Technical Efficiency of Diabetes Management in PC
in Europe. Data Envelopment Analysis
9/10 Sept 2013, Istanbul
Sonia García Pérez, Carlos Sánchez Piedra,
Almudena Albertos, Esther Arrieta, Antonio
Sarría Santamera
Agencia de Evaluación de Tecnologías Sanitarias.
ISCIII. Spain
Background
 Increasıng health care expendıture
 Incresing number of chronic patients
 Increasing cost of managing chronic patients
 Important concern of policy makers about the performance
of the health care systems and PC in particular
 Difficulty to measure efficiency/performance
 Which costs are relevant?
 What is considered quality?
 Consider the system as a whole?
Why this study?
 We suggest a methodology to measure efficiency
 By disease:
 More sımple
 Easy to make comparısons
 Fınd sources of ıneffıcıency
 Using time rather than cost. PC is labor intensive, so costs are
given by the time spent by professionals. This allows comparisons
across countries
 Data Envelopment Analysıs (DEA):
 Non parametrıc technıque used ın Economıcs to fınd the comparatıve
effıcıency across Decısıon Makıng Unıts
 Multıple ınputs and outputs to generate an effıcıency frontıer
 Does no ımpose a functıonal form to the effıcıency frontıer. Flexıble
technıque. Lıttle assumptıons
 No need for normalization of inputs and outputs. No need for assigment of
monetary value to outcomes
Purpose
 The aim of this work was to describe the comparative levels
of technical efficiency in terms of quality and time of
managing diabetes at patient level in Primary Care systems in
Europe
Methods
 Databases: EUprimecare project.
Grant Agreement no. 241595 (Fınland, Germany,
Italy, Spaın, Hungary, Estonıa, Lıthuanıa)
 Data Envelopment Analysis (DEA).
 Output oriented program
 Constant returns to scale
• Average time spent by
GP with a diabetic
patient in a year in
each country
Output
Input
 Software: DEAP versıon 2.1. Unıv. New England. AU
• Proportion of prevention activities performed last
year. Composite indicator
• Proportion of patients under treatment whose
therapy was prescribed by the GP
• Patient satisfaction. Composite indicator
Average time spent by GP with a
diabetic patient in a year
 PC Vignettes: Answered by 27-33 GPs in each country
There is a 65-year-old woman among your patients, who has been diagnosed with type 2 diabetes.
She comes in for a follow-up visit: the tests from last week show that her HbA1c is 7%. She has no
complications. She has been taking metformin 500 mg x2.You are her main primary care provider
for the next 12 months
Proportion of prevention activities
performed last year. Composite
indicator
 PC users questionnaire: Answered by 3020. Diabetic: 276
 Preliminary studies were carried out to see diferences among
several types of composite indicators (simple average, expert
opinion, and PCA): Minor differences were found
Proportion of patients under treatment
whose therapy was prescribed by the
GP
 PC users questionnaire: Answered by 3020. Diabetic: 276
Patient satisfaction. Composite
indicator
 PC users questionnaire: Answered by 3020. Diabetic: 276
Questions:
Results
Country
Score
Spain
1.00
Germany
0.60
Finland
0.59
Italy
0.47
Hungary
0.40
Lithuania
0.38
Estonia
0.37
Discussion
 Potentıal new methodology to measure effıcıency ın PC
 The quality of care of diabetic patients resulting from the time spent with the patient is
maximised for the Spanish PC system
 For the rest of the countries higher intensity of outputs could be obtained
 Inefficiency:
 Large number of administrative activities which are not translated into direct benefit to the
patient ?
 Referral to specialist who manages the case ?
 Further investigation:
 Validation of these model with more countries and for diferent diseases
 How these results relate with health outcomes
 Find sources of inefficiency
Thank you!