Evaluating Portuguese Public Hospitals Performance: Any Difference before and during COVID-19?

Abstract

COVID-19 is a well-known respiratory disease that has spread worldwide since January 2020, causing many deaths and massive pressure on health systems. This pandemic’s appearance compromised health service sustainability and quality as many procedures were postponed or canceled, with an expected increase of adverse events like nosocomial infections, in-hospital deaths, and the worsening of the patient’s clinical status. For instance, the year 2020 featured an increase in undesirable results in Portugal: a rise of 10% in delayed first medical appointments, 0.02% in avoidable bloodstream infections, and more than 100 post-operative pulmonary embolisms and septicemia cases per 100,000 inpatients. Therefore, assessing whether the healthcare providers’ performance has changed is paramount. In this case, we evaluated public hospitals in Portugal. To this end, we developed a network data envelopment analysis model relating to efficiency and effectiveness. We observed consistent drops in efficiency when the pandemic started, followed by a recovery to levels above the pre-pandemic ones. Regarding effectiveness, we observed a positive trend during the evaluated period. We conclude that, apart from the great resilience of public healthcare providers, the Portuguese state was unprepared for a pandemic like COVID-19, but still the actions taken (including massive vaccination) were beneficial.

The Portuguese Public Hospitals Performance Evolution before and during the SARS-CoV-2 Pandemic (2017–2022)

“…This result suggests that changes in performance should be interpreted in the light of internal structure (poor preparedness, staff burnout, hysteria, among others). As the World Health Organization has already decreed the pandemic's end, it is important that healthcare providers and governments prepare themselves for likely future pandemics, by following the best practices (benchmarks) and designing reliable contingency plans [104][105][106].…”

Vertical Integration in Healthcare and Patient Satisfaction: An Exploratory Analysis of Portuguese Reforms

“…The development of information systems to increase efficiency; -Reducing copayments to promote equity in terms of access; -Expanding primary healthcare to increase the scope of the services provided in primary care centres (exams, oral health appointments, visual health screenings); -Establishing incentives, either financial or not, to increase the social mobility of doctors from deprived areas and increase efficiency and equity in terms of access; -Sharing resources between SNS hospitals to increase efficiency and equity in terms of access [3,6,15].…”

“…Moreover, the advent of the COVID-19 pandemic exacerbated the preexisting issue of limited access to healthcare services. Additionally, the introduction of transparency measures such as the publication of data and information pertaining to care provision revealed certain inefficiencies that have contributed to user discontentment [15].…”

Evaluating private hospital performance before and during COVID-19 in China

“…[12] Some studies have analyze the organizational performance before and during COVID-19 in companies, [13][14][15] banks, [16][17][18] and libraries, [19] and very few studies have focused on the performance of medical institutions. [20,21] For example, Nunes and Ferreira [21] concluded that the efficiency of public hospitals dropped when COVID-19 started, and then recovered to prepandemic levels because of the actions taken by the Portuguese state. Caldas and Varela [22] also confirmed a drop in Portuguese public hospitals' performance during COVID-19.…”