Estudos de eficiência em saúde no Brasil por análise envoltória de dados: revisão integrativa

Abstract

Introduction: The technique known as Data Envelopment Analysis (DEA) is important management tool to assist administrators, managers and managers in planning and evaluation of the quality of services provided to society in the most diverse segments and levels of health care, strengthening and directing decision-making to reach the health efficiency. Objectives: Update the state of the art and present an overview of the applicability of studies that used DEA to assess health efficiency in Brazil, considering the most used decision-making units (DMUs). Methods: It is of an integrative literature review, carried out from a bibliographic survey, with articles collected in Scielo, Lilacs, Medline, PubMed, Scopus and Portal de Capes periodicals. Results: For analysis were identified 42 articles evaluating the health efficiency in Brazil that used the DEA methodology. 47.6% (20) of the publications are concentrated in the years 2012 to 2014. The decision-making units (DMUs) presented in the analyzed studies were: regional health department, microregion, health plan operator, clinical research, basic health unit and laboratory of pathological anatomy (2.4% or 1 article each); state (14.3% or 6 articles); municipality (33.3% or 14 articles); hospital, (38.1% or 16 articles). In municipal evaluations, there was greater concentration of studies in the South and Southeast regions. 69.0% (29 articles) used the model DEA-VRS and 16.7% (7) DEA-CRS. 78.6% (33 articles) had output orientation and 19.0% (8) they were input-oriented. Discussion: The scope of DEA applications in Brazil and the methodology has been improving in recent years. Although the hospital prevails in literature as the most frequently studied DMU, we found a small difference numerical in comparison with works that used the municipality as DMU (only 2 articles or 4.8%). This result indicates a trend, already signaled in other studies, of growing search for the evaluation of efficiency related to municipal management, with a view to implementation of new health policies and programs focused on expanding and improving the access to primary care. Conclusion: We envision a change in applicability and contribution of the DEA methodology in health in Brazil, which may become a trend in coming years, which consists of evaluating the efficiency analysis within the scope of management municipal, targeting primary health care.