title: Performance evaluation of hospitals that provide care in the public health system, Brazil.
abstract: OBJECTIVE To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System. METHODS This cross-sectional study evaluated data from the Hospital Information System and the Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Facilities), 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA) and Bonferroni correction. RESULTS The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed. CONCLUSIONS The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals.
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Marcelo Cristiano de Azevedo
authors.initials: MC
authors.lastname: Ramos
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Lucila Pedroso
authors.initials: LP
authors.lastname: da Cruz
authors.affiliation: Escola de Administração de Empresas de São Paulo, Fundação Getulio Vargas, São Paulo, SP, Brasil.
authors.forename: Vanessa Chaer
authors.initials: VC
authors.lastname: Kishima
authors.affiliation: Secretaria Adjunta, Secretaria de Estado da Saúde de São Paulo, São Paulo, SP, Brasil.
authors.forename: Wilson Modesto
authors.initials: WM
authors.lastname: Pollara
authors.affiliation: Hospital Sírio-Libanês, São Paulo, SP, Brasil.
authors.forename: Antônio Carlos Onofre
authors.initials: AC
authors.lastname: de Lira
authors.affiliation: Instituto Performa, São Paulo, SP, Brasil.
authors.forename: Bernard François
authors.initials: BF
authors.lastname: Couttolenc
mesh_terms: D001938:Brazil; D003430:Cross-Sectional Studies; D006296:Health Services / Q000592:standards*; D006751:Hospital Information Systems; D017052:Hospital Mortality; D006779:Hospitals, Public / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007902:Length of Stay; D009313:National Health Programs; D010343:Patient Admission