Can more use of supporting primary care health practitioners increase efficiency of health clinics? Evidence from California's San Joaquin Valley.

This study examined 67 primary health care centers operating in the San Joaquin Valley, California, and explored the factors that may have contributed to productive efficiency gains. The study used the data envelopment analysis (DEA) technique to measure efficiency of the clinics and then used tobit regression analysis to understand the factors that affected efficiency. It was found that clinics that employed relatively more "unlicensed" supporting practitioners compared to "licensed" practitioners were more likely to be efficient. The results also showed that clinics that employed fewer physicians compared to all "licensed" practitioners were likely to be more efficient. In addition, providing transportation services to patients also enhanced clinics' efficiency.