Performance in the Delivery of Primary Health Care Services: A Longitudinal Analysis

Rita Bastião () and Nuno de Sousa Pereira ()
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Rita Bastião: Faculty of Economics, University of Porto
Nuno de Sousa Pereira: Faculty of Economics, University of Porto and CEF.UP

CEF.UP Working Papers from Universidade do Porto, Faculdade de Economia do Porto

Abstract: Primary Health Care is considered to be the cornerstone of an efficient health care system. Surprisingly, however, it has been much less studied than other levels of care. In Portugal, several reforms have been implemented to increase the efficiency and the essential role of primary health care, but their final impact is not consensual. Currently, three different organizational structures provide this level of care: Personalized Health Care Units, and two different types of Family Health Units, which were conceived as innovative settings of multidisciplinary, self-established teams with functional autonomy and a performance-based payment system. FHUs are first established as type A, but they can transit into model B and have access to additional incentives after the fulfillment of certain requirements and after the approval by the competent authorities. Our aim is to evaluate if the units that are selected to transit to more complex organizational structures systematically exhibit better outcomes for different measures of performance, determining if the criteria used to select the winning units is appropriate. We also assess if the efficiency gaps between types of organizational structures are persistent over time. Our dataset follows more than 800 PHC units in Portugal for the period 2009-2014. We start by conducting Simar and Wilson (2007)'s two-stage procedure applied to Data Envelopment Analysis in order to measure technical efficiency and effectiveness. We complement this analysis by considering a partial frontier approach. We also employ the dynamic concepts of window analysis and the Malmquist index decomposition to panel data in order to analyze changes in efficiency over time. We observe that the average efficiency score of Portuguese PHC units ranges from 0.3 to 0.97, while the effectiveness score is on average around 0.9, ranging from 0.4 to 1. PHCUs significantly differ from FHUs in levels of efficiency and effectiveness, with the latter presenting better performance, particularly as FHUs- B. Units within vertical integration with hospitals are overall less efficient, but more effective in achieving specific health targets. We also observe significant geographical heterogeneity.

Keywords: Primary Health Care; Efficiency; Effectiveness; Productivity; Organizational structure (search for similar items in EconPapers)
JEL-codes: C33 H21 I11 O43 (search for similar items in EconPapers)
Pages: 65 pages
Date: 2020-05
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