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- Exploring the potential of Data Envelopment Analysis for performance-related-pay in health care provisionPublication . Kalinichenko, Olena; Amado, Carla; Santos, Sérgio Pereira dosIn this paper we explore the potential use of Data Envelopment Analysis (DEA) for enhancing pay-for-performance (P4P) in health care provision. Firstly, based on the literature review, we reflect on the state of the art in the P4P design, focusing on some of the controversial issues in the literature and discussing the potential contribution of DEA to addressing these issues. Secondly, we analyse the P4P programme applied to Portuguese Family Health Units (FHUs) to conclude about the possible use of DEA for its improvement.
- Performance assessment in primary health care: a systematic review of the literature and a new research agendaPublication . Kalinichenko, Olena; Amado, Carla; Santos, Sérgio Pereira dosThe aim of this research is to carry out a systematic review of the studies devoted to the performance assessment of primary health care providers. Focusing on the peculiarities of performance evaluation in the public sector, we examine performance measurement categories, dimensions and techniques in order to provide a holistic picture of the main developments and opportunities in the referred domain and to identify future research directions.
- Exploring the potential of Data Envelopment Analysis for enhancing pay-for-performance programme design in primary health carePublication . Kalinichenko, Olena; Amado, Carla; Santos, SérgioIn recent years, implementation of pay-for-performance (P4P) programmes in health care has become a worldwide initiative. However, most P4P programmes incorporate systems of Performance Indicators (PI) without accounting for trade-offs between indicators. This article has two objectives: (1) to develop a Data Envelopment Analysis (DEA) methodology for performance assessment of primary care providers; and (2) to propose an innovative methodology for P4P contracting based on the DEA assessment results. To achieve the first objective, we modify the standard DEA model to account for the necessary relations between the weights attributed to each PI and domain of performance and to account for the effect of the relevant environmental variables. To achieve the second objective, we combine relative and absolute performance assessments in the elaboration of several bases for reward, and then we link these assessments to a system of graduated rewards. A benchmarking programme is also proposed to contribute to the dissemination of best practices. This article contributes to the literature by proposing an enhanced methodology for performance assessment of primary care providers which can form the basis for P4P rewards planning. The applicability and advantages of the proposed methodology are illustrated with data from Portugal, but it can easily be adapted to different sets of PIs or domains, making it relevant for performance assessment and for P4P reward setting in other contexts and countries.
- Exploring performance assessment and incentive regulation in the context of primary health carePublication . Kalinichenko, Olena; Amado, Carla; Santos, Sérgio Pereira dosThis thesis consists of two research articles. The first article addresses two research questions: (1) what have been the main performance dimensions and measures used for primary care assessment? And (2) to what extent have key stakeholders been involved in primary care assessment? To answer these questions, we developed a conceptual framework that includes three stages of performance assessment (measurement, analysis, and action) and captures four performance dimensions (accessibility, equity, efficiency, and effectiveness). We applied this framework for a systematic review of the 166 empirical articles devoted to performance assessment of primary care providers. The results of the review show that a wide variety of performance measures has been used to assess primary care providers, and also that the four dimensions have mostly been explored separately. Furthermore, the results of the review reveal an insufficient involvement of stakeholders in the performance assessment process, indicating the potentially limited impact of the reviewed research on health care policy and practice. The second article aims two objectives: (1) to develop a DEA methodology for performance assessment of primary care providers in Portugal; and (2) to propose an alternative methodology for P4P contracting based on the DEA assessment results. To achieve the first objective, we modified the standard DEA model to account for the necessary relations between the weights attributed to each performance indicator and domain and to account for the effect of the relevant environmental variables. To achieve the second objective, we combined relative and absolute performance assessments in the elaboration of several bases for reward, and each of these two assessments is proposed to be linked to a system of graduated rewards. For underperforming units, we suggest establishing absolute targets derived from the relevant benchmarks, identified by DEA. We also recommend the creation of a benchmarking programme that will contribute to the dissemination of best practices among the providers.