Technical and cost efficiency of oral health care provision in Finnish health centres

• Published in: Social science & medicine (1982) 2003, Vol.56 (2), p.343-353
• Main Authors: Linna, Miika, Nordblad, Anne, Koivu, Matti
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Analysis. Health state; Biological and medical sciences; Child; Child, Preschool; Community Dentistry - economics; Community Dentistry - organization & administration; Community Dentistry - statistics & numerical data; Community Health Centers - economics; Community Health Centers - organization & administration; Cost analysis; Cost efficiency; Cost-effectiveness; Data analysis; Data envelopment analysis; Dentists; Efficiency; Efficiency, Organizational - economics; Efficiency, Organizational - statistics & numerical data; Epidemiology; Finance; Financing; Finland; General aspects; Health; Health care; Health Care Costs - statistics & numerical data; Health centres; Health economics; Health Services Research - methods; Humans; Infant; Local Government; Medical sciences; Medicine; Middle Aged; Models, Econometric; Office Visits - statistics & numerical data; Oral health; Oral health care; Oral health Financing Cost efficiency Data envelopment analysis Finland; Public health. Hygiene; Public health. Hygiene-occupational medicine; Social sciences; Statistics, Nonparametric
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/S0277-9536(02)00032-1

In this study we measured the productive efficiency of public dental health provision across Finland. The analysis was based on data envelopment analysis (DEA) using linear programming. In addition, we investigated various factors explaining the technical and cost efficiency of public dental care using a parametric Tobit model. These analyses revealed substantial variation in productive efficiency between health centres in different municipalities. The level of cost inefficiency was generally between 20% and 30%. Good dental health of the population, high rates of unemployment and high per capita expenditure on primary care in the municipality were associated with technical and cost inefficiency. According to the results, cost efficiency would not be improved by shifting input allocation towards more auxiliary manpower in health centres. Individual efficiency scores were clearly sensitive to the choice of output specification. Changing the unit of output measurement from visit- to patient-based measures affected markedly the ranking of dental health centres. However, the set of exogenous correlates associated to inefficiency was strikingly similar for both types of output specification. More resources are needed if the coverage of public dental care is extended to all age groups. The health centre specific efficiency scores obtained in this study can be used locally to evaluate, design and implement structural changes in the production processes.