How to achieve optimal organization of primary care service delivery at system level: lessons from Europe

Int J Qual Health Care. 2013 Sep;25(4):381-93. doi: 10.1093/intqhc/mzt020. Epub 2013 Feb 13.


Objective: To measure the relative efficiency of primary care (PC) in turning their structures into services delivery and turning their services delivery into quality outcomes.

Design: Cross-sectional study based on the dataset of the Primary Healthcare Activity Monitor for Europe project. Two Data Envelopment

Analysis: models were run to compare the relative technical efficiency. A sensitivity analysis of the resulting efficiency scores was performed.

Setting: PC systems in 22 European countries in 2009/2010.

Main outcome measures: Model 1 included data on PC governance, workforce development and economic conditions as inputs and access, coordination, continuity and comprehensiveness of care as outputs. Model 2 included the previous process dimensions as inputs and quality indicators as outputs.

Results: There is relatively reasonable efficiency in all countries at delivering as many as possible PC processes at a given level of PC structure. It is particularly important to invest in economic conditions to achieve an efficient structure-process balance. Only five countries have fully efficient PC systems in turning their services delivery into high quality outcomes, using a similar combination of access, continuity and comprehensiveness, although they differ on the adoption of coordination of services. There is a large variation in efficiency levels obtained by countries with inefficient PC in turning their services delivery into quality outcomes.

Conclusions: Maximizing the individual functions of PC without taking into account the coherence within the health-care system is not sufficient from a policymaker's point of view when aiming to achieve efficiency.

Keywords: benchmarking; health policy; health-care system; measurement of quality; primary care/general practice; quality indicators; setting of care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / administration & dosage
  • Asthma / epidemiology
  • Asthma / therapy
  • Continuity of Patient Care / organization & administration
  • Cross-Sectional Studies
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / therapy
  • Efficiency, Organizational*
  • Europe
  • Health Services Accessibility / organization & administration
  • Health Workforce
  • Humans
  • Primary Health Care / organization & administration*
  • Quality Indicators, Health Care
  • Quality of Health Care / organization & administration*
  • Socioeconomic Factors
  • Vaccination


  • Anti-Bacterial Agents