Insper - Institute of Education and Research, São Paulo, Brazil.
PLoS One. 2014 Jan 21;9(1):e86687. doi: 10.1371/journal.pone.0086687. eCollection 2014.
Previous cross-country studies have revealed a relationship between health and socio-economic factors. However, multinational studies that use aggregate figures could obfuscate the actual situation in each individual region, or even in each individual federal unit, mainly in a developing country that spans a continent and has large socioeconomic inequalities. We conducted a within-country study, in Brazil, of health system performance that examined data in the four perspectives that most strongly affect the performance of public health systems: financial, customer, internal processes and learning&growth. After estimating the interregional health system performance from each perspective, we identified the determinants of inefficiency (i.e., the factors that have the greatest potential for improvement in each region). The results showed that the major determinants of inefficiency in the less efficient regions (N and NE) are concentrated in the perspective of learning&growth (the number of health professionals and the number of graduates with a health-related undergraduate degree) and, in the regions with the best performance (S and SE) the major determinants of inefficiency are concentrated in the financial perspective (spending on health care and the amount paid for hospitalization).
先前的跨国研究已经揭示了健康与社会经济因素之间的关系。然而，使用总体数据的多国研究可能会混淆每个地区甚至每个联邦单位的实际情况，特别是在一个横跨大陆且存在巨大社会经济不平等的发展中国家。我们在巴西进行了一项国内卫生系统绩效研究，该研究考察了在对公共卫生系统绩效影响最大的四个方面的数据：财务、客户、内部流程和学习与成长。在从每个角度估算区域间卫生系统绩效之后，我们确定了效率低下的决定因素（即每个地区最具改进潜力的因素）。结果表明，效率较低的地区（北部和东北部）效率低下的主要决定因素集中在学习与成长方面（卫生专业人员人数和具有健康相关本科学位的毕业生人数），而在绩效最佳的地区（南部和东南部），效率低下的主要决定因素集中在财务方面（医疗保健支出和住院费用）。
