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A Systematic Review of Health Care Efficiency Measures

Authors

  • Peter S. Hussey,

    1. RAND, 1200 S. Hayes St., Arlington, VA 22202
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    • Address correspondence to Peter S. Hussey, Ph.D., RAND, 1200 S. Hayes St., Arlington, VA 22202; e-mail: hussey@rand.org. Han de Vries, M.S., is with RAND, Westbrook Centre, Cambridge, UK. John Romley, Ph.D., Margaret C. Wang, Ph.D., M.P.H., Susan S. Chen, B.A., and Elizabeth A. McGlynn, Ph.D., are with RAND, Santa Monica, CA. John Romley, Ph.D., is with Occidental College, Los Angeles, CA. Susan S. Chen, B.A., is with College of Agriculture and Natural Resources, Michigan State University, East Lansing, MI. Paul G. Shekelle, M.D., Ph.D., is with Southern California Evidence-based Practice Center—RAND, Santa Monica, CA, and Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA.

  • Han De Vries,

    1. RAND, Westbrook Centre, Cambridge, UK,
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  • John Romley,

    1. RAND, Santa Monica, CA,
    2. Occidental College, Los Angeles, CA,
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  • Margaret C. Wang,

    1. RAND, Santa Monica, CA,
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  • Susan S. Chen,

    1. RAND, Santa Monica, CA,
    2. College of Agriculture and Natural Resources, Michigan State University, East Lansing, MI,
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  • Paul G. Shekelle,

    1. Southern California Evidence-based Practice Center—RAND, Santa Monica, CA,
    2. Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA
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  • Elizabeth A. McGlynn

    1. RAND, Santa Monica, CA,
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Abstract

Objective. To review and characterize existing health care efficiency measures in order to facilitate a common understanding about the adequacy of these methods.

Data Sources. Review of the MedLine and EconLit databases for articles published from 1990 to 2008, as well as search of the “gray” literature for additional measures developed by private organizations.

Study Design. We performed a systematic review for existing efficiency measures. We classified the efficiency measures by perspective, outputs, inputs, methods used, and reporting of scientific soundness.

Principal Findings. We identified 265 measures in the peer-reviewed literature and eight measures in the gray literature, with little overlap between the two sets of measures. Almost all of the measures did not explicitly consider the quality of care. Thus, if quality varies substantially across groups, which is likely in some cases, the measures reflect only the costs of care, not efficiency. Evidence on the measures' scientific soundness was mostly lacking: evidence on reliability or validity was reported for six measures (2.3 percent) and sensitivity analyses were reported for 67 measures (25.3 percent).

Conclusions. Efficiency measures have been subjected to few rigorous evaluations of reliability and validity, and methods of accounting for quality of care in efficiency measurement are not well developed at this time. Use of these measures without greater understanding of these issues is likely to engender resistance from providers and could lead to unintended consequences.

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