Gestão de custos: eficiência de hospitais públicos através da análise envoltória de dados

Abstract

Health services require decentralized, synergistic and organic management to guarantee the population's right to health. Therefore, efficiency is one of the critical points. In this sense, the objective was to analyze the efficiency of public hospitals in the Unified Health System of Rio Grande do Norte (SUS/RN) under state management, from January 2018 to December 2021 through data envelopment analysis, with modeling Input-oriented CCR. In this case, 20 hospitals identified in the National Health Establishment Registry (CNES) as Decision Making Unit (DMU) and data from information systems made available through the National Department of SUS (DATASUS) were analyzed as inputs and outputs (outputs) to create the DMU efficiency frontier. Thus, each hospital received scores from 0 (inefficient) to 1 (efficient) and those that reached the efficiency frontier and with the best results were the benchmarks. In the study, the inputs and outputs used were: (i) Hospital procedures (ii) values of professional services (iii) average length of stay (iv) mortality rate (v) number of hospitalizations (xi) medium complexity procedures (xii) highly complex procedures. In addition to ranking the hospitals, an analysis of the evolution of efficiency over the period of time was carried out using the Malmquist index, indicating changes in total productivity. With this, it was identified that 80% of the sample was considered inefficient. However, from the perspective of the Malquist index, there was a decrease in efficiency over the period analyzed in 85% of hospital services. The 7th health region of the SUS/RN was the most negatively affected, possibly due to overload, lack of cooperation from institutional actors, lack of agreement between the entities involved and lack of personnel, structure and technology. The discrimination of benchmarks is considered positive, contributing to good practices and governance in health. Therefore, this study can help public managers to define strategies to increase the technical efficiency of health services.