Análise da eficiência do gasto público em ações e serviços de saúde nas capitais brasileiras

Abstract

Considering the obstacles to the optimization of public expenditure on health and the achievement of a single standard of performance that meets the different socioeconomic realities of the population, this research aimed to identify which factors are associated with the economic efficiency of the Brazilian capital cities in the allocation of the expenditure with actions and public health services, from 2006 to 2015. In thus, the first stage of the research used the Data Envelopment Analysis, with variable returns of scale and orientation for outputs, to identify efficient capitals cities in the period, the productivity changes, and the reference set for inefficient capital cities (benchmarks). The second stage of the research used the regression analysis by Ordinary Least Squares (OLS), with panel data and random effects. It was used as a dependent variable the efficiency scores calculated in the first stage, and as explanatory variables, exogenous factors over which managers do not have control in short time. The results of the research show that ten capital cities were efficient in all the analyzed periods (Salvador, Rio de Janeiro, Rio Branco, Recife, Porto Alegre, Manaus, João Pessoa, Fortaleza, Boa Vista e Belo Horizonte), and only two capital cities were efficient in just one year (Vitória e Campo Grande). The capital cities that performed better were those with lower per capita expenditures. 57% of the indications for the benchmark set were concentrated in five capital cities of the North (Rio Branco) and Northeast (João Pessoa, Recife, Salvador e Fortaleza) regions of the country. Regarding the determinants of efficiency levels, four variables were significant: the human development index in education, the per capita gross domestic product, the rate of urbanization and the percentage of the population benefited by the provision of potable water. Therefore, it can be concluded that the average capital performance is considered satisfactory, although the productivity variation in the period was insufficient for most of them. In this sense, there is a long way to go for all Brazilian capital cities to achieve maximum efficiency, greater higher productivity and provide higher levels of social well-being. This is due to greater investments in income distribution, potable water supply and urbanization.