Performance Evaluation of Home and Community Care

Abstract

In Canada, as in most developed countries, health care dollars claim a significant proportion of government budgets, and there is increased pressure to ensure that these funds are spent in an optimal manner. As a consequence, numerous mechanisms have emerged to assess the performance of hospitals and other health care institutions for health planning and policy evaluation (Peacock et al., 2001). One such mechanism has been the assessment of technical efficiency (i.e. the ability of mangers to optimally allocate their budgets to deliver high quality care to a diverse set of patients). Despite recent shifts in the setting for health care service provision from institutions to home and community care, there has been a paucity of efforts to assess the performance of the home and community care sector. Our study uses Data Envelopment Analysis (DEA) to estimate the technical efficiency of Ontario's 43 Community Care Access Centres (CCACs) in 2000/01 in their provision of home care services, after controlling for budget size and case-mix. While the results suggest that many CCACs are technically efficient, a significant proportion of urban CCACs are functioning at too large a size than is optimal. The addition of case-mix to the analyses explained some but not all of the observed variation in efficiency. Our research provides a baseline for the efficiency measurement in the provision of home care services in Ontario, Canada and a framework within which the quality of care may also be incorporated, should such data be available. The efficiency measurement represents an additional tool that decision-makers may use to inform the funding process, make resource allocation decisions, and assess the performance of managers in the home and community care sector.