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Authors
Abstract(s)
Perante o contexto de mudanças rápidas e dada a pressão para a contenção de custos,
foi necessário que os gestores das instituições prestadoras de cuidados de saúde dessem
uma resposta eficaz. A integração de cuidados de saúde surgiu assim como forma de
dar resposta aos novos desafios dos sistemas de saúde, passando a ser vista como um
meio para melhorar a capacidade instalada e aumentar os padrões de qualidade e
ganhos de eficiência. Contudo, a integração de cuidados por si só, não é suficiente para
garantir melhorias, sendo fundamental que o desempenho deste novo modelo seja
monitorizado.
O principal objetivo deste trabalho passou por conhecer os níveis de desempenho dos
Centros Hospitalares EPE e das Unidades Locais de Saúde EPE nacionais. Para o efeito,
foram avaliados dois dos parâmetros que compõem o desempenho: a eficiência e a
produtividade.
Primeiramente foi aplicada a técnica Data Envelopment Analysis (DEA) que permitiu
avaliar a eficiência relativa dos Centros Hospitalares e das Unidades Locais de Saúde.
Foram usados dados de 2015, 2016 e 2017 e um modelo de DEA baseado em
indicadores de recursos usados (inputs) relativos ao número de camas, número de
médicos e número de enfermeiros e indicadores de atividade realizada (outputs)
relativos ao número de consultas externas, número de cirurgias, número de
atendimentos na urgência e número de doentes saídos do internamento. Nesta análise
foi ainda empregue o pressuposto de rendimentos constantes à escala e uma orientação
de maximização de outputs.
Depois disso foi empregue o índice de Malmquist para avaliar a evolução da
produtividade desses dois tipos de instituições e por fim foi aplicada uma adaptação do
índice de Malmquist, com o intuito de contrapor o desempenho dos Centros
Hospitalares ao das Unidades Locais de Saúde.
Os resultados obtidos revelaram que a generalidade das instituições, nos anos em
análise, estavam a funcionar com baixos níveis de eficiência e produtividade.
Adicionalmente foi possível determinar que os Centros Hospitalares apresentam níveis
de desempenho superiores aos das Unidades Locais de Saúde.
In view of the rapid changes in the healthcare system and the need to maintain lower costs, healthcare managers were forced to provide an economically efficient answer. Clinical integration, appeared as the answer and a mean to improve capacity, quality standards, as well as, efficiency. Nonetheless, clinical integration, on its own will not be enough to ensure improvement. Hence, it is essential to provide close observation and monitoring of this new model. The main goal of this thesis is to evaluate the performance status of the EPE Hospital Centers and national EPE Local Health Units. In order to obtain a comprehensive answer two main parameters were evaluated: efficiency and productivity. Data Envelopment Analysis (DEA) was applied to evaluate the relative efficiency of the Hospital Centers and national Local Health Units. Data from 2015, 2016 and 2017 was collected. As inputs for the DEA model the number of beds, physicians and healthcare workers was collected and as outputs the amount of outpatient appointments, surgical interventions, acute consultations and the number of inpatients. In this analysis the following assumptions were made: constant returns to scale and output orientation. The Malmquist Index was used to evaluate the productivity of these healthcare institutions. Finally, the Malmquist Index was adapted in order to compare the performance of Hospital Centers with that of Local Health Units. The results obtained revealed that most institutions, in the years under analysis, were operating with low levels of efficiency and productivity., it was possible to determine that Hospital Centers have higher performance levels than those of Local Health Units.
In view of the rapid changes in the healthcare system and the need to maintain lower costs, healthcare managers were forced to provide an economically efficient answer. Clinical integration, appeared as the answer and a mean to improve capacity, quality standards, as well as, efficiency. Nonetheless, clinical integration, on its own will not be enough to ensure improvement. Hence, it is essential to provide close observation and monitoring of this new model. The main goal of this thesis is to evaluate the performance status of the EPE Hospital Centers and national EPE Local Health Units. In order to obtain a comprehensive answer two main parameters were evaluated: efficiency and productivity. Data Envelopment Analysis (DEA) was applied to evaluate the relative efficiency of the Hospital Centers and national Local Health Units. Data from 2015, 2016 and 2017 was collected. As inputs for the DEA model the number of beds, physicians and healthcare workers was collected and as outputs the amount of outpatient appointments, surgical interventions, acute consultations and the number of inpatients. In this analysis the following assumptions were made: constant returns to scale and output orientation. The Malmquist Index was used to evaluate the productivity of these healthcare institutions. Finally, the Malmquist Index was adapted in order to compare the performance of Hospital Centers with that of Local Health Units. The results obtained revealed that most institutions, in the years under analysis, were operating with low levels of efficiency and productivity., it was possible to determine that Hospital Centers have higher performance levels than those of Local Health Units.
Description
Keywords
Centros Hospitalares Dea Desempenho Eficiência Índice de Malmquist Integração de Cuidados Produtividade Unidades Locais de Saúde