Análise da eficiência de hospitais universitários sob a gestão da empresa brasileira de serviços hospitalares (EBSERH).

Abstract

The present study evaluated the efficiency of 31 General University Hospitals in Brazil under the administration of the Brazilian Company of Hospital Services (EBSERH) and aimed to determine, based on operational ratios of hospital performance, the factors that most influenced the efficiency of these organizations in the year of 2016. The research is characterized as an exploratory and quantitative study and utilized the non-parametric tool Data Envelopment Analysis (DEA) - model with Variable Returns of Scale (VRS) and with orientation to Maximization of the Outputs. The DEA-VRS approach was used for its analysis capacity to evaluate Decision Making Units with distinct size and production, which is, updated with variable returns of scale. Based on studies about hospitals performance was identified from the studies 62 operational ratios, which after a selection process, resulted in 7 (seven) final indicators, of which 4 (four) had characteristics of Inputs and 3 (three) had Output characteristics. Input indicators used were 1. Number of Beds (including beds of surgical, clinical and complementary types and excluding special beds). 2. Average Length of Stay (ALOS), in Days. 3. Full-Time equivalent in relation to bed occupancy (FTE/LO which represents the number of employees in relation to the number of bed occupied). And, 4. An index that evaluates the complexity of hospitals, given by the ratio between Hospital Revenue and Total Revenue (sum of Hospital Revenue plus Ambulatory Revenue). Given that hospital procedures are more complex than outpatient clinics procedures, those units with the highest proportion of Hospital Revenue in relation to Total Revenue presented higher Complexity Indices. The Output indicators were Total Revenue Received, Mortality Rate and Number of Procedures Performed. The results indicated 17 efficient sample units from 31 hospitals analyzed. Efficient hospitals presented in comparison with inefficient ones, on average, higher numbers of beds, lower FTE/LO and lower ALOS, greater complexity, greater number of procedures and revenues, and a Mortality Rate slightly above the average of the inefficient hospitals, which is weighted by the greater complexity of the frame. It was also denoted in the study that efficiency is positively correlated to the size of the hospital, thus, large hospitals were more efficient for the study in question. An inverse correlation between efficiency and the Average Length of Stay was also identified, indicating that higher ALOS resulted in lower efficiencies. In addition, the research indicated the main factors responsible by the efficiency of hospitals managed by EBSERH: FTE/LO, Average Length of Stay (ALOS), Complexity Index (CI), and Mortality Rate.