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[对服务于巴西统一国家卫生系统的公立和私立医院绩效的分析]

[Analysis of the performance of public and private hospitals serving the Brazilian Unified National Health System].

作者信息

Panitz Leandro Manassi, Prata David Nadler, Rodrigues Waldecy

机构信息

Ministério da Saúde, Brasília, Brasil.

Universidade Federal do Tocantins, Palmas, Brasil.

出版信息

Cad Saude Publica. 2024 Sep 27;40(9):e00156023. doi: 10.1590/0102-311XPT156023. eCollection 2024.

Abstract

This article aims to analyze the performance of the Brazilian Unified National Health System (SUS, acronym in Portuguese) hospital network based on the national databases of the Brazilian Hospital Information System (SIH, acronym in Portuguese) and the Brazilian National Registry of Health Establishments (CNES, acronym in Portuguese). The research used a set of indicators covering the production of admissions, the profile, quality and performance of care, associated with hospital size and legal nature. For data analysis, the Analysis of Variance with Tukey-Kramer test was used to highlight the differences between public and private hospitals, the moderation analysis to verify the effect of hospital size and the Pabon Lasso model to integrate the results. The results show that the increase in the number of beds influences the performance of the indicators differently for public and private hospitals. Public hospitals showed higher gains in scale efficiency with the increase in beds, whereas private non-profit hospitals showed a higher performance in the set of indicators and a more balanced performance in the different sizes. The application of the Pabon Lasso model showed that small hospitals, both public and private, perform poorly. It also showed that from medium-sized onwards, public and private hospitals perform well. However, each category displays particularities in its performance profile, reflecting a diversity of practices and operational results. This study thus confirms previous findings that hospital performance tends to improve as the number of beds increases, but also reveals that it varies significantly depending on the legal nature of these institutions.

摘要

本文旨在基于巴西医院信息系统(SIH,葡萄牙语首字母缩写)和巴西国家卫生机构登记处(CNES,葡萄牙语首字母缩写)的国家数据库,分析巴西统一国家卫生系统(SUS,葡萄牙语首字母缩写)医院网络的绩效。该研究使用了一组指标,涵盖住院量、护理的概况、质量和绩效,并与医院规模和法律性质相关联。对于数据分析,采用带图基 - 克雷默检验的方差分析来突出公立医院和私立医院之间的差异,采用调节分析来验证医院规模的影响,并采用帕邦·拉索模型来整合结果。结果表明,床位数量的增加对公立医院和私立医院指标绩效的影响不同。随着床位增加,公立医院在规模效率方面有更高的提升,而私立非营利性医院在这组指标中表现更优,且在不同规模下表现更为均衡。帕邦·拉索模型的应用表明,无论是公立医院还是私立医院,小型医院的表现都较差。研究还表明,从中型医院开始,公立医院和私立医院表现良好。然而,每个类别在其绩效概况中都有其特殊性,反映出实践和运营结果的多样性。因此,本研究证实了先前的研究结果,即医院绩效往往随着床位数量的增加而提高,但同时也表明,这很大程度上取决于这些机构的法律性质。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4993/11560136/327a4da98694/1678-4464-csp-40-09-PT156023-gf1.jpg

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