A Systematic Review of Health Care Efficiency Measures

Peter Hussey, RAND
Han de Vries, RAND
John A. Romley, RAND and Occidental College
Margaret Wang, University of California San Francisco and RAND
Susan Chen
Paul Shekelle, RAND
Elizabeth McGlynn, RAND

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 1990-2008, 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 8 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, unless quality is assumed to be equivalent across groups, the measures may reflect the costs of care only, not efficiency. Evidence on the measures’ scientific soundness was mostly lacking: evidence on reliability or validity was reported for 6 measures (2.3%) and sensitivity analyses were reported for 67 measures (25.3%).

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.