Performance evaluation of expenditure in primary care: the case of Brazil's southeastern cities

Abstract

This study aimed to analyze the performance of cities of Brazil's southeastern region on primary care expenditure, from 2007 to 2010. In order to do the performance analysis we used the technical efficiency scores produced by the Data Envelopment Analysis (DEA) methodology and the Ray and Desli Malmquist Index as the quantitative metrics. Before starting the cities' efficiency analysis, the cluster analysis was applied to group similar cities. This study proposes an analytical model of the comparative performance of 1097 cities, based on the National Primary Care Policy. The efficiency scores obtained highlights the disparities in the allocation of resources and lost in productivity through the years analyzed. This fact could be justified due the absence of procedures of relative comparison between cities and the decentralization of public expenses in public healthcare. The results shed light on the possibility to improve the quantity of primary care services, given the current level of expenditure.

A performance analysis of Brazilian public health: TOPSIS and neural networks application

“…This may be chased through the analysis of the production process, and investigation of the best practices used in the municipalities considered as a reference. This result is aligned with other academic studies that analyzed the performance of Brazilian public health services at the municipality level, applying DEA (Marinho, 2003;Santos et al, 2014;Varela et al, 2012). Despite the differences among the studies, including variables, method, year and municipalities, they all point out inefficiencies in the performance of Brazilian public health services.…”

“…Varela et al (2012) measured the performance of municipalities in São Paulo (SP) state in 2006, also using DEA, and found great discrepancies among the municipalities in the sample, with an average score of only 0.45. In turn, Santos et al (2014) applied DEA to assess the performance of public primary care services in Brazilian municipalities located in the Southeastern Region, including RJ and SP states, from 2007 to 2010, and found a low overall average score (0.61) and just a slight improvement within the period analyzed.…”

“…GDP per capita has also been acknowledged as an explanatory variable in the healthcare performance literature and results indicate that it is positively associated with hospitals' performance, since wealthier geographic areas present healthier individuals and improved health outcomes (Halkos and Tzeremes, 2011;Marinho 2003;Samut and Cafrı, 2016;Santos et al, 2014;Varela et al, 2012).…”

Controle na alocação de recursos na saúde pública: uma análise nas microrregiões do sudeste brasileiro

“…Marinho (2001;, Faria et al (2008), Gonçalves et al (2008), Gonçalves et al (2012), Santos et al (2014), que discorrem sobre o desempenho na área de saúde.…”

“…As pesquisas e produções científicas citadas têm contribuído para a avaliação comparativa de eficiência na área, estabelecendo Desde a promulgação da Política Nacional da Atenção Básica em 2007, como regra geral, a atenção primária (ou atenção básica, como também é conhecida) é realizada pelos municípios, e a secundária e a de alta complexidade, pelos estados e governo federal (Santos et al, 2014;Gonçalves et al, 2015).…”