A critical look at the Portuguese public-private partnerships in healthcare.

The pre-conceived idea that contracts in a public-private partnership (PPP) regime, in healthcare or in any other economic sector, are, as a rule, ruinous and appealing for only a share of the stakeholders, lacks a solid basis that confirms it. This idea, outset and nurtured by the media, has been instigating the distrust of the users who, in turn, demand a more rigorous and efficient utilisation of public resources. Being Portugal in the top of countries that resort to PPPs, it is urgent to inquire if its respective contracts originated an inefficient and ineffective management of resources. It is precisely this discussion that we address in this paper, focusing our efforts in the Portuguese healthcare sector.

Water utilities performance analysis in developing countries: On an adequate model for universal access.

The results of the analysis of water utility performance studies based on data envelopment analysis (DEA) can be very sensitive to the methodological approach and the variables employed. This study investigates approaches and variables for developing countries in order to identify an adequate model for universal access. Three models were developed and compared. The first used traditional variables, the second considered the quality of service variables, and the last are expanded on the second by incorporating the realization of the human right to water into efficiency estimation. Methodological approaches comprising the variable returns to scale DEA (most common for developing countries) and slack-based directional distance function (employed in this study) were also compared. The case study of 77 Brazilian water utilities suggests that a model that incorporates the objective of universal access in the efficiency estimation changes substantialy utility efficiency scores. Therefore, utilities that make investments to reach the universal access can be penalized since traditional models incorporate the expenses, but fail to capture the results. The research conclusions suggest that approaches and variable choices are likely to impact on the analysis results, misrepresenting them regardless of the purpose for using DEA in the study.

On evaluating health centers groups in Lisbon and Tagus Valley: efficiency, equity and quality.

BACKGROUND: Bearing in mind the increasing health expenses and their weight in the Portuguese gross domestic product, it is of the utmost importance to evaluate the performance of Primary Health Care providers taking into account both efficiency, quality and equity. This paper aims to contribute to a better understanding of the performance of Primary Health Care by measuring it in a Portuguese region (Lisbon and Tagus Valley) and identifying best practices. It also intends to evaluate the quality and equity provided. METHODS: For the purpose of measuring the efficiency of the health care centers (ACES) the non-parametric full frontier technique of data envelopment analysis (DEA) was adopted. The recent partial frontier method of order-m was also used to estimate the influence of exogenous variables on the efficiency of the ACES. The horizontal equity was investigated by applying the non-parametric Kruskal-Wallis test with multiple comparisons. Moreover, the quality of service was analyzed by using the ratio between the complaints and the total activity of the ACES. RESULTS: On the whole, a significant level of inefficiency was observed, although there was a general improvement in efficiency between 2009 and 2010. It was found that nursing was the service with the lowest scores. Concerning the horizontal equity, the analysis showed that there is no evidence of relevant disparities between the different subregions(NUTS III). Concerning the exogenous variables, the purchasing power, the percentage of patients aged 65 years old or older and the population size affect the efficiency negatively. CONCLUSIONS: This research shows that better usage of the available resources and the creation of a learning network and dissemination of best practices will contribute to improvements in the efficiency of the ACES while maintaining or even improving quality and equity. It was also proved that the market structure does matter when efficiency measurement is addressed.

Monitoring inequality in water access: Challenges for the 2030 Agenda for Sustainable Development.

The diffusion of the indicators for monitoring sustainable development goals (SDG) has conceptual and symbolic uses far beyond their instrumental uses. Despite its value in dismantling social and economic inequalities, the goal regarding guaranteed of water and sanitation for all did not specify any indicators for this purpose. This research contributes to the discussions on the best way to monitor inequality in access to water by the SDG. Inequality measures established in other areas of study and specific to the access to water were analyzed as their applicability for this purpose. Our study finds that current United Nations strategy does not allow for robust conclusions and does not respect some economical axioms. Furthermore, we show the potentialities and inconveniences of the most important metrics, but it can be concluded that if the objective is merely to measure inequality and communicate easily, the concentration index is the most appropriate measure. These results may contribute to a more refined discussion of how the SDGs can measures progress towards equality in water access and provides information to guide governments agendas for equality in water access.