Efficiency and Effectiveness in General Practice

Describes the exploratory use of a statistical technique called data envelopment analysis (DEA), which has been widely used in other parts of the service sector, to measure the efficiency of 52 general practices in three health districts, serving 378,500 patients (78 per cent of the resident population). DEA identified over half (60 per cent) of the 52 practices as less than 100 per cent efficient, with 25 per cent potentially capable of large increases in activity without higher resource levels. There was no significant relationship between efficiency and whether partnerships were training practices, computerized, holding regular meetings, or the total list size, or age structure of practice populations except that multi‐site practices were found to be significantly more efficient as list size increased. DEA efficiency ratings were compared with a proxy for effectiveness (the ability of practices to reach target levels set in the new GP contract). Practices which were below target levels before the new contract was introduced were far less likely to be able to reach these targets once the contract was in place if they had been classified by DEA as 100 per cent efficient (i.e. judged to be unable to achieve greater outputs without increased resources). More research effort now needs to be devoted to exploring the use of DEA in measuring efficiency in general practice, and to examining the relationship between measures of efficiency and effectiveness in primary care.

[1]  A. Szczepura,et al.  Effectiveness and cost of different strategies for information feedback in general practice. , 1994, The British journal of general practice : the journal of the Royal College of General Practitioners.

[2]  Emmanuel Thanassoulis,et al.  Applied data envelopment analysis , 1991 .

[3]  A. Mcguire,et al.  The measurement of hospital efficiency. , 1987, Social science & medicine.

[4]  Abraham Charnes,et al.  Measuring the efficiency of decision making units , 1978 .

[5]  D. Aigner,et al.  P. Schmidt, 1977,?Formulation and estimation of stochastic frontier production function models,? , 1977 .

[6]  Richard C. Morey,et al.  Reimbursement rate setting for Medicaid prescription drugs based on relative efficiencies , 1985 .

[7]  M. Farrell The Measurement of Productive Efficiency , 1957 .

[8]  S. Pliska,et al.  Hospital expenses in a sector model. , 1985, Health services research.

[9]  Emmanuel Thanassoulis,et al.  Relative Efficiency Assessments Using Data Envelopment Analysis: An Application to Data on Rates Departments , 1987 .

[10]  A. Lewin,et al.  Measuring the relative efficiency and output potential of public sector organizations: An application of data envelopment analysis , 1981 .

[11]  M. Feldstein Economic analysis for health service efficiency : econometric studies of the British National Health Service , 1968 .

[12]  R. Banker Estimating most productive scale size using data envelopment analysis , 1984 .

[13]  A. Gray THE PRODUCTION OF DENTAL CARE ION THE BRITISH NATIONAL HEALTH SERVICE , 1982 .

[14]  William W. Cooper,et al.  Evaluating Program and Managerial Efficiency: An Application of Data Envelopment Analysis to Program Follow Through , 1981 .

[15]  A. Charnes,et al.  Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis , 1984 .

[16]  A. Mcguire,et al.  A production function analysis of acute hospitals , 1983 .

[17]  Ala Szczepura,et al.  All Change: What is Happening in NHS General Practice? , 1991 .

[18]  T. J. Cook,et al.  Evaluating the administrative efficiency of courts , 1982 .

[19]  Jeff Kennington,et al.  An Application of Mathematical Programming to Assess Productivity in the Houston Independent School District , 1982 .

[20]  Rajiv D. Banker,et al.  PRODUCTNITY MEASUREMENT AND MANAGEMENT CONTROL , 1985 .

[21]  J. Chisholm The 1990 contract: its history and its content. , 1990, BMJ.

[22]  G. Mooney,et al.  Rethinking medical audit: the goal is efficiency. , 1992, Journal of epidemiology and community health.

[23]  Rc Morey,et al.  Comparing the allocative efficiencies of hospitals , 1990 .

[24]  C. Lovell,et al.  A survey of frontier production functions and of their relationship to efficiency measurement , 1980 .

[25]  D. Aigner,et al.  FORMULATION AND ESTIMATION OF STOCHASTIC PRODUCTION FUNCTION MODELS , 1977 .

[26]  P. Schmidt Frontier production functions , 1985 .

[27]  D. Whynes,et al.  A production function analysis of English maternity hospitals. , 1978, Socio-economic planning sciences.

[28]  R. Banker,et al.  A Comparative Application of Data Envelopment Analysis and Translog Methods: An Illustrative Study of Hospital Production , 1986 .