title: On evaluating health centers groups in Lisbon and Tagus Valley: efficiency, equity and quality.
abstract: BACKGROUND
  Bearing in mind the increasing health expenses and their weight in the Portuguese gross domestic product, it is of the utmost importance to evaluate the performance of Primary Health Care providers taking into account both efficiency, quality and equity. This paper aims to contribute to a better understanding of the performance of Primary Health Care by measuring it in a Portuguese region (Lisbon and Tagus Valley) and identifying best practices. It also intends to evaluate the quality and equity provided.
  
  
  METHODS
  For the purpose of measuring the efficiency of the health care centers (ACES) the non-parametric full frontier technique of data envelopment analysis (DEA) was adopted. The recent partial frontier method of order-m was also used to estimate the influence of exogenous variables on the efficiency of the ACES. The horizontal equity was investigated by applying the non-parametric Kruskal-Wallis test with multiple comparisons. Moreover, the quality of service was analyzed by using the ratio between the complaints and the total activity of the ACES.
  
  
  RESULTS
  On the whole, a significant level of inefficiency was observed, although there was a general improvement in efficiency between 2009 and 2010. It was found that nursing was the service with the lowest scores. Concerning the horizontal equity, the analysis showed that there is no evidence of relevant disparities between the different subregions(NUTS III). Concerning the exogenous variables, the purchasing power, the percentage of patients aged 65 years old or older and the population size affect the efficiency negatively.
  
  
  CONCLUSIONS
  This research shows that better usage of the available resources and the creation of a learning network and dissemination of best practices will contribute to improvements in the efficiency of the ACES while maintaining or even improving quality and equity. It was also proved that the market structure does matter when efficiency measurement is addressed.
authors.affiliation: Instituto Superior Técnico, University of Lisbon, Lisbon, Portugal. claudia.ferreira@tecnico.ulisboa.pt.
authors.forename: Cláudia
authors.initials: C
authors.lastname: Ferreira
authors.forename: Rui C
authors.initials: RC
authors.lastname: Marques
authors.forename: Paulo
authors.initials: P
authors.lastname: Nicola
mesh_terms: D019985:Benchmarking / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D017598:Efficiency, Organizational; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D015233:Models, Statistical; D011174:Portugal; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care / Q000592:standards* / Q000706:statistics & numerical data; D018709:Statistics, Nonparametric