Avaliação da eficiência dos serviços de saúde por meio da análise envoltória de dados. / Health services efficiency assessment by data envelopment analysis.

A epidemiologia de serviços de saúde é um campo multidisciplinar de investigação científica, porém a literatura sobre a pesquisa avaliativa não tem enfatizado estudos de eficiência. No campo da pesquisa operacional (PO), a metodologia mais frequentemente escolhida para abordagem de eficiência em saúde é a Análise Envoltória de Dados (DEA, do inglês data envelopment analysis), não paramétrica, baseada em programação linear. Neste trabalho, buscou-se apresentar essa metodologia de forma mais detalhada e compreensível para os profissionais de saúde e gestores, e realizou-se uma revisão da literatura sobre o estado de arte do conhecimento adquirido com as aplicações da técnica quando usada para avaliação de serviços de saúde nos últimos 30 anos. Desde 1983, foram publicados 189 artigos, predominantemente em periódicos que enfatizam administração e avaliação de sistemas e serviços de saúde. Verificou-se maior disseminação da técnica a partir do século 21 (76% das publicações), atualmente usada em todos os continentes, principalmente para apoio à tomada de decisões relacionadas a políticas públicas e sistemas locais de saúde, e na comparação com outras medidas de eficiência. DEA pode ser considerada uma ferramenta importante para pesquisadores e gestores no estudo de eficiência e na formulação de políticas de saúde.

The Health Services Epidemiology is a multidisciplinary of scientific investigation; nevertheless, the efficiency assessment approach has not been emphasized in the last few years. According to Operations Research (OR) discipline, in order to cope with efficiency studies, the methodology more frequently used is the non-parametric, linear programming-based, Data Envelopment Analysis (DEA). This paper intended to show a detailed and intelligible presentation of the methodology to be used among health professionals and managers, and to proceed a literature review on the state of art of the knowledge acquired from health services efficiency evaluations in the last 30 years. Since 1983, 189 papers were published, mainly in journals that emphasize management and evaluation of health systems and services. In this century, a dissemination of the technique was observed (76% of the papers), nowadays used in all world continents, mainly to aid health policy and local health systems decision making, along with studies that compare DEA with other efficiency approaches. DEA can be considered an important tool for researchers and decision makers to study efficiency and to formulate health policies.

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.

Avaliação de desempenho e integração docente-assistencial nos hospitais universitários / Evaluación del desempeño e integración docente-asistencial en los hospitales universitarios / Assessment of teaching-health care integration and performance in university hospitals

OBJETIVO: Avaliar o desempenho e a integração entre as dimensões de assistência e de ensino dos hospitais universitários brasileiros. MÉTODOS: Um modelo de data envelopment analysis em redes (network DEA) foi elaborado para aferir o desempenho de hospitais universitários federais, o qual permite considerar a relação entre as dimensões de ensino e de assistência, simultaneamente. Foram utilizados os dados do Sistema de Informação dos Hospitais Universitários do Ministério da Educação, referentes ao segundo semestre de 2003, e os resultados do modelo network foram comparados àqueles dos modelos DEA tradicionais para avaliação das vantagens da nova proposta metodológica. RESULTADOS: A eficiência dos hospitais avaliados variou entre 0,19 e 1,00 (média = 0,54)...

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)...