Avaliação da eficiência e da qualidade em hospitais entidades públicas empresariais e sector público administrativo.

Resumo

The main aim of this article is to evaluate the hospital expenditure by user in an efficiency perspective and to evaluate the quality of the health system using process indicators and outcome indicators. In an efficiency perspective the concept of technical efficiency has been chosen, and a correction has been made, as well, in what concerns a case-mix index (CMI). The indicators have been calculated by user in what concerns the main hospital activities (the expenditure in inpatient care by treated patient, in day hospital by treated patient, in outpatient care by consultation, etc), and as well the auxiliary sections of clinic support and the hotel support services. All the indicators have been corrected according to the case-mix index, in 2004, and have been weighted according to the relevance of its expenditure in total expenditure. In a quality perspective two types of indicators have been considered: process indicators and outcome indicators. Process indicators, as the percentage of surgeries in ambulatory care, the percentage of caesareans in total deliveries and the rate of autopsy. The outcome indicator number of episodes of inpatient care due to surgery infection in total days of inpatient care The composite indicator of efficiency, weighted by the inverse of the case-mix index presents the lower values in Tondela, Seia, and Fafe, while the Hospital of the Litoral Alentejano is, in this group, the most inefficient. The Agueda Hospital presents the better Composite Efficiency Indicator, in Group II, followed by the Barcelos and S. João da Madeira Hospitals, while the Figueira da Foz Hospital presents the worst situation. In hospitals from Group III the Hospitals of Vale de Sousa, EPE, and the Vila Franca de Xira Hospital present the better Composite Efficiency Indicator followed by the Barreiro Hospital, EPE. In Group IV it is the Hospital of S. Sebastião, EPE, that presents the lowest Composite Efficiency Indicator, followed by the Cascais Hospital, SPA, and by the Garcia de Orta Hospital, which are the less efficient hospitals. In Group V, with central hospitals and hospitals with functions of central hospital, it is the Hospital of Vila Real/Régua, EPE, to present the best situation of the Composite Efficiency Indicator, followed by the Santo António Hospital, EPE, the Santa Maria Hospital, EPE, and the HUC, while the hospitals with a worst situation of the Composite Efficiency Indicator are the Hospitals of Faro, Evora and S. José. In Group VI hospitals with a better Composite Efficiency Indicator are the hospitals of Santa Marta, Gama Pinto Institute and Orthopedic Hospital of Outão, while the Estefânia Hospital is the most inefficient. Tondela, Valongo and Peniche Hospitals (Group I), have a good value of the Composite Efficiency and Quality Indicator, while Barcelos, Oliveira de Azeméis and Póvoa de Varzim/Vila do Conde Hospitals (Group II) present also good values of this indicator. The Hospitals of Vila Franca de Xira, Bragança and Setúbal (Group III), the Hospitals of Santarém, Garcia de Orta, and Curry Cabral (Group IV), the Hospital of Vila Real/Régua, the Egas Moniz Hospital and the Santa Maria Hospital (Group V), and the Gama Pinto Institute, the Orthopedic Hospital of Outão, and the Santa Cruz Hospital (Group VI) are the best classified in their groups. EPE Hospitals (Hospitals publicly owned with private management) are the best classified in their groups in what efficiency is concerned, what is a better result tan the one shown in 2003. The lower inequality in relation to management indicators, in all hospital groups, exists in the areas of expenditure with inpatient care by user, what shows the existence of a norm of proceeding, in this traditional hospital area. The higher inequalities are those of day hospital, drugs in day hospital, drugs in outpatient care and rehabilitation by user. In what management indicators are concerned incentives must be created. The most efficient hospitals should be compensated and contract-programmes, between other, must be celebrated. The low rate of autopsies, 5.9%, is a indicator of quality which needs an intervention. The inequalities existing in this indicator are high in all hospital groups, due to the fact that most of the hospitals show no activity in this area. The low percentage of surgeries in ambulatory, 17.6 %, which does not exist in several hospitals, show the need for a politic of intervention in this area. The percentage of cesearians in total deliveries is very high in all the hospitals with a low variation coefficient. Norms of intervention should be defined in what management indicators are concerned in relation to the areas of expenditure with day hospital care, drugs in day hospital, drugs in outpatient care and rehabilitation by user. Day hospital, which is more used for hemodyalisis and chimiotherapy should be developed in all hospitals with those specialities, after cost-effective analysis studies with the involvement of the private sector. The area of hotel support, as well in what laundry and food are concerned, present high inequalities in all hospital groups and need a special intervention. Process indicators, as cesearians in total deliveries, ambulatory surgeries intervention, and the rate of autopsies, are important areas of the quality of the hospital and should be developed. The outcome indicator, percentage of inpatient care after surgeries due to infection needs also attention. This area which has already been subject to an intervention with actions at hospital level and specific actions of teaching in this area should be developed due to the high value of this indicator of 0.12%.