Avaliação de Eficiência Técnica e Mudança de Fronteira de Produção em Hospitais de Ensino: Uma Análise Multidimensional Pré e Pós-Pandemia

Abstract

Different criteria may be involved in evaluating the efficiency of teaching hospitals, institutions that offer internships, practical experience, and research opportunities for students and residents. However, in the public context, these institutions have historically faced budget constraints and low investment, and more recently, the Covid-19 pandemic has further strained the public health sector, making it central to global political debate. The state of the art in the literature demonstrates the existence of various models for evaluating the technical efficiency of hospitals, with fewer models specialized in assessing the performance of teaching hospitals. Additionally, there is a need to incorporate economic- financial and quality aspects into hospital efficiency assessment models. An efficiency evaluation based on models more calibrated to the reality of these institutions can provide more practical and appropriate solutions for their management and public policies. Thus, this study aims to validate a multidimensional model to evaluate the technical efficiency frontier of Federal University Hospitals in the Ebserh Network during the pre- and post-Covid-19 pandemic years. For this purpose, the efficiency of 37 Federal University Hospitals in the Ebserh Network was assessed to determine how it changed between 2019 and 2022 and how did the production frontier behave during this period. After an integrative literature review that culminated in the proposal of a framework of input and output variables used to evaluate the efficiency of teaching hospitals, this study employed multivariate statistical analysis techniques to determine the variables incorporated into the multidimensional model, which was tested through Data Envelopment Analysis and the Malmquist Index, solidifying the longitudinal approach of this thesis. The study revealed that 81% and 72% of the evaluated hospitals operated below the optimal level in 2019 and 2022, respectively. Most efficient Federal University Hospitals (HUFs) operate at extreme levels of complexity, and three hospitals in the Northeast region of Brazil became efficient in 2022, after the pandemic. Additionally, there was an unexpected decrease in total factor productivity, revealing that the positive technical change over time for the hospitals analyzed was insufficient to sustain an increase in their production function, given the changes and constraints faced during the pandemic. In addition to proposing research agendas, it was found that it is possible to expand the production capacity of the analyzed university hospitals, offering insights that may generate managerial and technical implications with an impact on Brazilian public policy, considering the size of the Federal University Hospital Network managed by Ebserh.