Três ensaios sobre o desempenho do setor hospitalar do Sistema Único de Saúde do Brasil

Abstract

The first essay aimed to characterize the organization of the Brazilian general hospitals that provide service to the Unified Health System (SUS) through indicators that describe the main dimensions of hospital care. It consists in an observational cross-sectional study for the year 2015 comprising the universe of general hospitals that attend SUS. We estimated indicators from two national administrative databases: National Registry of Health Facilities and Hospital Information System of SUS. The indicators include the main dimensions associated with hospital care organization: public-private mix, production, case-mix, production factors, performance, quality, and geographical coverage. The latent class analysis of the indicators with bootstrapping implementation allowed the identification of vocational profiles associated to hospital size, healthcare provider and teaching hospitals. The second essay combined Data Envelopment Analysis (DEA), and Spatial Analysis to measure hospital inefficiency, to identify predominant clusters, and to analyze its spatial pattern throughout the country. Our findings pointed to a high level of hospital inefficiency, mostly associated with small size and distributed across all Brazilian states. Many of these hospitals could increase production and reduce inputs to achieve higher efficiency standards. These findings suggested room for hospital resources optimization. The third essay aims to examine alternatives for hospital resources optimization and to propose the closure of the most inefficient hospitals whose patients do not have to travel more than 70 km. In most of the cases analyzed (84%), a more efficient hospital is located less than 70 km away. The study indicated that in most of the cases the optimization of hospital resources can be achieved without compromising the principle of equity.