ArticleBMC health services research2023
Exploring the association between primary care efficiency and health system characteristics across European countries: a two-stage data envelopment analysis.
Article in BMC health services research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Primary care education in Korean medical and nursing schools: current status, perceptions, and educational needs.Korean journal of medical education · 2026Article
- The impacts of removing pharmaceutical co-payments for chronic conditions at primary care level: a pilot study in rural China.Health policy and planning · 2025Article
- Efficiency of Primary Health Services in the Greek Public Sector: Evidence from Bootstrapped DEA/FDH Estimators.Healthcare (Basel, Switzerland) · 2024Article
- Configurations associated with the efficiency of the ophthalmology departments in public hospitals of Central South China.PloS one · 2024Article
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Authors and funding
3 authors.
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Abstract
backgroundPrimary care is widely seen as a core component of resilient and sustainable health systems, yet its efficiency is not well understood and there is a lack of evidence about how primary care efficiency is associated with health system characteristics. We examine this issue through the lens of diabetes care, which has a well-established evidence base for effective treatment and has previously been used as a tracer condition to measure health system performance.
methodsWe developed a conceptual framework to guide the analysis of primary care efficiency. Using data on 18 European countries during 2010-2016 from several international databases, we applied a two-stage data envelopment analysis to estimate (i) technical efficiency of primary care and (ii) the association between efficiency and health system characteristics.
resultsCountries varied widely in terms of primary care efficiency, with efficiency scores depending on the range of population characteristics adjusted for. Higher efficiency was associated with bonus payments for the prevention and management of chronic conditions, nurse-led follow-up, and a financial incentive or requirement for patients to obtain a referral to specialist care. Conversely, lower efficiency was associated with higher rates of curative care beds and financial incentives for patients to register with a primary care provider.
conclusionsOur results underline the importance of considering differences in population characteristics when comparing country performance on primary care efficiency. We highlight several policies that could enhance the efficiency of primary care. Improvements in data collection would enable more comprehensive assessments of primary care efficiency across countries, which in turn could more effectively inform policymaking.
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