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What Hospitals are Good or Bad? A Deviance Analysis of Public Sector Hospitals in Brazil

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  • Bauhoff, Sebastian
  • Goyeneche, Laura

Abstract

This study examines the characteristics of public sector 3,470 hospitals with high and low risk-adjusted intra-hospital mortality rates in Brazil, using administrative data for 2023 and 2013 from the Brazilian Unified Health System (SUS) and data from the 2013 World Management Survey of 260 hospitals. In 2023, hospitals with a high risk-standardized mortality rate (RSMR) were predominantly large, urban facilities with high patient volumes, longer hospital stays, and greater ICU capacity, suggesting they treat more critically ill patients. The results also suggest that intra-hospital mortality worsened between 2013 and 2023, particularly in rural and small hospitals. Hospitals with high intra-hospital mortality in 2013 had stronger management practices, particularly in performance monitoring and target setting. These findings highlight the need for targeted policy interventions, improved resource allocation, staffing strategies, and management practices to address disparities in hospital performance and patient care quality. Our analysis also highlights the importance of developing reliable and routine measures of hospital performance, including for quality of care.

Suggested Citation

  • Bauhoff, Sebastian & Goyeneche, Laura, 2025. "What Hospitals are Good or Bad? A Deviance Analysis of Public Sector Hospitals in Brazil," IDB Publications (Working Papers) 14465, Inter-American Development Bank.
    • Handle: RePEc:idb:brikps:14465
    DOI: http://dx.doi.org/10.18235/0013863
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    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • O54 - Economic Development, Innovation, Technological Change, and Growth - - Economywide Country Studies - - - Latin America; Caribbean

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