Primary care : Discussion
The development and refinement of techniques for assessing the efficiency based on the determination of the non-parametric frontiers AED has favored the implementation of the efficiency studies to areas such as the Primary Health Care, had been, until Just over five years, banned this kind of analysis.
Since the first application of the AED 198,915 in primary care to the present work have been mixed, especially Spaniards, who have valued the efficiency of care primaria11-14 ,16-20. Their review highlights the difficulties and restrictions that the area under study includes the analysis and attempts to overcome some of them. In this sense, the concern of some authors to improve the measurement of producto14 and incorporate the assessment of the productive factors influence externos13 or service quality prestado11, 12.14. None of the studies published so far has made a study of interregional efficiency of primary care as the Spanish that is presented in this work.
The precautions that have guided the selection of health centers under study allows the comparative analysis can be carried out, while ensuring that any discrepancies found in the (in) efficiency of the health centers selected only attributed to differences in management and organization of selected health centers and not to exogenous factors such as sociodemographic conditions, occupational or epidemiological faced in each of its business or differences in the supply of goods or with the objectives of the health centers.
The results obtained in the empirical analysis conducted no cross-evident, however, significant discrepancies in the (in) efficiency of the health centers in La Rioja, Alava and Navarre, so that at least in regard to the Primary Health Care, is not observed the expected differential behavior in terms of productive efficiency of the decentralized centers.
In this sense, a dynamic, even with the caution that this type of analysis requires, would compare the efficiency before and after decentralization and complement the results obtained. Results which, moreover, should be interpreted taking into account that the assessment of the efficiency of health facilities surveyed the conclusions can be drawn from it are conditioned by the selected variables, and these in turn, by the reality organizational products and inform the Spanish primary care.
It should be pointed out that while the problems associated with the specification of the transformation of the factors in product identification and measurement of the product or the difficulty to control users of primary care complicate the assessment and measurement efficiency, which has truly influenced the specification of the model analysis has been the availability of information required in all health centers in the sample. This has prevented the consideration of service quality as a dimension of the product and the necessary adjustment of consultations with the real need for assistance, depending on the complexity of each case, their diagnosis or personal or socioeconomic characteristics of the patient served.
It may be added in conclusion, the limitations that this study has added to the lack of a uniform information system and flexibility can not be attributed solely to the fact that schools are analyzed, assigned to various administrative agencies, because it is a problem that affects the entire health care system. For its solution is not just individual actions identified in the areas of health tested, we need a joint and ordered to take into account the current problems of lack of standardization and lack of information, and avoid that the sum of individual interests will translate into an uncontrolled explosion computing and information which impedes comparative research.