Visualisation of Data Envelopment Analysis in primary health services

Abstract

Benchmark efficiency analysis in public health typically focuses on hospitals rather than primary care providers. Data Envelopment Analysis (DEA) is widely used to assess resource efficiency among decision-making units (DMUs). However, traditional DEA struggles to differentiate between efficient units and is sensitive to the selection of inputs and outputs. Methods like super-efficiency and cross-efficiency address some of these limitations but often exclude outliers and may overlook efficiency related to specialisation. DEA Visualisation integrates DEA with multivariate statistical methods allowing for the identification of inefficiency sources and specialisation patterns without losing discriminatory power or removing extreme cases from the sample. This study analyses 82 public primary health centres in Madrid serving senior citizens in 2018. The findings reveal inefficiencies such as a preference for prescribing specific rather than generic drugs, increasing public health costs. Additionally, two extreme cases (outliers or mavericks) were identified as having high infrastructure costs and disproportionate staffing. Redistributing patients from overcrowded centres could enhance efficiency, while centres focused on preventive care showed greater cost-effectiveness, particularly in reducing prescription costs.