Hospital Performance in Brazil: The Search for Excellence

by Forgia, Gerard M. La

• ISBN13: 9780821373583
• ISBN10: 0821373587
• Edition: 1st
• Format: Paperback
• Copyright: 2008-05-01
• Publisher: World Bank

Summary

Hospitals are a critical component of the health care provided to many Brazilians. Hospitals-which absorb nearly 70 percent of public spending on health-are also a critical component of the government's budget, and are thus at the forefront of policy discussions. Why hospitals are important in Brazil is easy to understand. What makes hospitals deliver quality care efficiently-or not-is much harder to grasp.Drawing on an eclectic array of research and evaluative studies selected from a mix of sources, 'Hospital Performance in Brazil: The Search for Excellence' analyzes Brazilian hospital performance along several policy dimensions, including resource allocation and use, payment mechanisms, organizational and governance arrangements, management practices, and regulation and quality.Although a few Brazilian hospitals are world-class centers of excellence, many hospitals, including those who serve Brazil's poorest people, are low performers. Yet the Brazilian hospital system is both dynamic and pluralistic, and herein lies is strength. As is shown throughout the book, the foundations for change-approaches, ideas, innovations, and initiatives for addressing the shortcoming of underperforming facilities-are already present throughout the country's hospital system. Building on these strengths, the authors propose a policy- and practice-based hospital reform agenda that should assist policy makers and practitioners in their "search for excellence".

Table of Contents

Foreword	p. xiii
Acknowledgments	p. xv
About the Authors	p. xvii
Policy Summary	p. xix
Acronyms and Abbreviations	p. xliii
Introduction	p. 1
Why This Book?	p. 2
Objectives, Approach, and Conceptual Framework	p. 3
Audience and Policy Environment	p. 7
Chapter Summaries	p. 8
Sources and Caveats	p. 15
Notes	p. 16
The Brazilian Hospital Sector: Structure, Financing, Spending, and Outcomes	p. 17
The Brazilian Health Sector	p. 17
The Brazilian Hospital Sector	p. 28
Hospital Finance and Spending	p. 36
Summary Assessment	p. 40
An Indirect Method for Estimating Hospital Spending	p. 43
Supplementary Data	p. 44
Notes	p. 47
Comparative Analysis of Costs and Efficiency	p. 51
Hospital Costs: Measurement Challenges and Findings	p. 53
Efficiency Analysis	p. 66
Conclusions and Recommendations	p. 92
Cost Analysis Methodology: The De Matos Cost Study Methodology	p. 96
Supplementary Data	p. 100
Average Cost and Coefficient of Variation for Sample Hospital Procedures	p. 102
DEA Methodology	p. 106
Brazilian Studies on Hospital Efficiency	p. 112
Notes	p. 115
Hospital Payment Mechanisms and Contracting Arrangements	p. 121
Payment Mechanisms for Hospital Care in Brazil	p. 122
Critical Review of PPMs in Brazil	p. 125
The Plight of Private Hospitals under the SUS	p. 132
Payment Mechanisms and Performance	p. 134
Hospital Contracting Arrangements in the SUS	p. 138
Conclusions and Recommendations	p. 146
Characteristics and Effects of Main Provider Payment Mechanisms	p. 151
History of Government PPMs for Hospitals in Brazil	p. 154
Provider Payment Mechanisms Used by the SUS	p. 156
Differential Increases in Reimbursement Rates, 1995-2001	p. 158
From the AIH to DRGs	p. 159
Notes	p. 162
Organizational Arrangements and Performance of Brazilian Hospitals	p. 167
Organizational Arrangements: Framework and Literature	p. 168
Organizational Arrangements in Public Hospitals in Brazil	p. 171
Comparative Review of Organizational Features in Public Hospitals	p. 181
Private Sector Organizational Structures and Governance Arrangements	p. 184
Comparative Performance of Hospitals under Different Ownership and Organizational Arrangements	p. 191
Summary Assessment	p. 198
Organizational Arrangements in Public and Private Hospitals in Brazil: Summary	p. 204
Matrix: Features of Organizational Arrangements in Public Hospitals in Brazil	p. 208
Methods for Analysis of Alternative and Traditional Hospitals	p. 214
Methods for Comparative Analysis of OSS and Direct Administration Hospitals	p. 218
Matrix: Organizational Arrangements in European Hospitals	p. 219
Notes	p. 221
Inside the Black Box: Linking Organizational Arrangements, Managerial Behaviors, and Performance in Public and Private Hospitals	p. 227
Management Practices in Public Hospitals	p. 228
Brazil's Experience with Hospital Conversion: Overcoming Human Resource and Financial Obstacles	p. 246
International Experience with Hospital Conversion	p. 253
Managerial Practices in the Private Nonprofit Sector	p. 257
Summary Assessment and Recommendations	p. 261
Strengths and Weaknesses of the Public Sector Regime for Procurement, Labor, and Budgeting	p. 267
Comparison of Summary Labor Regime Characteristics for Physicians by Organizational Arrangement in Public and Private Nonprofit Hospitals	p. 269
Notes	p. 271
Quality of Care: Still the Forgotten Component?	p. 275
Quality, Quality Improvement, and Costs	p. 275
Quality in Brazilian Hospitals	p. 278
Summary Assessment	p. 298
Policy and Managerial Innovations Across Medical Disciplines, 2000-2005	p. 300
Process Shortcomings in Brazilian Hospitals and Possible Causes	p. 301
Notes	p. 303
Quality Assessment and Improvement	p. 305
Hospital Accreditation and Certification in Brazil: Adoption, Challenges, and Opportunities	p. 305
Other Quality Assessment and Improvement Initiatives	p. 319
Care Coordination Across Provider Levels	p. 323
Summary Assessment and Recommendations: A Framework for Systematic Quality Improvement	p. 328
An Example of ONA Standards and Performance Elements: Obstetrics	p. 335
Government Initiatives to Build National Capacity for Continuous Quality Improvement, 1997-2001	p. 336
Setting the Policy and Institutional Framework for Systematic Quality Measurement and Improvement: Examples from the United States, the United Kingdom, and Australia	p. 337
Hospital Report Cards: Motivating Hospitals to Perform?	p. 339
Quality-Based Purchasing in OECD Countries	p. 340
Notes	p. 342
Conclusions and Recommendations	p. 345
Problems in Brazil's Hospital Sector	p. 346
Building on Brazilian Innovations and Experience	p. 351
What Can be Done? Key Policy Priorities	p. 354
Moving Forward with Implementation	p. 366
Recommended Policies and Actions	p. 369
Notes	p. 374
Bibliography	p. 375
Index	p. 395
Figures
Conceptual Framework for Hospital Performance	p. 5
Main Players and Fund Flows in the Brazilian Hospital Sector	p. 25
Distribution of National Health Expenditure, by Source, 2004	p. 26
Trends in SUS Financing, by Source, 1985-2004	p. 27
Payment and Transfer Flows for SUS Hospitals	p. 29
Hospitals, by Size and Ownership, 2002	p. 30
Long-Term Trends in Bed Supply, 1976-2002	p. 31
Privately Financed and SUS-Financed Patients, 2002	p. 34
Inpatient Care, by Clientele and Hospital Ownership, 2000-3	p. 35
Sources of Hospital Care Financing, 2002	p. 36
Hospital Spending, by Facility Ownership, 2002	p. 37
Hospital Spending, by Line Item, 2002	p. 38
SUS Hospital Spending, by Type of Care, 2002	p. 39
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