[Efficiency in primary health care: a critical review of frontier measures]

The object of this paper is to review applied research on primary care efficiency in Spain performed using parametric and nonparametric production and cost frontiers. A review of the most important bibliographic databases showed 12 applied papers that used frontier approach to measure primary care efficiency in Spain. The most part of these papers only used Data Envelopment Approach to measure technical efficiency scores. There is only one study that has employed a stochastic and nonparametric approach to obtain cost efficiency estimates. Activity measures such as number of visits are a usual measure of output and inefficiency sources are rarely analysed in this literature. Important methodological problems observed in this literature severely limit their practical utility. Future research should consider more accurate output measures, use available methods more appropriately, and shed light on the sources of inefficiency.