Measures of Performance in Primary Care - a Review of Efficiency Studies

With the economic downturn inflicting austerity on the British National Health Service, the issue of efficiency is of paramount importance for health care policy makers who are called upon to identify where efficiency savings can be made without hindering the quality of care. Research exploring efficiency in health is still relatively new. The measurement of efficiency is made difficult by the multifaceted nature of the output of health care, particularly so in primary care. On the other hand simple measures of activity cannot be considered sufficient, particularly given the system of incentives introduced for primary care providers such as the Quality and Outcomes Framework (QOF) in UK. In this paper we review studies that have used stochastic frontier analysis to measure the efficiency of primary care providers and purchasers. We find that quality indicators are increasingly being used in explaining cost variation and relative efficiency differences. To our knowledge though, there are no UK based studies that have used data from the QOF. We argue that QOF is an invaluable source of information which should enable more accurate and insightful analysis of relative efficiency in primary care by incorporating appropriate measures of quality.