Efficiency Analysis of Public Health Spending in Brazilian Capitals Using Network Data Envelopment Analysis (DEA)
DOI:
https://doi.org/10.29015/cerem.538Keywords:
Network DEA, Efficiency Measurement, Health and Economic Development, Public HealthAbstract
Aim:
In 1988, Brazil implemented profound changes in the organization and financing of its public health system, with the creation of the Unified Health System (Sistema Unico de Saúde – SUS), establishing universal health coverage. The gradual expansion of the health system and entitlements to services has been accompanied by the debate about the appropriate level of government spending and health system efficiency.
Design / Research methods:
The study uses VRS - output oriented, Dynamic Network SBM DEA model, period 2008-2013, to depict the relationships that take place between diverse levels of care (primary health care/PHC and secondary-tertiary health care/STC). DMUs are Brazilian state capitals, which implement key health policies and assist patients from smaller surrounding municipalities, especially for STC. Inputs are PHC and STC budgets; outputs are their respective services provided and avoidable deaths. The link variable is PHC medical consultation, entrance door to the system and gatekeeper for more complex levels of care. Dynamic model evaluates efficiency across time.
Conclusions / findings:
Overall performance was 0.86; for PHC, 0.90; for STC, 0.85 (SD=0.15). 8 out of 27 capitals were fully efficient. Capitals increased average scores in both levels of care, but only STC had a positive technological change (frontier shift >1). Link variable behavior denotes a bottleneck between levels of care. Projections onto the frontier enable establish own management diagnosis and goals for financing and development.
Originality / value of the article:
Network models mimic hierarchically organized health systems. The appliance of results aids health policy.
References
Afonso A.S.T., Aubyn M. (2005), Non-parametric approaches to education and health expenditure efficiency in OECD countries, “Journal of applied economics”, 8(2): pp. 227-246.
(http://www.ucema.edu.ar/publicaciones/download/volume8/afonso.pdf)
Alexander M. (2008), Complex Decision Making using Non-Parametric Data Envelopment Analysis, in: Complex Decision Making: Theory and Practice, ed. Qudrat-Ullah H., Spector J.M., Davidsen P.I., Springer, pp: 97-112.
Castro Lobo, M.S., Estellita Lins, M. P.E., Menegolla, I. A. (2014), A new approach to assess the performance of the Brazilian National Immunization Program (NIP), “Socio-Economic Planning Sciences”, 48(1): pp. 49-56.
Cesconetto, A., Lapa J.D.S., Calvo, M.C.M. (2008), Evaluation of productive efficiency in the Unified National Health System hospitals in the State of Santa Catarina, Brazil, “Cadernos de Saude Publica”, 24(10): pp. 2407-2417.
Cooper W.W., Seiford LM., Tone K. (2007), Data envelopment analysis: a comprehensive text with models, applications, references and DEA-Solver Software, 2. ed., New York: Springer.
Costa J. (2012), Systems Pathology: a critical review. “Molecular Oncology”, 6: pp. 27-32.
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5528387/)
Costa, C. K. F., Balbinotto Neto, G., Sampaio, L.M.B. (2014), Efficiency of Brazilian states and the federal district in the public kidney transplant system based on DEA and the Malmquist index, “Cadernos de saúde pública”, 30(8): pp. 1667 -1679.
DATASUS - Ministry of Health / Brazil Morbidity Indicators Data System. http://www2.datasus.gov.br/DATASUS/index.php?area= (assessed in Aug 28, 2017)
de Souza P.C., Scatena J.H.G., Kehrig R.T. (2016), Data Envelopment Analysis application to evaluate the efficiency of SUS’s hospitals in the state of Mato Grosso, Brazil, “Physis”, 26(1): pp. 289-308.
Emrouznejad A, Amin G.R. (2009), DEA models for ratio data: Convexity consideration, “Applied Mathematical Modelling”, 33(1): pp. 486–498
Emrouznejad, A., De Witte K. (2010), "COOPER-framework: A unified process for non-parametric projects, "European Journal of Operational Research”, 207(3): pp. 1573-1586.
Emrouznejad A., Yang G. (2018), A survey and analysis of the first 40 years of scholarly literature in DEA: 1978-2016, “Socio-Economic Planning Sciences”, 61 (1): pp. 1-5.
(http://www.sciencedirect.com/science/article/pii/S0038012117300174?via%3Dihub)
Fàre, R., Grosskopf, S. (2000), Network DEA. “Socio-Economic Planning Sciences”, 34: pp. 35-49.
Ferreira, M.P., Pitta, M.T. (2008), Evaluation of the technical efficiency of the outpatient services of SUS in São Paulo, “São Paulo em Perspectiva”, 22(08): pp. 55–71.
Gonçalves, A.C., Noronha C.P., Lins M.P.E., Almeida R.M.V.R. (2007), Data envelopment analysis for evaluating public hospitals in Brazilian state capitals, “Revista de Saude Publica”, 41(3): pp. 427-435.
Gragnolati, M., Lindelow M., Couttolenc, B. (2013), 20 years of Health System Reform in Brazil: An Assessment of the Sistema Único de Saúde, The World Bank, Washington, D. C.
Guerra, M., de Souza A.A., Moreira D.R. (2012), Performance analysis: A study using data envelopment analysis in 26 Brazilian Hospitals. “Journal of Health Care Finance”, 38(4): pp. 19-35.
Hollingsworth B. (2008), The measurement of efficiency and productivity of health care delivery, “Health Economics”, 17: pp. 1107–1128. (https://www.ncbi.nlm.nih.gov/pubmed/18702091)
Lobo, M.S.C., Lins, M.P.E. (2010), Epistemic dialog between health services and operations research, “Pesquisa Operacional”, 30(2): pp. 371-386. (http://www.scielo.br/pdf/pope/v30n2/07.pdf)
Lobo, M.S.C., Lins, M.P.E., Silva, A.C.M., & Fiszman, R. (2010), Assessment of teaching-health care integration and performance in university hospitals, “Revista de Saúde Pública”, 44(08): pp. 581 – 590. (http://www.scielo.br/pdf/rsp/v44n4/en_01.pdf)
Lobo M.S.C, Rodrigues H.C, Gazzola E. C. A., de Azeredo J. A, Lins M.P.E. (2016) Dynamic network data envelopment analysis for university hospitals evaluation, “Revista de Saúde Pública”, 50(22): pp. 1-11.
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902099/)
Malta D.C., Sardinha L.M.V., Moura L., Lansky S., et al. (2010), Atualização da lista de causas de mortes evitáveis por intervenções do Sistema Único de Saúde, (Update of avoidable causes of deaths due to interventions at the Brazilian Health System), “Epidemiologia e Serviços de Saúde”, 19(2): pp. 173-176.
Malta, D.C., Santos, M.A.S., Stopa, S.R., Vieira, J.E.B., Melo, E.A., Reis, A.A.C. (2016), A Cobertura da Estratégia de Saúde da Família (ESF) no Brasil, segundo a Pesquisa Nacional de Saúde, 2013, (Family Health Strategy Coverage in Brazil, according to the National Health Survey, 2013), “Ciência & Saúde Coletiva”, 21(2): pp. 327-338. (http://www.scielo.br/pdf/csc/v21n2/en_1413-8123-csc-21-02-0327.pdf)
OECD (2015), OECD Economic Surveys: Brazil 2015, OECD Publishing, Paris. (http://dx.doi.org/10.1787/eco_surveys-bra-2015-en)
Paim, J, Travassos C, Almeida C, Bahia L, Machado J. (2011), The Brazilian health system: history, advances and challenges, “The Lancet”, 377: pp. 1778-1797.
Peters, D.H. (2014), The application of systems thinking in health: why use systems thinking?, “Health Research Policy and Systems”, 12(51): pp. 2-6.
Souza F. V., de Melo M. D., Araújo A., da Silva, M. (2013), Efficiency of public spending on hospital care: a study in Brazilian state capitals in the period 2008 to 2010, “Holos”, 1: pp. 203–216.
Tone K. (2001), A slacks-based measure of efficiency in data envelopment analysis, “European Journal of Operational Research”, 130: pp. 498-509. (http://econpapers.repec.org/article/eeeejores/v_3a130_3ay_3a2001_3ai_3a3_3ap_3a498-509.htm)
Tone K., Tsutsui M. (2009). Network DEA: A slacks-based measure approach, “European Journal of Operational Research”, 197: pp. 243-252.
Varela, P. S., Martins G. A., Fávero L.P.L. (2009), Production efficiency and financing of public health: an analysis of small municipalities in the state of São Paulo — Brazil, “Health Care Management Science”, 13(2): pp. 112–123.
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