Angela Cristina Moreira da Silva

Financing reform and productivity change in Brazilian teaching hospitals: Malmquist approach

This study evaluates the performance and productivity changes for the Brazilian Federal University Hospitals, considering the years of 2003 and 2006, that is, before and after a 2004 financing reform. The analysis is based on the Malmquist index approach. Results indicate that the financing reform provided improvement in the technical efficiency, although the technological frontier has not presented a positive shift. This suggests that increased budgets were a good stimulus for efficiency but the intended enhancement of the technology through the financing reform has not yet taken place.

O uso da Análise Envoltória de Dados (DEA) para avaliação de hospitais universitários brasileiros

In order to demonstrate how DEA modeling can be helpful for hospital performance assessments conducted in compliance with Brazils Teaching Hospital Policy, a case study is presented of 31 general hospitals linked to Federal Universities. It considers data on assistance, teaching and research and the use of the IDEAL (Interactive Data Envelopment Analysis Laboratory) software as a tool for assessing their efficiency. Developed in Brazil, this unique software provides a three-dimensional view of the productivity frontier, for easier exploratory analyses and selection of pertinent variables, with a better understanding of the outputs of the model (multiplier and envelope) for specialists and decision-makers. As an example, a University Hospital benchmark is presented through outputs that take structural and regional input differences into consideration. This modeling also indicates the changes required in the inefficient units (alterations to input and/or /output vectors), setting forth recommendations on public financing based on quality/efficiency.

Integrating the regulatory and utility firm perspectives, when measuring the efficiency of electricity distribution

Abstract Several DEA applications for benchmarking in utility regulation use classical models, which reveal inconsistencies due to Pareto inefficient targets. The natural course of action would be to incorporate weight restrictions, reflecting value judgments and requiring interaction between analyst and decision maker. We show that weight restricted DEA models still present some inconsistencies, since it is not possible to ensure that the target both dominates the observed DMU and lies on the empirical production frontier. Besides the decision maker and analyst interaction, it is necessary to consider a further distinction between the two parties: the regulatory agency and the utility company, which adopt different criteria to determine the efficient target. A model to obtain a preferred target DEA index is formulated, taking advantage of the dual-based DEA graphical analysis. Thus, we propose a two-phase DEA analysis that can integrate both perspectives. A case study about the Brazilian electricity sector is included, which illustrates the above-mentioned issues.

Evaluating the performance of Brazilian university hospitals

In order to demonstrate how DEA modeling can be helpful to aid decision making relative to the Brazilian Teaching Hospital Policy by means of hospital performance assessment, we develop a case study with 30 general hospitals linked to Brazilian Federal Universities. We consider data on medical care (Medical Model—MM), teaching and research (Teaching-Research Model—TRM) and use the software IDEAL (Interactive Data Envelopment Analysis Laboratory) as a tool for the units’ efficiency evaluation. IDEAL, developed in Brazil, is unique in providing a 3-D frontiers visualization, assisting in exploratory analysis and allowing a better understanding of the DEA modeling (envelopment and multiplier). Both models are input-oriented and each hospital is categorized according to its relative efficiency in the MM and TRM. In this phase, it is very important to discuss with the decision-makers the results and patterns of the DEA models. Finally, the modelling indicates the necessary changes for the inefficient units and generates recommendations for teaching ratios and public financing.

Regional Variations in Energy Consumption of Appliances: Conditional Demand Analysis Applied to Brazilian Households

Estimating the true consumption of appliances in use is important both for modeling and short term forecasting of electricity demand, as well as for planning and assessing Demand Side Management (DSM). This paper applies the new technique known as Conditional Demand Analysis (CDA) to estimate consumption of these appliances. This was made possible due to a major survey carried out for the Brazilian National Electricity Conservation Program by the Brazilian electric utility companies while they were still state owned. Results were checked against traditional appliance energy consumption figures, and investigations carried out to ascertain if differences were due to regional variations in consumption patterns from northern to southern Brazil.

Avaliação de desempenho e integração docente-assistencial nos hospitais universitários

OBJECTIVE To assess the performance and integration between the health care and teaching dimensions in Brazilian university hospitals. METHODS A network data envelopment analysis (DEA) model was designed to measure the performance of federal university hospitals, which enables the relationship between the teaching and health care dimensions to be considered simultaneously. Data from the Ministry of Education Information System of University Hospitals, in the second semester of 2003, were used. Results of the network model were compared to those of classical DEA models to assess the advantages of the new methodological proposal. RESULTS The efficiency of the hospitals assessed varied between 0.19 and 1.00 (mean = 0.54). The dimensional score showed that hospitals prioritize the gain in health care efficiency. It was observed that there was a need to double the number of medical students and increase the number of residents by 14% to obtain efficiency in the teaching dimension. CONCLUSIONS The model was useful for both unit managers, aiming to integrate teaching and health care, and regulatory organizations, when defining policies and incentives.OBJETIVO: Avaliar o desempenho e a integracao entre as dimensoes de assistencia e de ensino dos hospitais universitarios brasileiros. METODOS: Um modelo de data envelopment analysis em redes (network DEA) foi elaborado para aferir o desempenho de hospitais universitarios federais, o qual permite considerar a relacao entre as dimensoes de ensino e de assistencia, simultaneamente. Foram utilizados os dados do Sistema de Informacao dos Hospitais Universitarios do Ministerio da Educacao, referentes ao segundo semestre de 2003, e os resultados do modelo network foram comparados aqueles dos modelos DEA tradicionais para avaliacao das vantagens da nova proposta metodologica. RESULTADOS: A eficiencia dos hospitais avaliados variou entre 0,19 e 1,00 (media = 0,54). O escore dimensional mostrou que os hospitais priorizam o ganho de eficiencia assistencial. Observou-se que ha necessidade de dobrar o numero de alunos de medicina e de aumentar os residentes em 14% para que se tornem eficientes na dimensao de ensino. CONCLUSOES: O modelo mostrou utilidade de aplicacao tanto para os gestores das unidades, visando a integracao docente-assistencial, como para os orgaos reguladores, na definicao de politicas e incentivos.

Teaching hospitals in Brazil: Findings on determinants for efficiency

Abstract Hospital efficiency is an important dimension for health services evaluation and suffers the influence of different non-discretionary variables, not necessarily under the control of the hospital manager. These must be considered when establishing goals for efficient and socially committed health, which in many countries is now the primary goal. To test and further understand the context of non-controllable variables in healthcare delivery, this study examined 104 teaching hospitals in Brazil. The efficiency score was generated using weight restricted-output oriented data envelopment analysis model. A second-stage logistic regression analysis was deployed to examine the predictors of efficiency among the non-discretionary variables. The efficiency results indicate that, it requires reduction in labor and in bed capacity, while it increases necessary admissions and high complexity procedures. The main predictors of efficiency were the size of the hospital, high teaching intensity, and low teaching dedication. The model predicts no association between efficiency and ownership. Teaching load, as an important source of qualified human resources to society, although associated with higher health costs, when not considered in service delivery, may distort the analysis of efficiency for the teaching hospitals. These findings could have implications for any healthcare system that has teaching hospitals among its components.

Assessment of teaching-health care integration and performance in university hospitals

OBJECTIVE To assess the performance and integration between the health care and teaching dimensions in Brazilian university hospitals. METHODS A network data envelopment analysis (DEA) model was designed to measure the performance of federal university hospitals, which enables the relationship between the teaching and health care dimensions to be considered simultaneously. Data from the Ministry of Education Information System of University Hospitals, in the second semester of 2003, were used. Results of the network model were compared to those of classical DEA models to assess the advantages of the new methodological proposal. RESULTS The efficiency of the hospitals assessed varied between 0.19 and 1.00 (mean = 0.54). The dimensional score showed that hospitals prioritize the gain in health care efficiency. It was observed that there was a need to double the number of medical students and increase the number of residents by 14% to obtain efficiency in the teaching dimension. CONCLUSIONS The model was useful for both unit managers, aiming to integrate teaching and health care, and regulatory organizations, when defining policies and incentives.OBJETIVO: Avaliar o desempenho e a integracao entre as dimensoes de assistencia e de ensino dos hospitais universitarios brasileiros. METODOS: Um modelo de data envelopment analysis em redes (network DEA) foi elaborado para aferir o desempenho de hospitais universitarios federais, o qual permite considerar a relacao entre as dimensoes de ensino e de assistencia, simultaneamente. Foram utilizados os dados do Sistema de Informacao dos Hospitais Universitarios do Ministerio da Educacao, referentes ao segundo semestre de 2003, e os resultados do modelo network foram comparados aqueles dos modelos DEA tradicionais para avaliacao das vantagens da nova proposta metodologica. RESULTADOS: A eficiencia dos hospitais avaliados variou entre 0,19 e 1,00 (media = 0,54). O escore dimensional mostrou que os hospitais priorizam o ganho de eficiencia assistencial. Observou-se que ha necessidade de dobrar o numero de alunos de medicina e de aumentar os residentes em 14% para que se tornem eficientes na dimensao de ensino. CONCLUSOES: O modelo mostrou utilidade de aplicacao tanto para os gestores das unidades, visando a integracao docente-assistencial, como para os orgaos reguladores, na definicao de politicas e incentivos.

Influência de fatores ambientais na eficiência de hospitais de ensino

Summary Objective: to measure the performance of teaching hospitals by Data Envelopment Analysis (DEA) and to study the influence of environmental factors on the efficiency. Methodology: A hundred and four teaching hospitals were analyzed and the efficiency score was generated by DEA, VRS model, output oriented, with weight restrictions. The efficiency score criteria were then regressed on non-discretionary variables by logistic linear regression. Results: the efficiency score mean was 49% (SD=26%); five hospitals were efficient. In logistic regression, the main predictors of efficiency were the size of the hospital (p=0.001), high teaching intensity (p=0.027) and low teaching dedication (p=0.006). There was no association between efficiency and ownership form or HDI of the surrounding municipality. Conclusion: hospital efficiency suffers the influence of different environmental factors, not necessarily under the control of the manager, that should be considered when defining administrative goals and financing pacts.

Evaluación del desempeño e integración docente-asistencial en los hospitales universitarios

OBJECTIVE To assess the performance and integration between the health care and teaching dimensions in Brazilian university hospitals. METHODS A network data envelopment analysis (DEA) model was designed to measure the performance of federal university hospitals, which enables the relationship between the teaching and health care dimensions to be considered simultaneously. Data from the Ministry of Education Information System of University Hospitals, in the second semester of 2003, were used. Results of the network model were compared to those of classical DEA models to assess the advantages of the new methodological proposal. RESULTS The efficiency of the hospitals assessed varied between 0.19 and 1.00 (mean = 0.54). The dimensional score showed that hospitals prioritize the gain in health care efficiency. It was observed that there was a need to double the number of medical students and increase the number of residents by 14% to obtain efficiency in the teaching dimension. CONCLUSIONS The model was useful for both unit managers, aiming to integrate teaching and health care, and regulatory organizations, when defining policies and incentives.OBJETIVO: Avaliar o desempenho e a integracao entre as dimensoes de assistencia e de ensino dos hospitais universitarios brasileiros. METODOS: Um modelo de data envelopment analysis em redes (network DEA) foi elaborado para aferir o desempenho de hospitais universitarios federais, o qual permite considerar a relacao entre as dimensoes de ensino e de assistencia, simultaneamente. Foram utilizados os dados do Sistema de Informacao dos Hospitais Universitarios do Ministerio da Educacao, referentes ao segundo semestre de 2003, e os resultados do modelo network foram comparados aqueles dos modelos DEA tradicionais para avaliacao das vantagens da nova proposta metodologica. RESULTADOS: A eficiencia dos hospitais avaliados variou entre 0,19 e 1,00 (media = 0,54). O escore dimensional mostrou que os hospitais priorizam o ganho de eficiencia assistencial. Observou-se que ha necessidade de dobrar o numero de alunos de medicina e de aumentar os residentes em 14% para que se tornem eficientes na dimensao de ensino. CONCLUSOES: O modelo mostrou utilidade de aplicacao tanto para os gestores das unidades, visando a integracao docente-assistencial, como para os orgaos reguladores, na definicao de politicas e incentivos.