Data Envelopment Analysis Beyond Hospitals: Efficiency Measurement in Primary Care, District Health Systems, and Long-Term Care
Keywords:
Technical efficiency, primary care, long-term care, district health system, decision-making unit, resource allocation, public-sector managementAbstract
Data envelopment analysis (DEA) is widely used to assess hospital efficiency, but its application in primary care, district health systems, and long-term care remains methodologically inconsistent. Objective: This review synthesized non-hospital DEA applications, focusing on decision-making units, input–output selection, quality measurement, model specification, and implications for public-sector resource allocation. Methods: Following PRISMA 2020 principles, several electronic databases were used. Eligible studies applied DEA to primary care, district/regional health systems, or long-term care and reported decision-making units, inputs, outputs, and model specifications. Results: Thirty studies generated 33 setting-specific observations. Mean technical efficiency was 0.593 in primary care, 0.608 in long-term care, and 0.458 in district/regional systems. Conclusion: Non-hospital health systems show substantial efficiency gains, but policy interpretation should be cautious due to limited comparability, volume-based outputs, and weak quality adjustment. This review offers methodological guidance for context-sensitive DEA benchmarking in resource-constrained public health systems.
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