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The effect of environmental factors on technical and scale efficiency of primary health care providers in Greece.

Kontodimopoulos N, Moschovakis G, Aletras VH, Niakas D - Cost Eff Resour Alloc (2007)

Bottom Line: As for scale efficiency, IKA again outperformed the NHS (89.7% vs. 85.9%, Mann-Whitney P = 0.080), but results were reversed in respect to facility size and location.Within-group comparisons revealed significant efficiency differences between the two primary care providers.In respect to scale efficiency, the results were to some extent inconclusive and observed differences were mostly insignificant, although again IKA appeared to perform better.

View Article: PubMed Central - HTML - PubMed

Affiliation: Hellenic Open University, Faculty of Social Sciences, Riga Feraiou 169 & Tsamadou, 26222, Patras, Greece.

ABSTRACT

Background: The purpose of this study was to compare technical and scale efficiency of primary care centers from the two largest Greek providers, the National Health System (NHS) and the Social Security Foundation (IKA) and to determine if, and how, efficiency is affected by various exogenous factors such as catchment population and location.

Methods: The sample comprised of 194 units (103 NHS and 91 IKA). Efficiency was measured with Data Envelopment Analysis (DEA) using three inputs, -medical staff, nursing/paramedical staff, administrative/other staff- and two outputs, which were the aggregated numbers of scheduled/emergency patient visits and imaging/laboratory diagnostic tests. Facilities were categorized as small, medium and large (<15,000, 15,000-30,000 and >30,000 respectively) to reflect catchment population and as urban/semi-urban or remote/island to reflect location. In a second stage analysis, technical and scale efficiency scores were regressed against facility type (NHS or IKA), size and location using multivariate Tobit regression.

Results: Regarding technical efficiency, IKA performed better than the NHS (84.9% vs. 70.1%, Mann-Whitney P < 0.001), smaller units better than medium-sized and larger ones (84.2% vs. 72.4% vs. 74.3%, Kruskal-Wallis P < 0.01) and remote/island units better than urban centers (81.1% vs. 75.7%, Mann-Whitney P = 0.103). As for scale efficiency, IKA again outperformed the NHS (89.7% vs. 85.9%, Mann-Whitney P = 0.080), but results were reversed in respect to facility size and location. Specifically, larger units performed better (96.3% vs. 90.9% vs. 75.9%, Kruskal-Wallis P < 0.001), and urban units showed higher scale efficiency than remote ones (91.9% vs. 75.3%, Mann-Whitney P < 0.001). Interestingly 75% of facilities appeared to be functioning under increasing returns to scale. Within-group comparisons revealed significant efficiency differences between the two primary care providers. Tobit regression models showed that facility type, size and location were significant explanatory variables of technical and scale efficiency.

Conclusion: Variations appeared to exist in the productive performance of the NHS and IKA as the two main primary care providers in Greece. These variations reflect differences in primary care organization, economical incentives, financial constraints, sociodemographic and local peculiarities. In all technical efficiency comparisons, IKA facilities appeared to outperform NHS ones irrespective of facility size or location. In respect to scale efficiency, the results were to some extent inconclusive and observed differences were mostly insignificant, although again IKA appeared to perform better.

No MeSH data available.


Related in: MedlinePlus

CRS, VRS and scale efficiency by catchment population for NHS primary care centers.
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Figure 1: CRS, VRS and scale efficiency by catchment population for NHS primary care centers.

Mentions: Figures 1, 2 further elucidate the effect of catchment population on CRS, VRS and scale efficiency by depicting efficiency alterations with increasing population, for the NHS and IKA respectively. Specifically, figure 1 (NHS) shows opposite trends for technical and scale efficiency, which became more obvious in populations of approximately 18,000 and thereafter appeared to differ increasingly as population size increased. Simply put, the larger the catchment population (i.e. semi-urban and urban areas), the greater the variation between technical and scale efficiency, implying that for these larger areas, policymakers have more clues on where attention is required. The same generally held for IKA facilites (Figure 2), however the opposing trends emerged in smaller populations (of approximately 12,000) and started to converge in large ones (>100,000).


The effect of environmental factors on technical and scale efficiency of primary health care providers in Greece.

Kontodimopoulos N, Moschovakis G, Aletras VH, Niakas D - Cost Eff Resour Alloc (2007)

CRS, VRS and scale efficiency by catchment population for NHS primary care centers.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2211454&req=5

Figure 1: CRS, VRS and scale efficiency by catchment population for NHS primary care centers.
Mentions: Figures 1, 2 further elucidate the effect of catchment population on CRS, VRS and scale efficiency by depicting efficiency alterations with increasing population, for the NHS and IKA respectively. Specifically, figure 1 (NHS) shows opposite trends for technical and scale efficiency, which became more obvious in populations of approximately 18,000 and thereafter appeared to differ increasingly as population size increased. Simply put, the larger the catchment population (i.e. semi-urban and urban areas), the greater the variation between technical and scale efficiency, implying that for these larger areas, policymakers have more clues on where attention is required. The same generally held for IKA facilites (Figure 2), however the opposing trends emerged in smaller populations (of approximately 12,000) and started to converge in large ones (>100,000).

Bottom Line: As for scale efficiency, IKA again outperformed the NHS (89.7% vs. 85.9%, Mann-Whitney P = 0.080), but results were reversed in respect to facility size and location.Within-group comparisons revealed significant efficiency differences between the two primary care providers.In respect to scale efficiency, the results were to some extent inconclusive and observed differences were mostly insignificant, although again IKA appeared to perform better.

View Article: PubMed Central - HTML - PubMed

Affiliation: Hellenic Open University, Faculty of Social Sciences, Riga Feraiou 169 & Tsamadou, 26222, Patras, Greece.

ABSTRACT

Background: The purpose of this study was to compare technical and scale efficiency of primary care centers from the two largest Greek providers, the National Health System (NHS) and the Social Security Foundation (IKA) and to determine if, and how, efficiency is affected by various exogenous factors such as catchment population and location.

Methods: The sample comprised of 194 units (103 NHS and 91 IKA). Efficiency was measured with Data Envelopment Analysis (DEA) using three inputs, -medical staff, nursing/paramedical staff, administrative/other staff- and two outputs, which were the aggregated numbers of scheduled/emergency patient visits and imaging/laboratory diagnostic tests. Facilities were categorized as small, medium and large (<15,000, 15,000-30,000 and >30,000 respectively) to reflect catchment population and as urban/semi-urban or remote/island to reflect location. In a second stage analysis, technical and scale efficiency scores were regressed against facility type (NHS or IKA), size and location using multivariate Tobit regression.

Results: Regarding technical efficiency, IKA performed better than the NHS (84.9% vs. 70.1%, Mann-Whitney P < 0.001), smaller units better than medium-sized and larger ones (84.2% vs. 72.4% vs. 74.3%, Kruskal-Wallis P < 0.01) and remote/island units better than urban centers (81.1% vs. 75.7%, Mann-Whitney P = 0.103). As for scale efficiency, IKA again outperformed the NHS (89.7% vs. 85.9%, Mann-Whitney P = 0.080), but results were reversed in respect to facility size and location. Specifically, larger units performed better (96.3% vs. 90.9% vs. 75.9%, Kruskal-Wallis P < 0.001), and urban units showed higher scale efficiency than remote ones (91.9% vs. 75.3%, Mann-Whitney P < 0.001). Interestingly 75% of facilities appeared to be functioning under increasing returns to scale. Within-group comparisons revealed significant efficiency differences between the two primary care providers. Tobit regression models showed that facility type, size and location were significant explanatory variables of technical and scale efficiency.

Conclusion: Variations appeared to exist in the productive performance of the NHS and IKA as the two main primary care providers in Greece. These variations reflect differences in primary care organization, economical incentives, financial constraints, sociodemographic and local peculiarities. In all technical efficiency comparisons, IKA facilities appeared to outperform NHS ones irrespective of facility size or location. In respect to scale efficiency, the results were to some extent inconclusive and observed differences were mostly insignificant, although again IKA appeared to perform better.

No MeSH data available.


Related in: MedlinePlus