[A measure of the efficiency of primary care in Barcelona (Spain) incorporating quality indicators].
OBJECTIVE
To demonstrate the impact of the incorporation of quality indicators in assessing the technical efficiency of primary healthcare teams. The processes through which primary healthcare resources have been allocated since the onset of the financial crisis in 2008 have focussed on quantitative rather than qualitative indicators.


METHODS
This study applies data envelopment analysis (DEA) techniques to 58 primary healthcare teams from three different primary healthcare services from the province of Barcelona (Spain). We combine publicly available information from the regional government of Catalonia with data requested from the Catalan Health System Observatory. The analysis compares the results of three models, thereby allowing shifts in the efficiency of primary healthcare teams to be identified in terms of the (lack of) consideration for healthcare quality indicators.


RESULTS
Only 16% of the primary healthcare teams were found to be efficient according to the baseline models, which only incorporated input and output quantity indicators. However, once proxies for healthcare quality are included in the analysis, this percentage increases to 58.6%. No meaningful differences in primary healthcare team efficiency were found between public and privately owned centres, between regional primary care services and organisational models, or between rural and urban teams.


CONCLUSIONS
The results suggest the need to incorporate healthcare quality indicators as outputs when considering criteria for the streamlining of primary healthcare services. Failure to incorporate quality indicators is associated with various primary healthcare concepts.
Institut Català de la Salut (ICS), CAP Just Oliveras, EAP Sant Josep, L'Hospitalet de Llobregat (Barcelona), España. Electronic address: jromano@ambitcp.catsalut.net.
José
J
Romano
Institut d'Economia de Barcelona y Universidad de Barcelona, Barcelona, España.
Álvaro
Á
Choi
D004526:Efficiency; D015276:Health Care Rationing; D006296:Health Services / Q000592:standards; D006801:Humans; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000592:standards* / Q000706:statistics & numerical data; D013030:Spain
Atención primaria de salud; Calidad asistencial; Efficiency; Eficiencia; Estadística no paramétrica; Nonparametric statistics; Primary healthcare; Quality healthcare