Evaluation of the performance of actions and outcomes in primary health care

Miclos, Paula Vitali; Calvo, Maria Cristina Marino; Colussi, Claudia Flemming

doi:10.11606/S1518-8787.2017051006831

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Sumário

Original Articles • Rev. Saúde Pública 51 • 2017 • https://doi.org/10.11606/S1518-8787.2017051006831 copy

Evaluation of the performance of actions and outcomes in primary health care

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

The objective of this study has been to evaluate the performance of the primary care of Brazilian municipalities in relation to health actions and outcomes.

METHODS

This is an evaluative, cross-sectional research, with a quantitative approach, aimed at the identification of the efficiency frontier of the primary care in health actions and outcomes in Brazilian municipalities. Secondary data have been collected from the Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (National Program for Improving Access and Quality of Primary Care) and the Department of Informatics of the Brazilian Unified Health System, in 2012. The data envelopment analysis tool has been used for variable returns to scale with product orientation.

RESULTS

Municipalities have been analyzed by population size, and small municipalities have presented a high percentage of inefficiency for both models.

CONCLUSIONS

The analysis of efficiency has indicated the existence of a higher percentage of effective municipalities in the model of health actions than in the model of health outcomes.

Primary Health Care; Basic Health Services; Health Evaluation; Health Services Evaluation; Efficiency, Organizational; Decision Making

	Model 1 (Health Actions) Indicator	Source
Inputs	Model 1 (Health Actions) Indicator	Source	Number of Primary Care physicians	PMAQ-AB
	Number of Primary Care nurses	PMAQ-AB
	Number of basic health units with vaccination room	PMAQ-AB
	Number of basic health units with sonar or pinard	PMAQ-AB
Products	Number of home visits performed by Primary Care physician and nurse	PCIS
	Number of prenatal care appointments performed by Primary Care physician or nurse	PCIS
	Number of appointments or individual appointments performed by Primary Care nurse	PCIS
	Number of 3rd dose applied for tetra and pentavalent vaccines	IS-NIP
Controls	Number of Primary Care physicians per 1,000 inhabitants	PMAQ-AB/IBGE
	Number of Primary Care nurses per 1,000 inhabitants	PMAQ-AB/IBGE
	Percentage of basic health units with vaccination room	PMAQ-AB/IBGE
	Percentage of basic health units with devices – sonar or Pinard stethoscope	PMAQ-AB/IBGE

Model 2 (Outcomes)

Insumos	Number of Primary Care physicians	PMAQ-AB:
	Number of Primary Care nurses	PMAQ-AB:
	Number of basic health units	PMAQ-AB:
Produtos	Percentage of live births with normal birth weight	SINASC
Produtos	Percentage of hospitalization from non-primary care sensitive conditions	HIS
Controles	Number of Primary Care physicians per 1,000 inhabitants	PMAQ-AB/IBGE
	Number of Primary Care nurses per 1,000 inhabitants	PMAQ-AB/IBGE
	Number of Basic Health Units per 1,000 inhabitants	PMAQ-AB/IBGE

Size (1,000 inhabitants)	Region	Municipalities	Model 1		Model 2

		Total	n	%	n	%
1 (up to 5)	Midwest	144	57	39.6	85	59.0
	North	84	27	32.1	46	54.8
	Northeast	240	95	39.6	118	49.2
	South	435	140	32.2	209	48.0
	Southeast	395	100	25.3	168	42.5
	Total	1,298	419	32.3	626	48.2
2 (5 ┤ 10)	Midwest	103	50	48.5	62	60.2
	North	83	19	22.9	19	22.9
	Northeast	366	191	52.2	237	64.8
	South	268	81	30.2	108	40.3
	Southeast	390	135	34.6	186	47.7
	Total	1,210	476	39.3	612	50.6
3 (10 ┤ 20)	Midwest	108	45	41.7	54	50.0
	North	106	23	21.7	30	28.3
	Northeast	587	335	57.1	415	70.7
	South	232	99	42.7	128	55.2
	Southeast	355	146	41.1	199	56.1
	Total	1,388	648	46.7	826	59.5
4 (20 ┤ 50)	Midwest	76	30	39.5	32	42.1
	North	113	17	15.0	19	16.8
	Northeast	427	224	52.5	261	61.1
	South	152	41	27.0	47	30.9
	Southeast	287	90	31.4	105	36.6
	Total	1,055	402	38.1	464	44.0
5 (50 ┤ 100)	Midwest	17	3	17.6	2	11.8
	North	39	3	7.7	4	10.3
	Northeast	115	37	32.2	38	33.0
	South	53	8	15.1	8	15.1
	Southeast	102	15	14.7	15	14.7
	Total	326	66	20.2	67	20.6

Size		Variable of Model 1												Variable of Model 2

		I1	I2	I3	I4	P1	P2	P3	P4	P5	P6	P7	P8	I1	I2	I3	P1	P2	P3	P4	P5
1	Average	1.5	1.5	1.2	1.3	483.9	243.1	0.5	0.5	1.836.4	40.3	83.3	88.5	1.5	1.5	1.5	0.4	0.5	0.4	67.8	92.1
	SD	0.6	0.6	0.4	0.5	333.4	134.2	0.1	0.1	1.450.4	17.6	25.9	22.6	0.6	0.6	0.6	0.1	0.1	0.1	12.8	5.2
	Min.	1	1	1	1	52	17	0.2	0.2	126	6	20	20	1	1	1	0.2	0.2	0.2	17.1	69.2
	Max.	4	3	3	4	1.745	661	0.9	0.8	7.279	117	100	100	4	3	3	0.9	0.8	0.8	100	100
2	Average	3.2	3.2	1.9	2.4	951.4	530.9	0.4	0.4	4.478.5	94.1	62.7	77.8	3.2	3.1	3.2	0.4	0.4	0.4	65.4	92.2
	SD	1.1	1	0.9	1	607.7	243.8	0.1	0.1	2.780.7	31	28.6	25.6	1.1	1	1	0.1	0.1	0.1	12.6	3.4
	Min.	2	2	1	1	134	33	0.2	0.2	431	29	10	10	2	2	2	0.2	0.2	0.2	20.6	75.4
	Max.	7	7	5	7	3.034	1.131	0.9	0.8	13.793	246	100	100	7	7	7	0.9	0.8	0.8	100	100
3	Average	6.1	6	3.6	4.6	1.601.4	1.086.5	0.4	0.4	9.905.1	199.1	61.9	78.8	5.9	5.9	5.9	0.4	0.4	0.4	62.2	92.5
	SD	2.2	1.9	1.8	1.7	1.063.3	511.3	0.1	0.1	5.465.2	65.2	28.1	22.7	2.1	1.9	1.9	0.1	0.1	0.1	13.5	2.4
	Min.	3	3	1	1	268	56	0.2	0.2	762	68	8.3	14.3	3	3	3	0.2	0.2	0.2	8.3	80.4
	Max.	17	14	10	10	6.264	2.554	0.9	0.8	27.690	448	100	100	17	14	14	0.9	0.8	0.8	95.3	98.2
4	Average	10.9	10.8	7	8.4	2.786	2.219.3	0.4	0.4	20.224.2	419.4	67.7	81.1	10.8	10.7	10.6	0.4	0.4	0.4	62.8	92.3
	SD	3.7	3.4	3.1	2.8	1.931.4	1.058.1	0.1	0.1	10.725.5	142.4	25.6	19.1	3.7	3.4	3.4	0.1	0.1	0.1	11.9	1.9
	Min.	5	6	1	2	630	117	0.2	0.2	1.420	166	5.3	12.5	5	5	5	0.2	0.2	0.2	13.5	86.4
	Max.	32	25	19	19	15.385	6.030	0.9	0.7	64.642	954	100	100	32	25	25	0.9	0.7	0.8	85.7	98.5
5	Average	22	21.4	14.2	16.9	5.174	4.877.4	0.3	0.3	43.195.1	958.7	70.5	83.2	21.6	21.1	20.7	0.3	0.3	0.3	66.2	92.1
	SD	5.1	4.5	4.8	4.6	2.528.3	1.989.8	0.1	0.1	18.517.8	258.4	23	17.1	5.1	4.6	5.4	0.1	0.1	0.1	10.8	1.5
	Min.	14	14	4	5	1.886	931	0.2	0.2	10.634	447	23.3	33.3	14	13	14	0.2	0.2	0.2	36.1	89.5
	Max.	35	32	26	28	13.523	10.097	0.5	0.5	97.744	1.731	100	100	35	32	43	0.5	0.5	0.6	84	95.9

Population size	Inefficient		Efficient for itself		Efficient for more than 1 DMU

	n	%	n	%	n	%
Model 1	1,284	63.8	362	18.0	365	18.2
Size 1	378	90.2	16	3.8	25	6.0
Size 2	282	59.2	93	19.5	101	21.2
Size 3	384	59.3	142	21.9	122	18.8
Size 4	221	55.0	84	20.9	97	24.1
Size 5	19	28.8	27	40.9	20	30.3
Model 2	2,325	89.6	110	4.2	160	6.2
Size 1	613	97.9	3	0.5	10	1.6
Size 2	540	88.2	23	3.8	49	8.0
Size 3	729	88.3	38	4.6	59	7.1
Size 4	403	86.9	29	6.3	32	6.9
Size 5	40	59.7	17	25.4	10	14.9

Efficiency	Porte do município n (%)

	1	2	3	4	5	Total
Inefficient in the two models	332 (88.1)	238 (56.4)	362 (58.0)	211 (53.3)	13 (21.3)	1,156 (61.5)
Inefficient in one model and efficient for several municipalities in the other	30 (8.0)	81 (19.2)	90 (14.4)	65 (16.4)	11 (18.0)	277 (14.7)
Efficient only for itself in only one of the models	15 (4.0)	72 (17.1)	120 (19.2)	79 (19.9)	16 (26.2)	302 (16.1)
Efficient for itself in the two models	-	3 (0.7)	5 (0.8)	4 (1.0)	7 (11.5)	19 (1.0)
Efficient for itself in one model and for several municipalities in the other	-	14 (3.3)	27 (4.3)	19 (4.8)	12 (19.7)	72 (3.8)
Efficient for several municipalities in the two models	-	14 (3.3)	20 (3.2)	18 (4.5)	2 (3.3)	54 (2.9)

Total	377 (100)	422 (100)	624 (100)	396 (100)	61 (100)	1,880 (100)

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[1] Correspondence: Paula Vitali Miclos. Av. Miguel Stéfano, 400 Saúde, 04301-000 São Paulo, SP, Brasil. E-mail: pvmiclos@gmail.com