not include the CRS formulation since it is the same as the VRS minus Eq. 1.3.
 
6
gper = annual medical staff cost; gfunc = annual general service cost; gfarm = annual pharmacy cost
 
7
cons = annual number of medical visits; cont = annual number of medical check-up visits.
 
Literature
1.
2.
3.
4.
+Rodríguez, J., and Tokman, M., Resultados y rendimiento del gasto en el sector público de salud en Chile 1990–1999, Unidad de Estudios Especiales, CEPAL, 2000.
5.
Hollingsworth, B., Dawson, P. J., and Maniadakis, N., Efficiency measurement of health care: a review of non-parametric methods and applications. Health Care Manage Sci 2(3):161–172, 1999.CrossRef
6.
Hollingsworth, B., Non-parametric and parametric applications measuring efficiency in health care. Health Care Manage Sci 6(49):203–218, 2003.CrossRef
7.
Puig-Junoy, J., Eficiencia en la Atención Primaria en Salud: Una Revisión Crítica de las Medidas de Frontera. Rev Esp Salud Publica 74(5–6):483–795, 2000.
8.
Castro, R., Midiendo la eficiencia de la salud municipal, Serie Informe Social N o . 97, Libertad y Desarrollo, 2006.
9.
Peppers, S., El sistema de salud en Chile: Propuestas para una reforma en salud. Rev. Med. Chil. 4(18), 2000.
10.
Sáez, M., Condicionantes en la Utilización de los Servicios de Atención Primaria. Evidencias Empíricas e Inconsistencias Metodológicas. Gac. Sanit. 17(5):412–419, 2003.CrossRef
11.
Poblete, F., Araya, S., Pantoja, T., and Torres, F., Contribuyendo a la reducción de la brecha entre las políticas de salud nacionales y su ejecución en el nivel primario de salud como consecuencia de la gestión local: un aporte a la evaluación sistemática y mejoramiento de las prácticas de gestión para favorecer el éxito de la reforma de salud, Proyecto Políticas Públicas 2005, Pontificia Universidad Católica de Chile.
12.
Jacobs, R., Smith, P. C., and Street, A., Measuring efficiency in health care. Analytic techniques and health policy. Cambridge University Press, New York, 2006.CrossRef
13.
Guiffrida, A., and Gravelle, H., Measuring performance in primary care: Econometric analysis and DEA. Appl. Econ. 33:163–175, 2001.
14.
Cooper, W. W., Seiford, L. M., and Tone, K., Data envelopment analysis. A comprehensive text with models, applications, references and DEA-solver software. Springer, New York, 2007.MATH
15.
Kumbhakar, S. C., and Lovell, C. A. K., Stochastic frontier analysis. Cambridge University Press, Cambridge, 2003.
16.
Rosko, M. D., Cost efficiency of US hospitals: A stochastic frontier approach. Health. Econ. 10(6):539–551, 2001.CrossRef
17.
Tavares, G., A bibliography of data envelopment analysis [1978–2001], Rutcor Research Report RRR 01-02, 2002.
18.
Emrouznejad, A., Parker, B., and Tavares, G., Evaluation of research in efficiency and productivity: A survey and analysis of the first 30 years of scholarly literature in DEA. Socio. Econ. Plan. Sci. 42(3):151–157, 2008.CrossRef
19.
Worthington, A. C., Frontier efficiency measurement in health care: A review of empirical techniques and selected applications. Med. Care Res. Rev. 61(2):135–170, 2004.CrossRef
20.
21.
Luoma, K., Järviö, M., Suoniemi, I., and Hjerppe, R. T., Financial incentives and productive efficiency in Finnish health centres. Health Econ. 5:435–445, 1996.CrossRef
22.
Borge, L., and Haraldsvik, M., Efficiency potential and determinants of efficiency: An analysis of the care for the elderly sector in Norway. Int. Tax Public Finance 16(4):468–486, 2009.CrossRef
23.
Marschall, P., and Flessa, S., Assessing the efficiency of rural health centres in Burkina Faso: An application of data envelopment analysis. J. Public Health 17:87–95, 2009.CrossRef
24.
Marathe, S., Wan, T. T. H., Zhang, J., and Sherin, K., Factors influencing community health centers´efficiency: a latent growth curve modeling approach. J. Med. Sys. 31:265–374, 2007.CrossRef
25.
Pina, V., and Torres, L., Evaluating the efficiency of non-profit organizations: An application of data envelopment analysis to the public health services. Finan. Acc. Manage. 8:213–225, 1992.CrossRef
26.
Rosenman, R., Siddhartan, K., and Ahern, M., Output efficiency of health maintenance organizations in Florida. Health Econ 6:295–302, 1997.CrossRef
27.
Schinnar, A. P., Kamis-Gould, E., Delucia, N., and Rothbard, A. B., Organizational determinants of efficiency and effectiveness in mental health partial care programs. Health Serv. Res. 25(2):387–420, 1990.
28.
Bryce, C. L., Engberg, J. B., and Wholey, D. R., Comparing the agreement among alternative models in evaluating HMO efficiency. Health Serv. Res. 35(2):509–528, 2000.
29.
García, F., Marcuello, C., Serrano, D., and Urbina, O., Evaluation of efficiency in primary health care centres: An application of data envelopment analysis. Finan. Acc. Manage. 15(1):67–83, 1999.CrossRef
30.
Goñi, S., An analysis of the effectiveness of Spanish primary health care teams. Health Policy 48:107–117, 1999.CrossRef
31.
Kirigia, J. M., Emrouznejad, A., Cassona, B., Asbu, E. Z., and Barry, S., A performance assessment method for hospitals: The case of municipal hospitals in Angola. J. Med. Syst. 32:509–519, 2008.CrossRef
32.
García Fariñas, A., Sánchez Delgado, Z., Chaviano Moreno, M., and Muñiz Cepero, M., Niveles de eficiencia de las políclinicas de Matanzas, Cuba, según el método de análisis envolvente de datos. Rev. Panam. Salud Publica/Pan Am. J. Public Health 22(2):100–109, 2007.CrossRef
33.
Osei, D., d’Almeida, S., George, M. O., Kirigia, J. M., Mensah, A. O., and Kainyu, L. H., Technical efficiency of public district hospitals and health centres in Ghana: A pilot study. Cost Effectiveness and Resource Allocation 3:9, 2005.CrossRef
34.
Fuentelsaz, L., Marcuello, C., and Urbina, O., Eficiencia productiva en la prestación de servicios de salud: una aplicación a los centros de atención primaria. Hac. Pub. Esp. 138:29–36, 1996.
35.
Martí, T., and Greenzner, V., Modelos de Atención Primaria de Catalunya. Cuadernos de Gestión en Atención Primaria 5(3):116–123, 1999.
36.
Urbina, O., and Serrano, D., Evaluación de la eficiencia médica en atención primaria, XVII Jornadas de Economía de la Salud. AES, Murcia, 1997.
37.
Buck, D., The efficiency of the community dental services in England: A data envelopment analysis. Community Dent. Oral Epidemiol 28:274–280, 2000.CrossRef
38.
Zavras, A., Tsakos, G., Economou, C., and Kyriopoulos, J., Using DEA to evaluate efficiency and formulate policy within a Greek National Primary Health Care Network. J. Med. Studies 26(4):285–292, 2002.CrossRef
39.
Ligarda, J., and Ñaccha, M., La eficiencia de las organizaciones de salud a través del análisis envolvente de datos. Microrredes de la Dirección de Salud IV Lima Este 2003. Anales de la Facultad de Medicina, Universidad Nacional Mayor de San Marcos. 67(2):142–151, 2006.
40.
Masiye, F., Kirigia, J. M., Emrouznejad, A., Sambo, L. G., Mounkaila, A., Chimfwembe, D., and Okello, D., Efficient management of health centres human resources in Zambia. J. Med. Syst. 30:473–481, 2006.CrossRef
41.
Hollingsworth, B., and Smith, P. C., The use of ratios in data envelopment analysis. Appl. Econ. Lett. 10:733–735, 2003.CrossRef
42.
Emrouznejad, A., and Amin, G. R., DEA models for ratio data: Convexity consideration. Appl. Math. Model 33:486–498, 2009.MATHCrossRef
43.
Chen, A., Hwang, Y., and Shao, B., Measurement and sources of overall and input inefficiencies: Evidences and implications in hospital services. Eur. J. Oper. Res. 161:447–468, 2003.CrossRef
44.
Staat, M., Efficiency of hospitals in Germany: A DEA-bootstrap approach. Appl. Econ. 38:2255–2263, 2006.CrossRef
45.
Zen, F., and Baldan, C., The strategic paths and performance of Italian mutual banks: A non parametric analysis. Int. J. Banking, Acc., Finance 1(2):189–214, 2008.CrossRef
46.
Ozcan, Y. N., Physician benchmarking: measuring variation in practice behavior in treatment of otitis media. Health Care Manage. Sci. 1:5–17, 1998.CrossRef
47.
Szczepura, A., Davies, V., Fletcher, J., and Boussofiane, A., Efficiency and effectiveness in general practice. J. Manage. Med. 7(5):36–47, 1993.CrossRef
48.
Doyle, J. R., and Green, R. H., Efficiency and cross-efficiency in DEA: Derivations, meanings and uses. J. Oper. Res. Soc. 45(5):567–578, 1994.MATH
49.
Talluri, S., and Sarkis, J., Extensions in efficiency measurement of alternate machine component grouping solutions. IIEE Trans. Eng. Manage. 44(3), 1997.
50.
51.
52.
Kao, Ch, and Hung, H., Efficiency analysis of university departments: An empirical study. Omega 36:653–664, 2008.CrossRef
53.
Ward, D. R., Product differentiation and consumption efficiency in mortgage markets. J. Bus. Res. 62:805–809, 2009.CrossRef
54.
55.
Charnes, A., Cooper, W. W., and Rhodes, E., Measuring the efficiency of decision making units. Eur. J. Oper. Res. 2:429–444, 1978.MATHMathSciNetCrossRef
56.
Banker, R. D., Charnes, A., and Cooper, W. W., Some models for estimating technical and scale inefficiencies in data envelopment analysis. Manage. Sci. 30:1078–1092, 1984.MATHCrossRef
57.
Kontodimopoulos, N., Papathanasiou, N. D., Tountas, Y., and Niakas, D., Separating managerial inefficiency from influences of the operating environment: An application in Dialysis. J. Med. Syst. doi:10.​1007/​s10916-009-9252-2, 2009.
58.
Sinay, T., Productive efficiency of rural health clinics: The Midwest experience. J. Rural Health 17(3):239–250, 2001.CrossRef
59.
Chilingerian, J. A., and Sherman, H. D., Benchmarking physician practice patterns with DEA: A multi-stage approach for cost containment. Ann. Oper. Res. 67:83–116, 1996.CrossRef
60.
Akazili, J., Adjuik, M., Chatio, S., Kanyome, E., Hodgson, A., Aikins, M., and Gyapong, J., What are the technical and allocative efficiencies of public health centres in Ghana? Ghana Med. J. 42(4):149–155, 2008.
61.
Kirigia, J. M., Emrouznejad, A., Sambo, L. G., Munguti, N., and Liambila, W., Using data envelopment analysis to measure the technical efficiency of public health centers in Kenya. J. Med. Sys. 28(2):155–166, 2004.CrossRef
62.
Guifrida, A., and Gravelle, H., Measuring performance in primary care: econometric analysis and DEA. Appl. Econ. 33:163–175, 2001.
63.
Rosenman, R., and Friesner, D., Scope and scale inefficiencies in physician practices. Health Econ 13:1091–1116, 2004.CrossRef
64.
Chilingerian, J. A., and Sherman, H. D., DEA and primary care physician report cards: Deriving preferred practice cones from managed care service concepts and operating strategies. Ann. Oper. Res. 73:35–66, 1997.MATHCrossRef
65.
Filipe Amado, C. A., and Pereira dos Santos, S., Challenges for performance assessment and improvement in primary health care: The case of the Portuguese health centres. Health Policy 91:43–56, 2009.CrossRef
66.
Dervaux, B., Leleu, H., Valdmanis, V., and Walker, D., Parameters of control when facing stochastic demand: A DEA approach applied to Bangladeshi vaccination sites. Int. J. Health Care Finance Econ 3:287–299, 2003.CrossRef
67.
Bernet, P. M., Rosko, M. D., Valdmanis, V. G., Pilyavsky, A., and Aaronson, W. E., Productivity efficiencies in Ukrainian polyclinics: Lessons for health system transitions from differential responses to market changes. J. Prod. Anal. 29:103–111, 2008.CrossRef
68.
Renner, A., Kirigia, J. M., Zere, E. A., Barry, S. P., Kirigia, D. G., Kamara, C., and Muthuri, L. H. K., Technical efficiency of peripheral health units in Pujehum district of Sierra Leone: A DEA application. BMC Health Serv. Res. 5:77, 2005.CrossRef
69.
Jemai, I. J., Total performance of the health systems: A comparative study of Arab and African countries. Int. Rev. Bus. Res. Papers 3(4):11–124, 2007.
70.
Mohan, R., and Mirmirani, S., An assessment of OECD Health Care System Using Panel Data Analysis. SouthWest Bus. Econ. J. 16(09), 2008.
71.
Retzlaff-Roberts, D., Chang, C. F., and Rubin, R. M., Technical efficiency in the use of health care resources: A comparison of OECD countries. Health Policy 69:55–72, 2004.CrossRef
72.
Coelli, T. J., Prasada Rao, D. S., O’Donnell, C. J., and Battese, G. E., An introduction to efficiency and productivity analysis, 2nd edition. Springer, New York, 2005.
73.
Coelli, T. J., and Perelman, S., A comparison of parametric and non-parametric distance functions: With applications to European railways. Eur. J. Oper. Res. 117(2):326–339, 1999.MATHCrossRef
74.
Chilingerian, J. A., Evaluating physician efficiency in hospitals: A multivariate analysis of best practices. Eur. J. Oper. Res. 80:548–574, 1995.MATHCrossRef
75.
Simar, L., and Wilson, P. W., Sensitivity analysis of efficiency scores: How to bootstrap in nonparametric frontier models. Manage. Sci. 44(1):49–61, 1998.MATHCrossRef
76.
Gabriel, K. R., The biplot graphical display of matrices with application to principal component analysis. Biometrika 58:453–467, 1971.MATHMathSciNetCrossRef
77.
Wooldridge, J. M., Introductory econometrics, 4th edition. South-Western GENGAGE Learning, USA, 2006.
78.
Blasius, J., Eliers, P. H. C., and Gower, J., Better biplots. Comp. Stat. Data An 53:3145–3158, 2009.MATHCrossRef
79.
Gower, J. C., and Hand, D. J., Biplots. Chapman & Hall, London, 1996.MATH
80.
Banker, R. D., and Natarajan, R., Evaluating contextual variables affecting productivity using data envelopment analysis. Oper. Res. 56(1):48–58, 2008.MATHMathSciNetCrossRef
Metadata
Title
A Multiple Stage Approach for Performance Improvement of Primary Healthcare Practice
Authors
Martha T. Ramírez-Valdivia
Sergio Maturana
Sonia Salvo-Garrido
Publication date
01-10-2011
Publisher
Springer US
Published in
Journal of Medical Systems / Issue 5/2011
Print ISSN: 0148-5598
Electronic ISSN: 1573-689X
DOI
https://doi.org/10.1007/s10916-010-9438-7

Other articles of this Issue 5/2011

Journal of Medical Systems 5/2011 Go to the issue

ORIGINAL PAPER

Variable Threshold Method for ECG R-peak Detection

Original Paper

A Hand-held Mosaicked Multispectral Imaging Device for Early Stage Pressure Ulcer Detection

Original Paper

Governance and Performance: The Performance of Dutch Hospitals Explained by Governance Characteristics

Original Paper

The Impact of Non-Discretionary Factors on DEA and SFA Technical Efficiency Differences

Original Paper

Accurate Automated Detection of Autism Related Corpus Callosum Abnormalities

Original Paper

Thermal Shock Resistance of Skin Tissue