Public Expenditures and Productivity in Medium and High-Complexity Health Services in the Brazilian States
DOI:
https://doi.org/10.17524/repec.v12i4.1847Keywords:
Public Expenditures, Public Health, Efficiency, ProductivityAbstract
Objective: Verify to what extent the volume of public expenditures in health has influence the efficiency and productivity gains of medium and high-complexity services in the Brazilian States.
Method: Based on Data Envelopment Analysis (DEA) and Malmquist’s Productivity Index, a theoretical-empirical study was developed with a quantitative approach, using the Brazilian states that disclosed information in Datasus between 2008 and 2015 as analysis units.
Results: The main findings evidenced that the states with the mean highest resource volume could not be considered the most efficient, indicating that there may exist a negative relationship between the growth of public expenditures and the efficiency in the services offered. In addition, in the states that increased their spending in health between 2009 and 2015, the productivity was not directly proportional to the resource volume used.
Contributions: The research offers empirical elements that evidence the need to seek better outcomes for the health system, in the context of medium and high-complexity care, based on the efficiency and productivity gains offered, in principle without liberating new resources for the sector.
References
Aday, L., Begley, C., Lairson, D., & Slater, C. (2004). Evaluating the healthcare system: effectiveness, efficiency, and equity (3rd ed.). Washington: Health Administration Press.
Albuquerque, M. V. de, Viana, A. L. d’Ávila, Lima, L. D. de, Ferreira, M. P., Fusaro, E. R. & Iozzi, F. L. (2017). Desigualdades regionais na saúde: mudanças observadas no Brasil de 2000 a 2016. Ciência & Saúde Coletiva, 22(4), 1055–1064. doi: 10.1590/1413-81232017224.26862016
Allin, S., Grignon, M. & Wang, L. (2016). The determinants of efficiency in the Canadian health care system. Health Economics, Policy and Law, 11(01), 39–65. doi: 10.1017/S1744133115000274
Banker, R. D., Charnes, A. & Cooper, W. W. (1984). Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis. Management Science, 30(9), 1078–1092. doi: 10.1287/mnsc.30.9.1078
Beauvais, B. & Wells, R. (2006). Does Money Really Matter? A Review of the Literature on the Relationships between Healthcare Organization Finances and Quality. Hospital Topics, 84(2), 20–29. doi: 10.3200/HTPS.84.2.20-29
Bogetoft, P. & Otto, L. (2011). Benchmarking with DEA, SFA, and R (1st ed., Vol. 157). New York, NY: Springer New York. doi: 10.1007/978-1-4419-7961-2
Bokhari, F. A. S., Gai, Y. & Gottret, P. (2007). Government health expenditures and health outcomes. Health Economics, 16(3), 257–273. doi: 10.1002/hec.1157
Brasil. (1988). Constituição da República Federativa do Brasil, de 05 de outubro de 1988. Brasília - DF: Diário Oficial da República Federativa do Brasil.
Brasil. (1990). Lei no 8080/1990. Dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento dos serviços correspondentes e dá outras providências. Brasília - DF: Diário Oficial da União.
Brasil. (2007). Portaria N° 204 /GM de 29 de janeiro de 2007. Regulamenta o financiamento e a transferência dos recursos federais para as ações e os serviços de saúde, na forma de blocos de financiamento, com o respectivo monitoramento e controle. Ministério da Saúde. Brasilia: Ministério da Saúde.
Brasil. (2013). Caderno de Diretrizes, Objetivos, Metas e Indicadores : 2013 – 2015. Brasília: Ministério da Saúde, Secretaria de Gestão Estratégica e Participativa.
Caves, D. W., Christensen, L. R. & Diewert, W. E. (1982). The Economic Theory of Index Numbers and the Measurement of Input, Output, and Productivity. Econometrica, 50(6), 1393. doi: 10.2307/1913388
Charnes, A., Cooper, W. W. & Rhodes, E. (1978). Measuring the efficiency of decision making units. European Journal of Operational Research, 2(6), 429–444. doi: 10.1016/0377-2217(78)90138-8
Charnes, A., Cooper, W. W. & Rhodes, E. (1981). Evaluating Program and Managerial Efficiency: An Application of Data Envelopment Analysis to Program Follow Through. Management Science, 27(6), 668–697. doi: 10.1287/mnsc.27.6.668
Coelli, T., Rao, D. S. P., O’Donnel, C. J. & Battese, G. E. (2005). An Introduction to Efficiency and Productivity Analysis (2nd ed.). Boston, MA: Springer US. doi: 10.1007/b136381
Cooper, W. W., Seiford, L. M. & Zhu, J. (2011). Data Envelopment Analysis: History, Models, and Interpretations. In W. W. Cooper, L. M. Seiford, & J. Zhu (Eds.), Handbook on Data Envelopment Analysis (2nd ed., Vol. 108, pp. 29–66). New York: Springer US. doi: 10.1007/978-1-4419-6151-8_1
Donabedian, A. (1988). The quality of care. How can it be assessed? JAMA : The Journal of the American Medical Association, 260(12), 1743–1748. doi: 10.1001/jama.260.12.1743
Donabedian, A. (2003). An introduction to quality assurance in health care. New York: Oxford University Press.
Evans, D. B., Tandon, A., Murray, C. J. L. & Lauer, J. A. (2000). The comparative efficiency of national health systems in producing health : an analysis of 191 countries. Global Programme on Evidence for Health Discussion Paper Series: No. 29. World Health Organization.
Färe, R., Grosskopf, S., Lindgren, B. & Poullier, J. P. (1997). Productivity growth in health-care delivery. Medical Care, 35(4), 354–66.
Fare, R., Grosskopf, S., Lindgren, B. & Roos, P. (1994). Productivity developments in swedish hospitals: a Malmquist output index approach. In A. Charnes, W. W. Coope, A. Y. Lewin, & L. M. Seiford (Eds.), Data Envelopment Analysis: Theory, Methodology, and Application (1st ed.). New York: Kluwer Academic Publishers.
Färe, R., Grosskopf, S., Norris, M. & Zhang, Z. (1994). Productivity Growth, Technical Progress, and Efficiency Change in Industrialized Countries. The American Economic Review, 84(1), 66–83. doi: 2117971
Farrell, M. J. (1957). The Measurement of Productive Efficiency. Journal of the Royal Statistical Society. Series A (General), 120(3), 253–290. doi: 10.1016/S0377-2217(01)00022-4
Ferrari, A. (2006). Market oriented reforms of health services: A non-parametric analysis. The Service Industries Journal, 26(1), 1–13. doi: 10.1080/02642060500358720
Filmer, D., & Pritchett, L. (1999). The impact of public spending on health: does money matter? Social Science & Medicine, 49(10), 1309–1323. doi: 10.1016/S0277-9536(99)00150-1
Giuffrida, A. (1999). Productivity and efficiency changes in primary care: a Malmquist index approach. Health Care Management Science, 2(1), 11–26. doi: 10.1023/A:1019067223945
Gupta, S., Davoodi, H. R. & Tiongson, E. (2001). Corruption and the provision of health care and education services. In A. K.Jain (Ed.), The Political Economy of Corruption (pp. 124–154). Routledge. doi: 10.1093/brain/aww118
Gupta, S., Verhoeven, M. & Tiongson, E. R. (2003). Public spending on health care and the poor. Health Economics, 12(8), 685–696. doi: 10.1002/hec.759
Hollingsworth, B. (2003). Non-Parametric and Parametric Applications Measuring Efficiency in Health Care. Health Care Management Science, 6(4), 203–218. doi: 10.1023/A:1026255523228
Hollingsworth, B. & Peacock, S. (2008). Efficiency Measurement in Health and Health Care. Efficiency Measurement in Health and Health Care. Routledge. doi: 10.4324/9780203486566
Junior, A. P. & Mendes, A. N. (2015). O Fundo Nacional de Saúde e a Prioridade da Média e Alta Complexidade. Argumentum, 7(2), 161–177. doi: 10.18315/argumentum.v7i2.10510
Koerich, C., Drago, L. C., Melo, T. A. P., Andrade, S. R. & Erdmann, A. L. (2016). Financiamento em Saúde: analise da produção científica no período 2007-2013. Revista Baiana de Enfermagem, 30(3), 1–15. doi: 10.18471/rbe.v30i3.16429
Löthgren, M. & Tambour, M. (1999). Productivity and customer satisfaction in Swedish pharmacies: A DEA network model. European Journal of Operational Research, 115(3), 449–458. doi: 10.1016/S0377-2217(98)00177-5
Lyroudi, K., Glaveli, N., Koulakiotis, A. & Angelidis, D. (2006). The productive performance of public hospital clinics in Greece: a case study. Health Services Management Research, 19(2), 67–72. doi: 10.1258/095148406776829059
Makuta, I. & O’Hare, B. (2015). Quality of governance, public spending on health and health status in Sub Saharan Africa: a panel data regression analysis. BMC Public Health, 15(1), 932. doi: 10.1186/s12889-015-2287-z
Malmquist, S. (1953). Index numbers and indifference surfaces. Trabajos de Estadistica, 4(2), 209–242. doi: 10.1007/BF03006863
Marinho, A. (2003). Avaliação da eficiência técnica nos serviços de saúde nos municípios do Estado do Rio de Janeiro. Revista Brasileira de Economia, 57(3), 515–534. doi: 10.1590/S0034-71402003000300002
Marinho, A. & Façanha, L. O. (2001). Hospitais universitários: Avaliação Comparativa de eficiência técnica. IPEA, Instituto de Pesquisa Economica Aplicada.
Marques, R. M. & Mendes, Á. (2012). A problemática do financiamento da saúde pública brasileira: de 1985 a 2008. Economia e Sociedade, 21(2), 345–362. doi: 10.1590/S0104-06182012000200005
Martins, E., Diniz, J.A. & Miranda, G. J. (2012). Análise avançada das demonstrações contábeis: uma abordagem crítica. São Paulo: Atlas.
Novignon, J., Olakojo, S. A. & Nonvignon, J. (2012). The effects of public and private health care expenditure on health status in sub-Saharan Africa: new evidence from panel data analysis. Health Economics Review, 2(1), 22. doi: 10.1186/2191-1991-2-22
Piola, S. F. & Vianna, S. M. (2002). Economia da Saúde: Conceito e contribuição para a gestão da saúde. Ipea, 294.
Queiroz, M. de F. M. de, Silva, J. L. M. da, Figueiredo, J. de S. & Vale, F. F. R. do. (2013). Eficiência no Gasto Público com Saúde : Uma análise nos Municípios do Rio Grande do Norte. Revista Econômica Do Noredeste, 44(3), 761–776.
Ribeiro, M. B. (2008). Desempenho e eficiência do gasto público: uma análise comparativa entre o Brasil e um conjunto de países da América Latina (Texto para Discussão N° 1368). IPEA. Rio de Janeiro.
Santos, N. R. Dos. (2007). Desenvolvimento do SUS, rumos estratégicos e estratégias para visualização dos rumos. Ciência & Saúde Coletiva, 12(2), 429–435. doi: 10.1590/S1413-81232007000200019
Santos, & Gerschman, S. (2004). As segmentações da oferta de serviços de saúde no Brasil: arranjos institucionais, credores, pagadores e provedores. Ciênc.Saúde Coletiva, 9(3), 795–806. doi: 10.1590/S1413-81232004000300030
Seiford, L. M. & Thrall, R. M. (1990). Recent developments in DEA. Journal of Econometrics, 46(1–2), 7–38. doi: 10.1016/0304-4076(90)90045-U
Silva, M. Z. da, Moretti, B. R. & Schuster, H. A. (2016). Avaliação da Eficiência Hospitalar por Meio da Análise Envoltória de Dados. Revista de Gestão Em Sistemas de Saúde, 5(2), 100–114. doi: 10.5585/rgss.v5i2.248
Sola, M. & Prior, D. (2001). Measuring Productivity and Quality Changes Using Data Envelopment Analysis: An Application to Catalan Hospitals. Financial Accountability and Management, 17(3), 219–245. doi: 10.1111/1468-0408.00129
Souza, F. J. V. de & Barros, C. da C. (2013). Eficiência na alocação ae recursos públicos destinados a hssistência Hospitalar os estados brasileiros. Revista de Gestão, Finanças e Contabilidade, 3(1), 71–89.
Souza, P. C. de, Scatena, J. H. G. & Kehrig, R. T. (2016). Aplicação da Análise Envoltória de Dados para avaliar a eficiência de hospitais do SUS em Mato Grosso. Physis: Revista de Saúde Coletiva, 26(1), 289–308. doi: 10.1590/S0103-73312016000100016
Spedo, S. M., Pinto, N. R. D. S. & Tanaka, O. Y. (2010). O difícil acesso a serviços de média complexidade do SUS: o caso da cidade de São Paulo, Brasil. Physis: Revista de Saúde Coletiva, 20(3), 953–972. doi: 10.1590/S0103-73312010000300014
Varela, P. S., Martins, G. de A. & Fávero, L. P. L. (2012). Desempenho dos municípios paulistas: uma avaliação de eficiência da atenção básica à saúde. Revista de Administração, 47(4), 624–637. doi: 10.5700/rausp1063
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