1. Technical Efficiency of Diabetes Management in PC in Europe
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

2. 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?

3. 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

4. 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

5. Methods
Databases: EUprimecare project Grant Agreement no (Fınland, Germany, Italy, Spaın, Hungary, Estonıa, Lıthuanıa)
Data Envelopment Analysis (DEA).
Output oriented program
Constant returns to scale
Software: DEAP versıon 2.1. Unıv. New England. AU
Output
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
Input
Average time spent by GP with a diabetic patient in a year in each country

6. Average time spent by GP with a diabetic patient in a year
PC Vignettes: Answered by 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

7. Proportion of prevention activities performed last year
Proportion of prevention activities performed last year. Composite indicator
PC users questionnaire: Answered by 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

8. Proportion of patients under treatment whose therapy was prescribed by the GP
PC users questionnaire: Answered by Diabetic: 276

9. Patient satisfaction. Composite indicator
PC users questionnaire: Answered by Diabetic: 276
Questions:

10. Results Country Score Spain 1.00 Germany 0.60 Finland 0.59 Italy 0.47
Hungary
0.40
Lithuania
0.38
Estonia
0.37

11. 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

12. Thank you!