Using DEA to profile in-hospital surgeon services: A South African funder perspective

Master Thesis


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University of Cape Town

The comparative assessment of physician performance, also known as ‘physician profiling’ is frequently used by healthcare funders. It aims to identify and improve the resource efficiency and quality of physician care. South African private healthcare funders use a wide range of profiling techniques; however, currently the use of frontier analysis is absent. This study explores the use of the non - parametric frontier analysis technique called Data Envelopment Analysis (DEA) for the profiling of physicians in South Africa. This is investigated by following a DEA profiling approach to evaluate the performance of 403 general/ paediatric surgeons in providing in - hospital services in 2012. A 7 - input 1 - output VRS DEA model is used to determine the efficiency of the surgeons. The profiling results are then analysed to determine their usefulness. It results reveal that 58 surgeons are efficient, representing only 14.4% of surgeons profiled. Therefore, the DEA approach reveals a large potential for efficiency improvements. The average efficiency score of inefficient surgeons is found to be 0.68. This means that, on average, inefficient surgeons have to decrease resource utilisation by 32% to achieve efficiency. The DEA approach is also found to be proficient at identifying the physicians presenting the most severe levels of inefficiency. 37 surgeons are found to be significantly inefficient. The approach also allows for the identification of peers against which inefficient surgeons are able to directly compare their practices. These results are determined to be of significant potential use to South African private healthcare funders. It is, however, noted that the analysis and results obtained was solely of a statistical nature. Closer consideration of the clinical appropriateness of the results is essential. In any case, this study concludes that a DEA profiling approach can be considered a useful technique in the comparison of physician performance in South Africa.

Includes bibliographical references.