Efficiency of Primary Health Care Spending by Municipalities in the Metropolitan Region of Sao Paulo: A Comparative Analysis Pf DEA Models

By Varela, Patricia Siqueira; de Andrade Martins, Gilberto | Review of Business, Winter 2011 | Go to article overview

Efficiency of Primary Health Care Spending by Municipalities in the Metropolitan Region of Sao Paulo: A Comparative Analysis Pf DEA Models


Varela, Patricia Siqueira, de Andrade Martins, Gilberto, Review of Business


Executive Summary

Purpose: This research aimed to assess the technical efficiency of municipalities in the metropolitan region of Sao Paulo regarding the application of public resources in primary health care actions, and to compare the results and information produced by three Data

Envelopment Analysis (DEA) models:

1. basic-BM;

2. with non-controllable variables and use of regression analysis - NCVR; and

3. with non-controllable variables and based on the model by Banker and Morey (1986)-NCVBM.

Design/methodology/approach: The formulation of efficiency models for primary health care was based on the writings of classical authors on public good production and efficiency analysis. Two theoretical arguments of management control literature were essential in the analysis: (1) managers should be assessed according to the variables within their control, and (2) benchmarking standards permit adjusting assessments to the current operating experience and to the economic circumstances the entities face along a given period. In the DEA Basic Model, efficiency scores were calculated based on paid out expenses with primary health care procedures and the quantity of direct outputs produced by each sub-function of health care. Environmental variables were tested using correlation analysis, but the variable that indicated influence on the efficiency scores calculated in the Basic Model was population density, favoring decreased inefficiency. Two models with non-controllable variables were applied in the analysis: score adjustment based on regression analysis - NCVR, and the model based on Banker and Morey (1986)-NCVBM.

Findings: As for the information produced by the three DEA models, it will be difficult for municipalities with unfavorable environmental conditions to be part of the efficiency frontier in the basic model, with consequent punishment to their managers. Models with non-controllable variables permit assessing the influence of their manager's decisions in relation to the allocation of public resources on the results achieved. Between the two models bearing non-controllable variables, NCVBM not only adjusts the ranking of municipalities, but also gives the possibility of projecting improvement objectives regarding the use of resources in service rendering, and may therefore be considered the best model to assess public managers. The results also indicated that it was possible to raise the quantity of services rendered to the population considerably without the need of more budget resources.

Research limitations/implications: This study focused on primary health care, but other sub-functions of health should also be assessed, such as medium and high-complexity outpatient and hospital care. In addition, other regions in Sao Paulo should also be assessed to verify which environmental variables interfere in performance and how.

Practical implications: This study identifies the information that each model offers, as well as their limitations for efficiency analysis. It may contribute to the discussion on assessment of public managers' performance, since knowing the influence of environmental variables on the results of public policies will help define the criteria that take into consideration the horizontal inequalities among municipalities; it may also become support to the improvement of methodologies by external control entities, mainly Audit Courts.

Originality/value: Comparative performance assessment permits identifying management's weak points, as well as those aspects that might be taken as a reference for other jurisdictions, putting into practice one of the advantages of federal structures like the one in Brazil, i.e. learning through a range of experiences. This study contributed to indicate possibilities and restrictions for comparative performance evaluation when the three models of DEA are used.

1. Introduction

The last decades have been marked by recent efforts to modernize public management, based on the dissemination of the principles of new public management, whose focus is on result-oriented management and efficient resource use. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

Efficiency of Primary Health Care Spending by Municipalities in the Metropolitan Region of Sao Paulo: A Comparative Analysis Pf DEA Models
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Author Advanced search

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.