IDEAS home Printed from https://ideas.repec.org/a/kap/hcarem/v23y2020i3d10.1007_s10729-020-09505-5.html
   My bibliography  Save this article

Brazilian hospitals’ performance: an assessment of the unified health system (SUS)

Author

Listed:
  • Laura Botega

    (Universidade Federal de Minas Gerais (UFMG)
    Universidade Federal de Minas Gerais (UFMG), Centro de Desenvolvimento e Planejamento Regional (Cedeplar))

  • Mônica Viegas Andrade

    (Universidade Federal de Minas Gerais (UFMG)
    Universidade Federal de Minas Gerais (UFMG), Centro de Desenvolvimento e Planejamento Regional (Cedeplar))

  • Gilvan Ramalho Guedes

    (Universidade Federal de Minas Gerais (UFMG)
    Universidade Federal de Minas Gerais (UFMG), Centro de Desenvolvimento e Planejamento Regional (Cedeplar))

Abstract

This paper assesses the economic efficiency of Brazilian general hospitals that provide inpatient care for the Unified Health System (SUS). We combined data envelopment analysis (DEA) and spatial analysis to identify predominant clusters, measure hospital inefficiency and analyze the spatial pattern of inefficiency throughout the country. Our findings pointed to a high level of hospital inefficiency, mostly associated with small size and distributed across all Brazilian states. Many of these hospitals could increase production and reduce inputs to achieve higher efficiency standards. These findings suggest room for optimization, but inequalities in access and the matching of demand and supply must be carefully considered in any attempt to reorganize the hospital system in Brazil.

Suggested Citation

  • Laura Botega & Mônica Viegas Andrade & Gilvan Ramalho Guedes, 2020. "Brazilian hospitals’ performance: an assessment of the unified health system (SUS)," Health Care Management Science, Springer, vol. 23(3), pages 443-452, September.
    • Handle: RePEc:kap:hcarem:v:23:y:2020:i:3:d:10.1007_s10729-020-09505-5
    DOI: 10.1007/s10729-020-09505-5
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s10729-020-09505-5
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s10729-020-09505-5?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Ferreira, Diogo Cunha & Nunes, Alexandre Morais & Marques, Rui Cunha, 2018. "Doctors, nurses, and the optimal scale size in the Portuguese public hospitals," Health Policy, Elsevier, vol. 122(10), pages 1093-1100.
    2. Avdic, Daniel, 2016. "Improving efficiency or impairing access? Health care consolidation and quality of care: Evidence from emergency hospital closures in Sweden," Journal of Health Economics, Elsevier, vol. 48(C), pages 44-60.
    3. Grant Miller & Kimberly Singer Babiarz, 2013. "Pay-for-Performance Incentives in Low- and Middle-Income Country Health Programs," NBER Working Papers 18932, National Bureau of Economic Research, Inc.
    4. Ilaria Mosca, 2007. "Decentralization as a determinant of health care expenditure: empirical analysis for OECD countries," Applied Economics Letters, Taylor & Francis Journals, vol. 14(7), pages 511-515.
    5. Michele Gragnolati & Magnus Lindelow & Bernard Couttolenc, 2013. "Twenty Years of Health System Reform in Brazil : An Assessment of the Sistema Único de Saúde," World Bank Publications - Books, The World Bank Group, number 15801, December.
    6. Finan, Frederico & Ferraz, Claudio, 2005. "Reelection Incentives and Political Corruption: Evidence from Brazilian Audit Reports," 2005 Annual meeting, July 24-27, Providence, RI 19544, American Agricultural Economics Association (New Name 2008: Agricultural and Applied Economics Association).
    7. Gerard M. La Forgia & Bernard F. Couttolenc, 2008. "Hospital Performance in Brazil : The Search for Excellence," World Bank Publications - Books, The World Bank Group, number 6516, December.
    8. Cláudia Araújo & Carlos Barros & Peter Wanke, 2014. "Efficiency determinants and capacity issues in Brazilian for-profit hospitals," Health Care Management Science, Springer, vol. 17(2), pages 126-138, June.
    9. W. Cooper & L. Seiford & K. Tone & J. Zhu, 2007. "Some models and measures for evaluating performances with DEA: past accomplishments and future prospects," Journal of Productivity Analysis, Springer, vol. 28(3), pages 151-163, December.
    10. repec:wly:hlthec:v:26:y:2017:i::p:5-22 is not listed on IDEAS
    11. repec:wly:hlthec:v:26:y:2017:i::p:38-62 is not listed on IDEAS
    12. Capps, Cory & Dranove, David & Lindrooth, Richard C., 2010. "Hospital closure and economic efficiency," Journal of Health Economics, Elsevier, vol. 29(1), pages 87-109, January.
    13. H. David Sherman & Joe Zhu, 2006. "Service Productivity Management," Springer Books, Springer, number 978-0-387-33231-4, September.
    14. Carlos Pestana Barros & Silvestre Dumbo & Peter Wanke, 2014. "Efficiency Determinants and Capacity Issues in Angolan Insurance Companies," South African Journal of Economics, Economic Society of South Africa, vol. 82(3), pages 455-467, September.
    15. Schmitt, Matt, 2017. "Do hospital mergers reduce costs?," Journal of Health Economics, Elsevier, vol. 52(C), pages 74-94.
    16. Thomas Czypionka & Markus Kraus & Susanne Mayer & Gerald Röhrling, 2014. "Efficiency, ownership, and financing of hospitals: The case of Austria," Health Care Management Science, Springer, vol. 17(4), pages 331-347, December.
    17. Annika Herr & Hendrik Schmitz & Boris Augurzky, 2011. "Profit efficiency and ownership of German hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 20(6), pages 660-674, June.
    18. Collins, Charles & Araujo, Jose & Barbosa, Jarbas, 2000. "Decentralising the health sector: issues in Brazil," Health Policy, Elsevier, vol. 52(2), pages 113-127, June.
    19. Roberto Colombi & Gianmaria Martini & Giorgio Vittadini, 2017. "Determinants of transient and persistent hospital efficiency: The case of Italy," Health Economics, John Wiley & Sons, Ltd., vol. 26(S2), pages 5-22, September.
    20. Varabyova, Yauheniya & Schreyögg, Jonas, 2013. "International comparisons of the technical efficiency of the hospital sector: Panel data analysis of OECD countries using parametric and non-parametric approaches," Health Policy, Elsevier, vol. 112(1), pages 70-79.
    21. Francesco Longo & Luigi Siciliani & Hugh Gravelle & Rita Santos, 2017. "Do hospitals respond to rivals' quality and efficiency? A spatial panel econometric analysis," Health Economics, John Wiley & Sons, Ltd., vol. 26(S2), pages 38-62, September.
    22. Chen, Andrew & Hwang, Yuhchang & Shao, Benjamin, 2005. "Measurement and sources of overall and input inefficiencies: Evidences and implications in hospital services," European Journal of Operational Research, Elsevier, vol. 161(2), pages 447-468, March.
    23. Gerard M. La Forgia & Bernard F. Couttolenc, 2008. "Hospital Performance in Brazil : The Search For Excellence," World Bank Publications - Reports 10284, The World Bank Group.
    24. Francesco Longo & Luigi Siciliani & Hugh Gravelle & Rita Santos, 2017. "Do hospitals respond to rivals’ quality and efficiency? a spatial econometrics approach," Working Papers 144cherp, Centre for Health Economics, University of York.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Jesús A. Tapia & Bonifacio Salvador, 2022. "Data envelopment analysis efficiency in the public sector using provider and customer opinion: An application to the Spanish health system," Health Care Management Science, Springer, vol. 25(2), pages 333-346, June.
    2. Mansour Zarrin & Jan Schoenfelder & Jens O. Brunner, 2022. "Homogeneity and Best Practice Analyses in Hospital Performance Management: An Analytical Framework," Health Care Management Science, Springer, vol. 25(3), pages 406-425, September.
    3. Cuoghi, Kaio Guilherme & Leoneti, Alexandre Bevilacqua & Passador, João Luiz, 2022. "On the choice of public or private management models in the Brazilian Unified Health System (SUS)," Socio-Economic Planning Sciences, Elsevier, vol. 84(C).
    4. Rita Matos & Diogo Ferreira & Maria Isabel Pedro, 2021. "Economic Analysis of Portuguese Public Hospitals Through the Construction of Quality, Efficiency, Access, and Financial Related Composite Indicators," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 157(1), pages 361-392, August.
    5. Diogo Ferraz & Enzo Barberio Mariano & Patricia Regina Manzine & Herick Fernando Moralles & Paulo César Morceiro & Bruno Guimarães Torres & Mariana Rodrigues Almeida & João Carlos Soares de Mello & Da, 2021. "COVID Health Structure Index: The Vulnerability of Brazilian Microregions," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 158(1), pages 197-215, November.
    6. Bianca B P Antunes & Leonardo S L Bastos & Silvio Hamacher & Fernando A Bozza, 2021. "Using data envelopment analysis to perform benchmarking in intensive care units," PLOS ONE, Public Library of Science, vol. 16(11), pages 1-13, November.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Annika Maren Schneider & Eva-Maria Oppel & Jonas Schreyögg, 2020. "Investigating the link between medical urgency and hospital efficiency – Insights from the German hospital market," Health Care Management Science, Springer, vol. 23(4), pages 649-660, December.
    2. Yauheniya Varabyova & Carl Rudolf Blankart & Aleksandra Torbica & Jonas Schreyögg, 2017. "Comparing the Efficiency of Hospitals in Italy and Germany: Nonparametric Conditional Approach Based on Partial Frontier," Health Care Management Science, Springer, vol. 20(3), pages 379-394, September.
    3. Wuckel, Christiane, 2022. "The impact of structural and strategic competition on hospital quality," Ruhr Economic Papers 959, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    4. Sepideh Kaffash & Marianna Marra, 2017. "Data envelopment analysis in financial services: a citations network analysis of banks, insurance companies and money market funds," Annals of Operations Research, Springer, vol. 253(1), pages 307-344, June.
    5. Sriubaite, Ieva, 2021. "Who will be the mediator? Local politics and hospital closures in Germany," Ruhr Economic Papers 897, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    6. Eduardo J. Gómez, 2016. "Confronting Health Inequalities in the BRICS: Political Institutions, Foreign Policy Aspirations and State-civil Societal Relationships," Global Policy, London School of Economics and Political Science, vol. 7(4), pages 500-509, November.
    7. Lewis, Maureen & Pettersson, Gunilla, 2009. "Governance in health care delivery : raising performance," Policy Research Working Paper Series 5074, The World Bank.
    8. Paola Bertoli & Veronica Grembi, 2017. "The life‐saving effect of hospital proximity," Health Economics, John Wiley & Sons, Ltd., vol. 26(S2), pages 78-91, September.
    9. Kaffash, Sepideh & Azizi, Roza & Huang, Ying & Zhu, Joe, 2020. "A survey of data envelopment analysis applications in the insurance industry 1993–2018," European Journal of Operational Research, Elsevier, vol. 284(3), pages 801-813.
    10. Montmartin, Benjamin & Herrera-Gómez, Marcos, 2023. "Spatial dependence in physicians’ prices and additional fees: Evidence from France," Journal of Health Economics, Elsevier, vol. 88(C).
    11. Francesco Longo & Luigi Siciliani & Andrew Street, 2019. "Are cost differences between specialist and general hospitals compensated by the prospective payment system?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(1), pages 7-26, February.
    12. Cristian Barra & Raffaele Lagravinese & Roberto Zotti, 2022. "Exploring hospital efficiency within and between Italian regions: new empirical evidence," Journal of Productivity Analysis, Springer, vol. 57(3), pages 269-284, June.
    13. Lisi, Domenico & Moscone, Francesco & Tosetti, Elisa & Vinciotti, Veronica, 2021. "Hospital quality interdependence in a competitive institutional environment: Evidence from Italy," Regional Science and Urban Economics, Elsevier, vol. 89(C).
    14. Esteve, Miriam & Aparicio, Juan & Rodriguez-Sala, Jesus J. & Zhu, Joe, 2023. "Random Forests and the measurement of super-efficiency in the context of Free Disposal Hull," European Journal of Operational Research, Elsevier, vol. 304(2), pages 729-744.
    15. Berger, Michael & Sommersguter-Reichmann, Margit & Czypionka, Thomas, 2020. "Determinants of soft budget constraints: how public debt affects hospital performance in Austria," LSE Research Online Documents on Economics 116865, London School of Economics and Political Science, LSE Library.
    16. Benjamin Montmartin & Marcos Herrera-Gómez, 2022. "Imitative Pricing: the Importance of Neighborhood Effects in Physicians’ Consultation Prices," Working Papers 123, Red Nacional de Investigadores en Economía (RedNIE).
    17. Cavalieri, Marina & Di Caro, Paolo & Guccio, Calogero & Lisi, Domenico, 2020. "Does neighbours' grass matter? Testing spatial dependent heterogeneity in technical efficiency of Italian hospitals," Social Science & Medicine, Elsevier, vol. 265(C).
    18. Jack, William & Lewis, Maureen, 2009. "Health investments and economic growth : macroeconomic evidence and microeconomic foundations," Policy Research Working Paper Series 4877, The World Bank.
    19. Matthias Klumpp & Dominic Loske & Silvio Bicciato, 2022. "COVID-19 health policy evaluation: integrating health and economic perspectives with a data envelopment analysis approach," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(8), pages 1263-1285, November.
    20. Sepideh Abolghasem & Mehdi Toloo & Santiago Amézquita, 2019. "Cross-efficiency evaluation in the presence of flexible measures with an application to healthcare systems," Health Care Management Science, Springer, vol. 22(3), pages 512-533, September.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:kap:hcarem:v:23:y:2020:i:3:d:10.1007_s10729-020-09505-5. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.