Volume 25, Issue 3 (12-2022)
jha 2022, 25(3): 50-72 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Rahimi H, Goudarzi R, Haghdoost A, Noorihekmat S. Performance evaluation of the districts' primary health care system in Iran; A case study. jha 2022; 25 (3) :50-72
URL: http://jha.iums.ac.ir/article-1-4199-en.html
URL: http://jha.iums.ac.ir/article-1-4199-en.html
1- Assistant Professor, School of Medicine, Dezful University of Medical Sciences, Dezful
2- Kerman University of Medical University
3- Professor, Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman
4- Associate Professor, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman ,snhekmat@gmail.com
2- Kerman University of Medical University
3- Professor, Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman
4- Associate Professor, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman ,
Abstract: (907 Views)
Introduction: Managers need to evaluate the performance of their subordinates in order to plan, organize, and improve the performance of their organizations. In this study, the performance and efficiency of the district's primary health care (PHC) system in the southeast of Iran were evaluated using the data envelopment analysis (DEA) model.
Methods: In this study, the efficiency of 9 cities affiliated to Kerman University of Medical Sciences was analyzed in 2019. The quantitative non-parametric DEA was used to evaluate the performance of the PHC system in the districts. Human forces, physical facilities, and vehicles were the variables used as the inputs, and the number of services and service recipients was considered as the outputs to measure efficiency. Data collection was done in the field using a checklist. The data were analyzed using the DEAP 2.1 software, efficiency was calculated with the output maximization approach and the assumption of variable returns to scale. It was carried out as linear programming with nine scenarios for nine districts in 2018.
Results: The mean efficiency of the studied districts with the assumption of variable returns to scale was 0.68, indicating at least 32% capacity to increase efficiency in the studied PHC systems without any increase in production factors. According to the mean values, Kerman was efficient while the other 8 districts were inefficient. The most inefficient PHC systems were those of Shahr-e Babak, Baft, and Orzooieh.
Conclusion: Inefficiency in most PHC systems of the studied districts, indicating that PHC managers can provide more health services to the community through proper management of available resources. Inefficient districts can compare themselves with successful and reference districts to eliminate their shortcomings and improve their performance.
Methods: In this study, the efficiency of 9 cities affiliated to Kerman University of Medical Sciences was analyzed in 2019. The quantitative non-parametric DEA was used to evaluate the performance of the PHC system in the districts. Human forces, physical facilities, and vehicles were the variables used as the inputs, and the number of services and service recipients was considered as the outputs to measure efficiency. Data collection was done in the field using a checklist. The data were analyzed using the DEAP 2.1 software, efficiency was calculated with the output maximization approach and the assumption of variable returns to scale. It was carried out as linear programming with nine scenarios for nine districts in 2018.
Results: The mean efficiency of the studied districts with the assumption of variable returns to scale was 0.68, indicating at least 32% capacity to increase efficiency in the studied PHC systems without any increase in production factors. According to the mean values, Kerman was efficient while the other 8 districts were inefficient. The most inefficient PHC systems were those of Shahr-e Babak, Baft, and Orzooieh.
Conclusion: Inefficiency in most PHC systems of the studied districts, indicating that PHC managers can provide more health services to the community through proper management of available resources. Inefficient districts can compare themselves with successful and reference districts to eliminate their shortcomings and improve their performance.
Type of Study: Research |
Subject:
Health Economics
Received: 2022/06/23 | Accepted: 2022/09/20 | Published: 2023/02/27
Received: 2022/06/23 | Accepted: 2022/09/20 | Published: 2023/02/27
References
1. Janati A, Maleki MR, Gholizadeh M, Narimani MR, Vakili S: Assessing the strengths & weaknesses of family physician program. Knowledge & Health 2010, 4(4):38-43.
2. Bayati A, Ghanbari F, Hosseini S, Maleki A, Shamsi M: Factors Influencing Family Physician Programfrom the Perspective of the Health Team. Journal of Mazandaran University of Medical Sciences 2014, 24(115):22-35.
3. Pettigrew LM, De Maeseneer J, Anderson M-IP, Essuman A, Kidd MR, Haines A: Primary health care and the Sustainable Development Goals. The Lancet 2015, 386(10009):2119-2121. [DOI:10.1016/S0140-6736(15)00949-6]
4. Amado CAdEF, dos Santos SP: Challenges for performance assessment and improvement in primary health care: the case of the Portuguese health centres. Health Policy 2009, 91(1):43-56. [DOI:10.1016/j.healthpol.2008.11.008]
5. De Maeseneer J, Van Weel C, Egilman D, Mfenyana K, Kaufman A, Sewankambo N: Strengthening primary care: addressing the disparity between vertical and horizontal investment. Br J Gen Pract 2008, 58(546):3-4. [DOI:10.3399/bjgp08X263721]
6. Bengoa R, Adams O, Kawar R: Primary health care: A framework for future strategic directions (updated draft). Geneva: World Health Organization Available online: www who int/chronic_conditions/primary_health_care/en/phc_report_oct03 pdf 2003
7. Takian A, Doshmangir L, Rashidian A: Implementing family physician programme in rural Iran: exploring the role of an existing primary health care network. Family practice 2013, 30(5):551-559. [DOI:10.1093/fampra/cmt025]
8. Macinko J, Almeida C, de Sá PK: A rapid assessment methodology for the evaluation of primary care organization and performance in Brazil. Health policy and planning 2007, 22(3):167-177. [DOI:10.1093/heapol/czm008]
9. Moghadam MN, Sadeghi V, Parva S: Weaknesses and challenges of primary healthcare system in Iran: a review. The International journal of health planning and management 2012, 27(2):e121-e131. [DOI:10.1002/hpm.1105]
10. Dehnavieh R, Noorihekmat S, Masoud A, Moghbeli M, Rahimi H, Poursheikhali A, Hoseinpour M, Salari S: Evaluating the Tabriz health complex model, lessons to learn. Iranian Journal of Epidemiology 2018, 13(5):59-70.
11. Zare Ahmadabadi H, Masoudian S, Zare Banadkouki MR: Evaluating the technical efficiency of Yazd City health centers with a combined approach of DEA and GT. SSU_Journals 2019, 26(8):717-732.
12. Rahimi H, Bahmaei J, Shojaei P, Kavosi Z, Khavasi M: Developing a strategy map to improve public hospitals performance with balanced scorecard and dematel approach. Shiraz E Medical Journal 2018, 19(7):e64056. [DOI:10.5812/semj.64056]
13. Kirigia JM, Emrouznejad A, Sambo LG, Munguti N, Liambila W: Using data envelopment analysis to measure the technical efficiency of public health centers in Kenya. Journal of Medical Systems 2004, 28(2):155-166. [DOI:10.1023/B:JOMS.0000023298.31972.c9]
14. Seddighi H, Nejad FN, Basakha M: Health systems efficiency in Eastern Mediterranean Region: a data envelopment analysis. Cost Effectiveness and Resource Allocation 2020, 18(1):1-7. [DOI:10.1186/s12962-020-00217-9]
15. Cordero-Ferrera JM, Crespo-Cebada E, Murillo-Zamorano LR: Measuring technical efficiency in primary health care: the effect of exogenous variables on results. Journal of medical systems 2011, 35(4):545-554. [DOI:10.1007/s10916-009-9390-6]
16. Farahabadi E, Yousefi M, Bahmanzeiari N, Fereydoni F, Fazeli S: Efficiency analysis of selected urban health centers affiliated in Isfahan University of medical sciences. haspital journal 2011, 10(1):35-44.
17. Yousefi Nayer M, Fazaeli AA, Hamidi Y, Amiri J: Assessment of Technical Efficiency of Comprehensive Health Services Centers of Hamadan by Data Envelopment Analysis (DEA) in 2019. Journal of healthcare management 2021, 12(39):93-101.
18. Kirigia JM, Sambo LG, Renner A, Alemu W, Seasa S, Bah Y: Technical efficiency of primary health units in Kailahun and Kenema districts of Sierra Leone. International archives of medicine 2011, 4(1):1-14. [DOI:10.1186/1755-7682-4-15]
19. Tigga NS, Mishra US: On measuring technical efficiency of the health system in India: An application of Data Envelopment Analysis. Journal of Health Management 2015, 17(3):285-298. [DOI:10.1177/0972063415589229]
20. Montegut AJ, Cartwright CA, Schirmer JM, Cummings S: An international consultation: the development of family medicine in Vietnam. FAMILY MEDICINE-KANSAS CITY- 2004, 36(5):352-356.
21. Esmaeili R, Hadian M, Rashidian A, Shariati M, Ghaderi H: Family medicine in Iran: Facing the health system challenges. Global journal of health science 2015, 7(3):260. [DOI:10.5539/gjhs.v7n3p260]
22. Jahad Sarvestani A, Barouni M, Amiresmaeili M: Evaluation of Economic Efficiency in Radiology Wards: A Case Study in Kerman Province. Sadra Med Sci J 2016, 4(1):31-42.
23. Rahimi H, Goudarzi R, Noorihekmat S, Haghdoost A, Khodabandeh F: Inequality in households' access to primary health care (PHC): a case study in Kerman, southeast Iran. BMC Health Services Research 2022, 22(1):1-11. [DOI:10.1186/s12913-022-08467-4]
24. Marschall P, Flessa S: Efficiency of primary care in rural Burkina Faso. A two-stage DEA analysis. Health economics review 2011, 1(1):5. [DOI:10.1186/2191-1991-1-5]
25. AliMohammadiArdakani M, SaeidaArdekani S, SayadiToranloo H: Staff Relative Efficiency Appraisal of Health Centers Using Data Envelopment Analysis Models. Journal of Rafsanjan University of Medical Sciences 2011, 10(4):255-266.
26. Oikonomou N, Tountas Y, Mariolis A, Souliotis K, Athanasakis K, Kyriopoulos J: Measuring the efficiency of the Greek rural primary health care using a restricted DEA model; the case of southern and western Greece. Health care management science 2016, 19(4):313-325. [DOI:10.1007/s10729-015-9324-4]
27. Schmacker ER, McKay NL: Factors affecting productive efficiency in primary care clinics. Health services management research 2008, 21(1):60-70. [DOI:10.1258/hsmr.2007.007018]
28. Linna M, Nordblad A, Koivu M: Technical and cost efficiency of oral health care provision in Finnish health centres. Social science & medicine 2003, 56(2):343-353. [DOI:10.1016/S0277-9536(02)00032-1]
29. Mossialos E, Allin S, Davaki K: Analysing the Greek health system: a tale of fragmentation and inertia. Health economics 2005, 14(S1):S151-S168. [DOI:10.1002/hec.1033]
30. Cordero JM, Alonso-Morán E, Nuño-Solinis R, Orueta JF, Arce RS: Efficiency assessment of primary care providers: A conditional nonparametric approach. European Journal of Operational Research 2015, 240(1):235-244. [DOI:10.1016/j.ejor.2014.06.040]
31. Zare Ahmadabadi H, Masoudian S, Banadkouki Z, Reza M: Evaluating the technical efficiency of Yazd City health centers with a combined approach of DEA and GT. Journal of Shahid Sadoughi University of Medical Sciences 2018, 26(8):717-732.
32. Rahimi H, Kalantari A, Rafiee N, Khosravi S: Social trends affecting the future of Iran's health system: A qualitative study using focus group discussion. International journal of preventive medicine 2019, 10:115. [DOI:10.4103/ijpvm.IJPVM_322_18]
33. Murillo-Zamorano LR, Petraglia C: Technical efficiency in primary health care: does quality matter? The European Journal of Health Economics 2011, 12(2):115-125. [DOI:10.1007/s10198-010-0232-8]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
Site Keywords
Health, Administration, Scientific Article, Iran University of Medical Sciences,
