The effect of environmental factors on technical and scale efficiency of primary health care providers in GreeceReportar como inadecuado

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Cost Effectiveness and Resource Allocation

, 5:14

First Online: 17 November 2007Received: 24 April 2007Accepted: 17 November 2007


BackgroundThe 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.

MethodsThe 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.

ResultsRegarding 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.

ConclusionVariations 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.

Electronic supplementary materialThe online version of this article doi:10.1186-1478-7547-5-14 contains supplementary material, which is available to authorized users.

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Autor: Nick Kontodimopoulos - Giorgos Moschovakis - Vassilis H Aletras - Dimitris Niakas


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