benchmarking, community, health, centers, efficiency, multivariate, analysis


Community Health Centers (CHCs), designed to provide accessible and affordable health care services to low-income families, were first funded by the Federal Government as part of the War on Poverty in the mid-1960s. Improving healthcare organizational performance efficiency is paramount. It is an especially pressing need for CHCs' because they carry a disproportionate burden of caring for the uninsured within limited budgets. Prior studies suffer from conceptual and methodological limitations. A longitudinal multivariate analysis of factors influencing the performance of CHCs is needed. The purpose of this study is to benchmark CHC performance in terms of technical and cost efficiency, and examine factors that affect its variation. A theoretically grounded non-experimental study design is used, with five waves of panel data from 493 CHCs for the years 2000 through 2004. This study found that data mining and predictor tree analysis of factors influencing the variation in CHCs' technical and cost efficiency yielded inconsistent results. A declining trend in technical efficiency scores over the five-year study period was observed. Based on growth curve modeling, the three factors that influenced technical efficiency at the initial period of the study are: the percentages of Medicare, Medicaid, and Hispanic population being served by the CHCs. The five factors that positively influenced the variation in cost efficiency at the initial period were: the initial score of technical efficiency, the percentage of Hispanic patient population, staffing mix (ratio of providers to total staff), pay mix (ratio of federal grant dollars to total revenue), and percentage of Medicare-eligible. The initial cost-efficiency score and the initial technical efficiency score are negatively associated with the growth trend of technical efficiency. The initial level of technical efficiency is not statistically significantly associated with the growth trend of cost efficiency. The two factors influencing the growth trend of cost efficiency are the growth trend of technical efficiency (with a positive influence) and the initial level of cost efficiency (with a negative influence). Analysis of the effects of contextual and organizational-structural variables on the technical efficiency and cost efficiency of community health centers found that the explanatory power of the predictors is much greater for cost efficiency than for technical efficiency. The study lends support to contingency theory and confirms the independent and additive influences of contextual and organizational predictors on efficiency. Irrespective of the efficiency measures, contextual factors have much more influence on CHCs' efficiency than design (organizational structural) factors do. The three study hypotheses supported by multivariate analysis are: technical efficiency is associated with contextual factors and organizational factors; cost efficiency is associated with contextual factors and organizational factors; and technical efficiency positively affects cost efficiency.


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Graduation Date





Wan, Thomas


Doctor of Philosophy (Ph.D.)


College of Health and Public Affairs


Public Administration

Degree Program

Public Affairs








Length of Campus-only Access


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Doctoral Dissertation (Open Access)