Total productivity change of Health Centers in Greece in 2016-2018: a Malmquist index data envelopment analysis application for the primary health system of Greece.

BACKGROUND: This paper attempts to evaluate the primary health care system by evaluating health centres in Greece. METHODS: Malmquist Index Data Envelopment Analysis is applied to study the total productivity of 155 health centres in Greece during 2016-2018. The data were collected from the Ministry of Health and submitted to quality tests to ensure validity and avoid bias. RESULTS: This paper measures the productivity of each of the 155 health centres in Greece and how it shifted during 2016-2018. In addition, the overall productivity change of the 155 health centres over time is calculated and analysed as being due to technical efficiency or technological efficiency. The analysis of the mean values showed a decrease of 0.9% in the overall productivity factor from 2016 to 2017 and a decrease of 5.2% from 2017 to 2018. The overall decrease in the productivity of the 155 health centres was 3.1%. From 2016 to 2018, 59 health centres changed their productivity mainly due to technological change and 91 changed mainly due to technical efficiency change. One health centre showed regression to its total productivity due to equal regression of its technical efficiency and technology. CONCLUSIONS: The method used is nonparametric data envelopment analysis along with the Malmquist index to include panel data in the analysis. Meaningful results were extracted by indicating the number of health centres that improved their productivity, regressed in productivity, or remained constant through the period 2016-2018. This paper may contribute to improving health centres' efficiency and productivity. Furthermore, valuable results can be extracted for the National Health Care System to match available resources that correspond to each health centre's needs, as well as for manager planners and stakeholders in primary health care.

Evaluation of the Efficiency in Public Health Centers in Greece Regarding the Human Resources Occupied: A Bootstrap Data Envelopment Analysis Application.

In this paper, the overall efficiency of health centers in Greece is measured by applying the input-oriented model of Data Envelopment Analysis. In addition, four different models were subjected to the input-oriented Data Envelopment Analysis to investigate the contribution of each category of human resources to the efficiency results of the health centers. The bootstrap technique was performed to generate confidence intervals for the models. Data for 155 health centers in Greece were provided by the Ministry of Health. The health centers submitted in the analysis obtained an average efficiency value of 0.932. The average results of the partial models in terms of each input show that the efficiency values achieved by the health centers are mostly influenced by the number of physicians and the number of managers employed. The second factor influencing the efficiency values of the health centers are the number of nursing staff occupied in the health centers. Non-medical staff employed in the health centers had the least contribution to the efficiencies measured. This paper provides important information for the stakeholders and the Government of Greece so as to better allocate the personnel employed in primary health care according to the efficiencies attained by the health centers.