Productivity and efficiency changes in primary care: a Malmquist index approach

The reforms of the National Health System in the UK introduced in 1990 led to substantial changes in the organisation of primary health care. In this paper we analyse the efficiency of primary care provision in the English Family Health Service Authorities (FHSAs) over the period 1990/91–1994/95. We use Data Envelopment Analysis to measure Malmquist indices of productivity changes, which are then decomposed into indices of pure technical efficiency change, scale efficiency change and technological change. The analysis indicates a small improvement in the productivity over the period considered. The increase is attributed to pure technical efficiency improvement and positive change in scale efficiency, while the technology does not show significant change. The analysis suggests that there is very limited scope for productivity gains in this sector.