Balancing efficiency of health services and equity of access in remote areas in Greece

Data envelopment analysis (DEA) was used to investigate the efficiency of a set of small-scaled Greek hospitals known as hospital-health centers (HHCs). These facilities naturally provide primary and secondary care but are also expected to function as health centers addressing mostly preventive medicine, hygiene and other public health issues. They are located in remote rural areas and serve the relatively small local populations. This study aimed to obtain insight on their productive efficiency in light of their particular role. The sample consisted of 17 from the 18 units existing in the Greek NHS. Variables chosen to characterize production were numbers of doctors, nurses and beds as inputs, and admissions, outpatient visits and preventive medical services as outputs. The DEA model was input oriented, allowed for constant returns to scale and units were ranked according to a benchmarking approach. Analyses were performed with and without the preventive medicine variable and the results demonstrated technical inefficiencies 26.77 and 25.13%, respectively. Location appeared to affect performance, with remote units, e.g. on small islands, more inefficient. This raises the question if correcting reduced efficiency compromises equity of service access for highly dependent populations. Moreover, we observed superior performance of units additionally offering preventive medical services. This generates another question as to the role these facilities should play in our currently changing health care system.