PMU63 - EFFICIENCY ASSESSMENT IN PRIMARY HEALTHCARE CENTERS OF A HEALTH DISTRICT

To analyze the technical efficiency of primary healthcare centers in a Health District in 2015 and to identify the variables that most influence the results. 18 functional units (FU) were analysed by data envelopment analysis (DEA). The data available are the costs of each FU, the number of employees, the activity performed and the results in health and quality. Input variables were the number of general practitioners and nurses and costs, aggregated or disaggregated in personnel, imaging tests, laboratory tests and pharmacy. Output variables were the number of outpatient contacts (medical and nursing), referrals, hospital emergencies, avoidable hospitalizations, mortality and efficiency in pharmaceutical prescription. The robustness of the analysis is contrasted with different input - output models. A regression analysis was carried out to validate the models, including environmental/exogenous variables, that cannot be controlled but determine the characteristics of the covered population, such as the percentage of people above 65 years old, case-mix (morbidity), equivalent patients and vulnerability index. The efficient frontier was obtained for different models. The main results show that some FU are always efficient, meaning they make a better use of the public resources. Other FUs are efficient depending on the combination of inputs and outputs used and the use of constant or variable returns to scale. In general terms, between 22% and 33% of the FUs are efficient, but other FUs are usually found very close to the efficient frontier. The results show that efficiency is affected mainly by pharmacy cost and hospital emergencies. If these variables are replaced by the number of outpatient contacts and referrals, efficiency improves significantly. The effect of exogenous variables needs to be determined, but preliminary results show a great incidence in the efficiency scores.