Performance assessment of primary health care services using data envelopment analysis and the quality-adjusted malmquist index
提出一种基于数据包络分析和质量调整马尔奎斯特指数的方法，评估巴西圣卡塔琳娜州2008-2014年初级卫生保健服务的生产率和质量变化，发现服务规划需同时考虑活动量和影响。
Primary Health Care (PHC) is intended to provide a comprehensive response to the patients’ health needs. Considering the increasing demand to optimise the use of the available resources while keeping a high-quality standard, it is essential to investigate the health services’ performance. We propose a methodology based on the Data Envelopment Analysis (DEA) technique, examining the volume of activities performed and considering the impact of these activities by using a quality indicator directly related to care outcomes. To perform a longitudinal analysis and observe the changes in quality separately, a Quality-Adjusted Malmquist Productivity Index is implemented. The methodology is illustrated by analysing the performance and the evolution in productivity and quality of the primary care services delivered by the municipalities of the Brazilian state of Santa Catarina from 2008 to 2014. Our findings reinforce the view that adequate planning and structuring of PHC services must consider not only the volume of activity but also the impact of the services delivered.