Analysis of the efficiency in the use of health resources in the largest brazilian municipalities

Authors

DOI:

https://doi.org/10.33448/rsd-v10i15.22669

Keywords:

Efficiency in Public Management, Resources Applied in Public Health, Data envelopment analysis.

Abstract

This study analyzes the extent to which medical resources for public health in the 80 largest Brazilian municipalities are used efficiently. This research is based on the search for government efficiency, arising from the managerialism developed in the public sector. In this sense, it is assumed that public institutions need their resources economically, maintaining or increasing the quality of services provided. The investigation focuses on 76 cities with data between 2013 to 2017 and measured efficiency through Data Envelopment Analysis (DEA). Health expenses (incomings) and 6 other outgoing variables (outflows) were considered, namely: Hospital Admission Authorization, deaths, days of stay, average value of admissions, value of hospital services and days of admissions. The DEA modeling was developed with input orientation by the BCC model (variable returns to scale). The results of the study demonstrate that the most efficient cities are concentrated in the south and southeast regions. However, the main demonstration of the finding is that only the increase in health expenses does not correspond to more efficient services. The data show that the efficiency obtained is related to the good management of public resources and not necessarily to the volume of administrative resources. It should also be emphasized that public managers can use the municipalities listed in the result as a benchmark for the model, in order to enhance the indicators and improve the management of public resources. Furthermore, the study is advancing the theory in public administration and accounting for social management in the health area.

Author Biographies

  • Alessandro Lepchak, Universidade Estadual do Centro-Oeste
    Graduated in Accounting from Unicentro - PR (2005), MBA in Accounting Management from
    Facinter - PR (2008), Master in Accounting from UFPR (2014). Doctoral student in
    Accounting at the Federal University of Paraná. Capes Scholarship - Master in
    Accounting - UFPR (2012-2014). Professional experience in Accounting as an accountant
    partner at BLV Contadores (2005-2015). Collaborating professor in the area of
    ​​Management Accounting at Unicentro - PR (2013-2015). Assistant Professor in the area
    of ​​Management Accounting at Unicentro - PR (2015-current).  
  • Saulo Silva Lima Filho, Universidad Federal de Paraná
    Doctor and Master in Accounting from the Federal University of Paraná, Specialist in
    Accounting and Finance and Social Security Management, graduated in Administration and
    Accounting Sciences. It focuses on research related to the public sector, especially
    in financial administration, public budgeting and Accounting Applied to the Public
    Sector. Instructor of courses related to procedural compliance for budget and financial
    execution; management reports based on information from accounting systems such as the
    Federal Government's Integrated Financial Administration System (SIAFI); in addition
    to courses on applications in office suites with routines related to financial
    administration. He has professional experience in Financial and Budget Management,
    Accounting Applied to the Public Sector and in investment analysis. In these areas,
    he assumed the functions of head of units, finance manager, director of financial
    administration, director of accounting and finance (substitute) and coordinator of
    financial administration. He is currently a public servant at the Federal University
    of Paraná, with the Department of Accounting and Finance in the Dean of Planning,
    Budget and Finance.  
  • Eduardo Oliveira da Silva, Universidade Federal do Paraná

    This study analyzes the extent to which medical resources for public health in the 80 largest Brazilian municipalities are used efficiently. This research is based on the search for government efficiency, arising from the managerialism developed in the public sector. In this sense, it is assumed that public institutions need their resources economically, maintaining or increasing the quality of services provided. The investigation focuses on 76 cities with data between 2013 to 2017 and measured efficiency through Data Envelopment Analysis (DEA). Health expenses (incomings) and 6 other outgoing variables (outflows) were considered, namely: Hospital Admission Authorization, deaths, days of stay, average value of admissions, value of hospital services and days of admissions. The DEA modeling was developed with input orientation by the BCC model (variable returns to scale). The results of the study demonstrate that the most efficient cities are concentrated in the south and southeast regions. However, the main demonstration of the finding is that only the increase in health expenses does not correspond to more efficient services. The data show that the efficiency obtained is related to the good management of public resources and not necessarily to the volume of administrative resources. It should also be emphasized that public managers can use the municipalities listed in the result as a benchmark for the model, in order to enhance the indicators and improve the management of public resources. Furthermore, the study is advancing the theory in public administration and accounting for social management in the health area.

  • Blênio Cezar Severo Peixe, Universidade Federal do Paraná
    Associate Professor of the Undergraduate Course in Accounting, Lato Sensu Graduate
    Program and Stricto Sensu Graduate Program in Accounting at the Federal University of
    Paraná, Former Titular Member of CEPE / COUN / UFPR and Other Councils of UFPR,
    researcher with a project approved by CNPq (Vice-leader of the Research Group-PPGcont /
    UFPR - Certified by CNPq). Graduated in Accounting Sciences - UFPR (1984), Master in
    Accounting Sciences - UERJ / FGV (1995), Doctor in Business Sciences - UMSA (2005) and
    Doctor in Production Engineering - UFSC (2014). He coordinated the Post-Graduate Course in
    Accounting Sciences, Vice-Coordinator of the Post-Graduate Program in Stricto Sensu in
    Accounting - UFPR and coordinated several Post-Graduate Courses in Sensu - UFPR. Elaborated
    the project / proposal for the creation of the Masters in Accounting Sciences-UFPR / SCSA
    (approved / 2004 by CAPES). He has experience in Public Administration / Finance, with an
    emphasis on Public Policy Formulation and Management, Accounting, Governance and
    Accountability Applied to the Public Sector. He has published several articles in national
    and international magazines and congresses. Led the coordination and organization of the
    publications of 9 Books / Public Finance, Formulation and Management of Public Policies and
    20 book chapters. Published 1 book on public finance - Government Comptroller. And works in
    the areas of: Public Finance; New Public Management (NGP); Accounting, Governance and
    Accountability Applied to the Public Sector (Masters and Doctorate? PPGCont / UFPR) and
    Management Accounting (Postgraduate and Specialization). Permanent member of the Academy of
    the Brazilian Academy of Economic, Political and Social Sciences? National Academy of
    Economy (ANE), headquartered in Rio de Janeiro-RJ, founded in 1944 (Cátedra nº 75).

References

Abreu, C. R., & Câmara, L. M. (2014). O Orçamento Público Como Instrumento de Ação Governamental: uma análise de suas redefinições no contexto da formulação de políticas públicas de infraestrutura. Revista de Administração Pública. 49(1), 73-90.

Abrucio, F. L. (2006). Os Avanços e os Dilemas do Modelo Pós-Burocrático: A Reforma da Administração Pública à Luz da Experiência Internacional Recente. In Bresser Pereira, L.C., & Spink, P.K. (Org). Reforma do Estado e Administração Pública Gerencial. (pp 173 - 199). FGV.

Aragão, A. S. de. (2004). O Princípio da Eficiência. Revista de Direito Administrativo, 24(3), 1–6.

Araújo, C. E. L., Gonçalves, G. Q., & Machado, J. A. (2017). Os municípios brasileiros e os gastos próprios com saúde: algumas associações. Ciência & Saúde Coletiva, 22(3), 953–963. https://doi.org/10.1590/1413-81232017223.15542016

Arretche, M. T. S. (2011). Tendências no estudo sobre avaliação. In Avaliação de Políticas Sociais: uma questão de debate. São Paulo: Cortez.

Ashraf, J. & Uddin, S. (2016). New public management, costa saving and regressive effects: A casa from less developed country. Critical Perspectives on Accounting. 41(1), 18-33.

Banker, R. D. (1993). Maximum Likelihood, Consistency and Data Envelopment Analysis: A Statistical Foundation. Management Science, 39(10), 1265–1273. https://doi.org/10.1287/mnsc.39.10.1265.

Barros, L.O.; Silva, F. G. F.; & Prata, B. T. (2021). Avaliação de desempenho e capacidade do sistema de saúde espanhol na pandemia de SARS-CoV-2. Research, Society and Development, 10(1), e53410111886. http://dx.doi.org/10.33448/rsd-v10i1.11886.

Bogetoft, P., & Otto, L. (2020), Benchmarking with DEA and SFA, R package version 0.29.

Charnes, A., & Cooper, W. W. (1984). Preface to topics in data envelopment analysis. Annals of Operations Research, 2(1), 59–94. https://doi.org/10.1007/BF01874733.

Crispim, D. L.; Rodrigues, R. S. S.; Vieira, A. S. de A.; Pessoa, F. C. L.; & Fernandes, L. L. (2020). Health indicators in Amazonian cities: case study in the State of Pará, Brazil. Research, Society and Development, 9(7), e635973531. 10.33448/rsd-v9i7.3531.

Denhardt, R. B., & Catlaw, T. J. (2017). Teorias da Administração Pública. (2a ed). Cengage Learning.

Dumitrescu, P. A., & Dogaru, T. C. (2016). The challenges of the administrative process in a financial crisis and their effectiveness. Procedia Economics and Finance. 39 (1), 827-832.

Espírito Santo, A. C. G. do., Fernando, V. C. N., & Bezerra, A. F. B. (2012). Despesa pública municipal com saúde em Pernambuco, Brasil, de 2000 a 2007. Ciência & Saúde Coletiva, 17(4), 861–871. https://doi.org/10.1590/S1413-81232012000400009

Farrel, M. J. (1957). The Measurement of Productive Efficiency. Journal of the Royal Statistical Society, 120(3), 253–290.

Fávero, L.P. & Belfiore, P. (2017). Manual de Análise de Dados. Elsevier.

Fernádez-Gutiérrez, M., & Walle, S.V. (2018). Equity or Efficiency? Explaining Public Official’s Values. Public Administration Review. 79(1), 25-34.

Gemelli Savian, M. P., & Bezerra, F. M. (2013). Análise de eficiência dos gastos públicos com educação no ensino fundamental no Estado do Paraná. Economia & Região, 1(1), 26–47. https://doi.org/10.5433/2317-627X.2013v1n1p26

Geri, M., Monterubbianesi, P. D., Lago, F. P., & Moscoso, N. S. (2017). Eficiencia del Gasto Total en Salud: Análisis no paramétrico en una muestra amplia de países Total health expenditure efficiency: non-parametric analysis in a large sample of countries. Revista Salud Pública, 19(1), 79–85. https://doi.org/10.15446/rsap.v19n1.44546

Giacomoni, J. (2019). Orçamento Governamental: teoria, sistema, processo. Atlas.

Graciliano, E. A., Filho, J. C. M., Nunes, A. de P., Pontes, F. C. de M., & Zampa, F. F. (2010). Accountability na administração pública federal: contribuição das auditorias operacionais do TCU. Pensar Contábil, 12(47), 43–51.

Ho, A. T. (2018). From Performance Budgeting to Performance Budget Management: Theory and Practice. Public Administration Review.1-11.

Jesus, A. C. S.; Dantas, A. L. F.; & Silva, M. V. (2019). A eficiência do gasto público em educação: Uma avaliação na região do Seridó Potiguar (2008-2015). Research, Society and Development, 8(12), e138121602. https://doi.org/10.33448/rsd-v8i12.1602.

Kaveski, I. D. S., Mazzioni, S., & Hein, N. (2013). A eficiência na utilização de recursos no setor de saúde: uma análise dos municípios do oeste catarinense. Revista de Gestão Em Sistemas de Saúde, 2, 53–84. https://doi.org/10.5585/rgss.v2i2.72

Macedo, M. A. da S., Ferreira, A. C. de S., & Cruz, C. F. da. (2011). Índice De Desenvolvimento Sustentável: Uma Análise Apoiada Em Dea Para Os Municípios do Estado do Rio de Janeiro. Gestão & Regionalidade, 27(81), 19–31. https://doi.org/10.13037/gr.vol27n81.1108.

Machado Junior, S. P., Irffi, G., & Benegas, M. (2011). Análise da Eficiência Técnica dos Gastos com Educação, Saúde e Assistência Social dos Municípios Cearenses. Planejamento e Políticas Públicas, (36), 87-113. http://www.repositorio.ufc.br/handle/riufc/814.

Marinho, A. (2003). Avaliação da eficiência técnica nos serviços de saúde nos municípios do Estado do Rio de Janeiro. Revista Brasileira de Economia, 57(3), 515–534. https://doi.org/10.1590/S0034-71402003000300002

Mathiasen, D.G. (1999). The New Public Management and Its Critics. International Public Management Journal. 2(1), 90-111.

Matias-Pereira, J. (2018). Administração Pública (5 ed). São Paulo: Atlas.

Mazon, L. M., Mascarenhas, L. P. G., & Dallabrida, V. R. (2015). Eficiência dos gastos públicos em saúde: Desafio para municípios de Santa Catarina, Brasil. Saúde e Sociedade, 24(1), 23–33. https://doi.org/10.1590/S0104-12902015000100002

Modesto, P. (2014). Notas para um debate sobre o princípio da eficiência. Revista do Serviço Público, 51(2), 105–119. https://doi.org/10.21874/rsp.v51i2.328

Moritz, S., & Bartz-Beielstein, T. (2017). ImputeTS: Time Series Missing Value Imputation in R. The R Journal, 9(1), 207-218. 10.32614/RJ-2017-009.

OMS, O. M. da S. (2010). Relatório mundial da saúde: financiamento dos sistemas de saúde: o caminho para a cobertura universal. Retrieved from www. who.int/whr/2010/whr10_pt.pdf

OPAS/OMS, P.A. da S. O. (2012). Estratégia de Cooperação Técnica da OPAS/OMS com a República Federativa do Brasil, 2008-2012. Brasília: OPAS/OMS.

Purohit, B. C. (2014). Efficiency of social sector expenditure in India: a case of health and education in selected Indian states. Healthcare in Low-Resource Settings, 2(1). https://doi.org/10.4081/hls.2014.1866

Rezende, A. J., Slomski, V., & Corrar, L. J. (2005). A gestão pública municipal e a eficiência dos gastos públicos: Uma investigação empírica entre as políticas públicas e o Índice de Desenvolvimento Humanao (IDH) dos municípios do estado de São Paulo. Revista Universo Contábil, 1(1), 24–40.

Santos, F. R., Jankoski, A. R. M. C., Oliveira, A. G., & Rasoto, V. I. (2017). O Orçamento-Programa e a Execução das Políticas Públicas. Revista do Serviço Público. 68(1), 191-212.

Silva, M. C. da, Maciel, J. H. B. A., Chacon, M. J. M., & Oliveira, A. (2008). Gastos com Saúde: uma Análise do Cumprimento da Emenda Constitucional no 29 / 2000 pelos 100 Municípios Brasileiros mais Populosos, no período de 2000 a 2008. REUNIR – Revista de Administração, Contabilidade e Sustentabilidade, 2(1), 1–20.

Sousa, M. da C. S. de., & Ramos, F. S. (1999). Eficiência técnica e retornos de escala na produção de serviços públicos municipais: o caso do nordeste e do sudeste brasileiros. Revista Brasileira de Economia, 53(4), 433–461.

Souza, F. J. V. de., & Barros, C. da C. (2013). Eficiência Na Alocação De Recursos Públicos Destinados a Assistência Hospitalar Nos Estados Brasileiros. Revista de Gestão, Finanças e Contabilidade, 3(1), 71–89.

Varela, P. S., Martins, G. D. A., & Favero, L. P. L. (2010). Production efficiency and financing of public health: an analysis of small municipalities in the state of Sao Paulo-Brazil. Health Care Management Science, 13(2),112–123.https://doi.org/10.1007/s10729-009-9114-y

Wallmeler, F., Helmig, B., & Feeney, M. K. (2018). Knowledge Construction in Public Administration: A Discourse Analysis of Public Value. Public Administration Review, 8 Nov, 488-499. https://doi.org/10.1111/puar.13005

Wilbert, M. D., & D´Abreu, E. C. C. F. (2013). Eficiência dos Gastos Públicos na Educação: Análise dos Municípios do Estado de Alagoas. Advances in Scientific and Applied Accounting, 6(3), 348–372.

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Published

2021-11-28

Issue

Vol. 10 No. 15

Section

Review Article

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Copyright (c) 2021 Alessandro Lepchak; Saulo Silva Lima Filho; Eduardo Oliveira da Silva; Blênio Cezar Severo Peixe

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Analysis of the efficiency in the use of health resources in the largest brazilian municipalities. Research, Society and Development, [S. l.], v. 10, n. 15, p. e382101522669, 2021. DOI: 10.33448/rsd-v10i15.22669. Disponível em: https://rsdjournal.org/rsd/article/view/22669. Acesso em: 5 dec. 2025.