Data envelopment analysis applied to quality in primary health care

The performance of primary care should ultimately be judged on its effect on the health outcome of individual patients. However, for the foreseeable future, it is inconceivable that the outcome data necessary to come to a judgement on performance will be available. And in any case, specification of the statistical model necessary to analyze outcome is fraught with difficulty. This paper therefore sets out a model of primary care performance which is based on the premise that certain measurable quality indicators can act as proxies for outcome. This being the case, a model of performance can be deduced which takes into account the effect of resources and patient characteristics on outcome. The most appropriate analytic technique to make this model operational is data envelopment analysis (DEA). It is argued that DEA can handle multiple dimensions of performance more comfortably, and is less vulnerable to the misspecification bias that afflicts statistically based models. The issues are illustrated with an example from English Family Health Service Authorities.