Abstract It is well-known that health-care systems all over the world try to improve efficiency and effectiveness due to high pressure to pursue rational performance. Many of the health-care reforms in different countries are conducted with the objectives to rationalise costs, to make health services more available, and to increase, or at least not to reduce, the quality of health services. Adequate efficient metrics used in assessing health-care services are critical for the quality of decision-making. The subject of this research is efficiency measurement in the institutes of public health in Croatia oriented to preventive activities, i.e. monitoring, analysis, and evaluation of the health of the population. Diversity of the programmes and temporal variability are the characteristics of public health services, and it is therefore harder to measure the effects in the long run. This research aims to analyse and propose a new approach to the measurement system using two methods: the Data Envelopment Analysis (DEA) and the Balanced Score Card (BSC), combined into the DEABSC integrative model, which can be an efficient method for the decision-making process. The starting point of this research is the analysis of the measurement system in public-health services in Croatia. The results confirm a weak and inadequate efficiency measurement system and very low effectiveness measurement. To enhance the efficiency measurement, we have developed the conceptual integrative DEABSC model which has been tested at the Teaching Institute of Public Health – the Department of Health Ecology. Using DEA for 2017, we have identified relatively efficient units that helped establish future goals set in the BSC strategic map. The combination of DEA and BSC allows identifying options for improving the effectiveness of public-health service programmes. The study confirms that it is possible to determine the relative efficiency of different DMUs within the Department of Health Ecology and use best practice for each perspective in the BSC Cause & Effect conceptual model. This paper also provides recommendations for an easier establishment of performance measurement in order to achieve the mission of public health institutions, but also indicates some limitations in the application of the methods.

中文翻译：

---

在公共卫生服务中使用DEA和BSC方法进行有效性评估

摘要众所周知，由于追求合理绩效的巨大压力，全世界的医疗保健系统都在试图提高效率和有效性。进行了许多不同国家的医疗改革，目标是合理化成本，使医疗服务更容易获得以及提高或至少不降低医疗服务的质量。用于评估保健服务的足够有效指标对于决策质量至关重要。这项研究的主题是克罗地亚公共卫生机构中针对预防活动的效率测量，即监视，分析和评估人口健康。方案的多样性和时间的变异性是公共卫生服务的特征，因此，从长远来看，很难衡量其影响。这项研究旨在使用两种方法分析和提出一种新的测量系统方法：数据包络分析（DEA）和平衡计分卡（BSC），并结合到DEABSC集成模型中，这可以作为一种有效的决策方法制作过程。这项研究的起点是对克罗地亚公共卫生服务中的测量系统进行分析。结果证实了效率测量系统的薄弱和不足以及效率测量的非常低。为了提高效率衡量，我们开发了概念性的DEABSC集成模型，该模型已在公共卫生教学学院-卫生生态学系中进行了测试。使用2017年的DEA，我们已经找到了相对有效的部门，这些部门帮助建立了BSC战略地图中设定的未来目标。DEA和BSC的结合可以确定提高公共卫生服务计划有效性的选项。该研究证实，有可能确定健康生态部内不同DMU的相对效率，并在BSC因果概念模型中针对每个角度使用最佳实践。本文还提供了一些建议，以便更轻松地建立绩效衡量标准，以实现公共卫生机构的使命，同时也指出了该方法在应用中的一些局限性。DEA和BSC的结合可以确定提高公共卫生服务计划有效性的选项。该研究证实，有可能确定健康生态部内不同DMU的相对效率，并在BSC因果概念模型中针对每个角度使用最佳实践。本文还提供了一些建议，以便更轻松地建立绩效衡量标准，以实现公共卫生机构的使命，同时也指出了该方法在应用中的一些局限性。DEA和BSC的结合可以确定提高公共卫生服务计划有效性的选项。该研究证实，有可能确定健康生态部内不同DMU的相对效率，并在BSC因果概念模型中针对每个角度使用最佳实践。本文还提供了一些建议，以便更轻松地建立绩效衡量标准，以实现公共卫生机构的使命，同时也指出了该方法在应用中的一些局限性。