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Avaliação a nível nacional da Eficiência obtida pelas Unidades de Cuidados na Comunidade, com recurso da técnica Data Envelopment Analysis
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Abstract(s)
A recente reforma dos Cuidados de Saúde Primários (CSP) trouxe desenvolvimentos importantes, como a criação dos Agrupamentos de Centros de Saúde (ACeS) e as Unidades de Cuidados na Comunidade (UCC), consideradas inovadoras pela prestação de cuidados de saúde de âmbito domiciliário e comunitário.
Para uma adequada gestão dos recursos existentes, a avaliação de desempenho é essencial, como é o caso deste trabalho, baseado na técnica não paramétrica Data Envelopment Analysis (DEA). O mesmo teve como principal objetivo a avaliação da eficiência de 241 UCC a nível nacional, com dados referentes ao ano 2019.
Para atingir este objetivo foram desenvolvidos dois modelos: Acesso e Gestão da Saúde e da Doença (ambos baseados na matriz multidimensional das UCC), com uma orientação para maximizar outputs. Esta orientação foi usada nos dois modelos sob o pressuposto Constant Returns to Scale (CRS) e Variable Returns to Scale (VRS).
Nos dois modelos, a percentagem de UCC identificadas como estando nas respetivas fronteiras de boas práticas (em todas as dimensões avaliadas) é baixa. Apenas foram encontradas nos dois modelos, 11 UCC eficientes, sendo que 8 são da Administração Regional de Saúde (ARS) Norte. Estes resultados apontam para a existência de uma margem de manobra alargada, no sentido de melhorar a eficiência destas unidades funcionais, a nível nacional.
Na análise comparativa entre ARS, confirmaram-se os bons resultados da ARS Norte, já a ARS Algarve evidenciou-se no modelo 1 (Acesso) pelo pior resultado obtido. Este resultado pode ser explicado por especificidades próprias das UCC desta ARS.
Finalmente, uma análise de correlação foi usada para identificar as variáveis externas/ambientais com influência na eficiência das UCC, permitindo concluir que as unidades que servem populações mais jovens tendem a apresentar níveis de eficiência no modelo 2 (Gestão da Saúde e da Doença) mais elevados do que as que servem populações mais idosas.
The recent reforms in the Primary Healthcare Services (CSP) led to important developments, such as the creation of Healthcare Center Groups (ACeS) and Community Service Units (UCC), considered pioneers within home care and community healthcare services. For an adequate management of the available resources, performance evaluation is pivotal, such as the one done in this research based on the non-parametric technique Data Envelopment Analysis (DEA). This research had as the main objective to evaluate the efficiency of 241 UCC at a national level, using data from 2019. To reach this goal, two models were developed: Access and Management of Health and Disease (both based on the multidimensional matrix of the UCC), aimed at maximizing outputs. This orientation was used in both models assuming Constant Returns to Scale (CRS) and Variable Returns to Scale (VRS). In both models, the percentage of UCC identified as being within the good practice frontier is low. Only eleven UCC obtained the best possible score in both models, eight of them belonging to the Regional Health Administration (ARS) of the North. These results point to the existence of considerable room for improvement at the national level in which regards the services provided by these functional units. When comparing the results by ARS, it was possible to confirm the good results of ARS North and that the ARS Algarve displayed the worst performance in model 1 related with the access to the services. These results are explained in part by the intrinsic specificities of the UCC belonging to this ARS. Finally, a correlation analysis was used to identify the external variables with influence on the UCC’s efficiency, allowing us to conclude that the units that serve younger populations tend to present higher efficiency levels in model 2 (Management of Health and Disease) than the ones serving older populations.
The recent reforms in the Primary Healthcare Services (CSP) led to important developments, such as the creation of Healthcare Center Groups (ACeS) and Community Service Units (UCC), considered pioneers within home care and community healthcare services. For an adequate management of the available resources, performance evaluation is pivotal, such as the one done in this research based on the non-parametric technique Data Envelopment Analysis (DEA). This research had as the main objective to evaluate the efficiency of 241 UCC at a national level, using data from 2019. To reach this goal, two models were developed: Access and Management of Health and Disease (both based on the multidimensional matrix of the UCC), aimed at maximizing outputs. This orientation was used in both models assuming Constant Returns to Scale (CRS) and Variable Returns to Scale (VRS). In both models, the percentage of UCC identified as being within the good practice frontier is low. Only eleven UCC obtained the best possible score in both models, eight of them belonging to the Regional Health Administration (ARS) of the North. These results point to the existence of considerable room for improvement at the national level in which regards the services provided by these functional units. When comparing the results by ARS, it was possible to confirm the good results of ARS North and that the ARS Algarve displayed the worst performance in model 1 related with the access to the services. These results are explained in part by the intrinsic specificities of the UCC belonging to this ARS. Finally, a correlation analysis was used to identify the external variables with influence on the UCC’s efficiency, allowing us to conclude that the units that serve younger populations tend to present higher efficiency levels in model 2 (Management of Health and Disease) than the ones serving older populations.
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Keywords
Eficiência Data envelopment analysis (dea) Unidades de cuidados na comunidade(ucc) Cuidados de saúde primários (csp) Variáveis externas