Abstract
BackgroundPrimary Health Care (PHC) is an efficient strategy to improve health outcomes in populations. Nevertheless, studies of technical efficiency in health care have focused on hospitals, with very little on primary health care centers. The objective of the present study was to use the Data Envelopment Analysis to estimate the technical efficiency of three women’s health promotion and disease prevention programs offered by primary care centers in Bucaramanga, Colombia.MethodsEfficiency was measured using a four-stage data envelopment analysis with a series of Tobit regressions to account for the effect of quality outcomes and context variables. Input/output information was collected from the institutions’ records, chart reviews and personal interviews. Information about contextual variables was obtained from databases from the primary health program in the municipality. A jackknife analysis was used to assess the robustness of the results.ResultsThe analysis was based on data from 21 public primary health care centers. The average efficiency scores, after adjusting for quality and context, were 92.4 %, 97.5 % and 86.2 % for the antenatal care (ANC), early detection of cervical cancer (EDCC) and family planning (FP) programs, respectively. On each program, 12 of the 21 (57.1 %) health centers were found to be technically efficient; having had the best-practice frontiers. Adjusting for context variables changed the scores and reference rankings of the three programs offered by the health centers.ConclusionThe performance of the women’s health prevention programs offered by the centers was found to be heterogeneous. Adjusting for context and health care quality variables had a significant effect on the technical efficiency scores and ranking. The results can serve as a guide to strengthen management and organizational and planning processes related to local primary care services operating within a market-based model such as the one in Colombia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1837-0) contains supplementary material, which is available to authorized users.
Highlights
Primary Health Care (PHC) is an efficient strategy to improve health outcomes in populations
The performance of Health Centers (HC) is crucial to the functioning of the Colombian SGSSS and measuring their efficiency is important to prioritizing strategies that contribute to the sustainability of the SGSSS
The objective of the present study is to use the Data Envelopment Analysis (DEA) analysis to measure the technical efficiency of 21 HC in the Bucaramanga metropolitan area, capital of Santander, Colombia, in regard to three health promotion and disease prevention programs for women: Antenatal care (ANC), Family Planning (FP) and Early Detection of Cervical Cancer (EDCC)
Summary
Primary Health Care (PHC) is an efficient strategy to improve health outcomes in populations. The objective of the present study was to use the Data Envelopment Analysis to estimate the technical efficiency of three women’s health promotion and disease prevention programs offered by primary care centers in Bucaramanga, Colombia. In Colombia, the General Social Security Health System (SGSSS, Spanish acronym) faces additional challenges derived from a decentralized, market-oriented health model based on managed competition and a managed care organizational structured [3,4,5,6,7]. These include a lack of efficiency, quality and effective access. PHC is known to play a key role in the financial sustainability, quality of care and health outcomes of health systems [9, 10]
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