Total Productivity Change of Health Centers in Greece in 2016-2018: A Malmquist Index Data Envelopment Analysis Application for the Primary Health System of Greece.

BACKGROUND This paper attempts to evaluate the primary health care system by evaluating health centres in Greece. METHODS Malmquist Index Data Envelopment Analysis is applied to study the total productivity of 155 health centres in Greece during 2016-2018. The data were collected from the Ministry of Health and submitted to quality tests to ensure validity and avoid bias. RESULTS This paper measures the productivity of each of the 155 health centres in Greece and how it shifted during 2016-2018. In addition, the overall productivity change of the 155 health centres over time is calculated and analysed as being due to technical efficiency or technological efficiency. The analysis of the mean values showed a decrease of 0.9% in the overall productivity factor from 2016 to 2017 and a decrease of 5.2% from 2017 to 2018. The overall decrease in the productivity of the 155 health centres was 3.1%. From 2016 to 2018, 59 health centres changed their productivity mainly due to technological change and 91 changed mainly due to technical efficiency change. One health centre showed regression to its total productivity due to equal regression of its technical efficiency and technology. CONCLUSIONS The method used is nonparametric data envelopment analysis along with the Malmquist index to include panel data in the analysis. Meaningful results were extracted by indicating the number of health centres that improved their productivity, regressed in productivity, or remained constant through the period 2016-2018. This paper may contribute to improving health centres' efficiency and productivity. Furthermore, valuable results can be extracted for the National Health Care System to match available resources that correspond to each health centre's needs, as well as for manager planners and stakeholders in primary health care.