Performance evaluation in home and community care.

Our research objective was to estimate the technical efficiency of regions in Ontario, Canada delivering home care relative to the 'best performance' frontier. Data Envelopment Analysis (DEA), an efficiency frontier technique, measured the technical efficiency of each geographically-defined Community Care Access Centre (CCAC) controlling for case-mix and service quality. Differences in case-mix and service quality did not fully explain the variation in efficiency scores across CCACs. Most CCACs in our sample were scale inefficient (i.e., not operating at an optimal size). The inability of home care providers to select patients or to adjust the service area is a potential explanation for the observed patterns in inefficiency. Efficiency analysis appears to represent an additional tool for use in assessing the performance of providers in the home and community care sector.