Federalismo e gastos em saúdecompetição e cooperação nos municípios da região metropolitana de São Paulo

Resumo

The objective of this investigation was to examine the implications of the Brazilian federative structure in the comparative evaluation of publicspending performance in the health sector. Its further aim was to discuss the accountability of municipal public administrators and evaluate the technical efficiency of the municipalities of the São Paulo Metropolitan Region in terms of primary health-care. Primary health-care is the only sub-function that is the exclusive responsibility of local managers. Other health responsibilities are shared by the municipalities and the other federation entities, union and states. To explore the characteristics of cooperative and competitive federalism, data collected from the municipalities and aggregated for the different health regions that comprise the metropolitan region were analyzed. The study's focus was the technical efficiency, which is theability of an entity to obtain maximum outputs with fewer inputs. The analysis was performed using the Data Envelopment Analysis (DEA) method. The results showed a wide dispersion of municipality data in terms of both expenditure and the number of procedures performed, including coverage of the main primary health-care programs: the Family Health Program (Programa de Saúde da Família - PSF) and the Community Health Agents Program (Programa de Agentes Comunitários de Saúde - PACS). The results show that less than 20% of the municipalities are efficient. The analysis of the municipalities within their respective regions suggests the prevalence of competitive over cooperative practices. Such information may help improve the integration of services in health-care networks and encourage the reconsideration of the agreements existing between municipalities in a given health-care region. Furthermore, this article can contribute to the current debate on controllership in the public sector by outlining the potentialities and limitations of the methods used to generate information for decision making.

Ficha do documento

Tipo

Artigo científico

Ano

2012

Instituição

Universidade de São Paulo, Faculdade de Economia, Administração e Contabilidade, Departamento de Contabilidade e Atuária

Fonte

Repositório da FGV

Idioma

Português

Acesso

Acesso aberto

DOI

10.1590/S1519-70772012000200004

Identificador

oai:repositorio.fgv.br:10438/21471

Temas

Gestão PúblicaFinanças PúblicasDesenvolvimento RegionalSaúdeGestão Municipal

Palavras-chave

Competition and cooperation in federalismUnified Health System (Sistema Único de Saúde - SUS)Comparative performance assessmentEfficiency of public spendingMetropolitan Region of São PauloCompetição e cooperação federativaSistema Único de Saúde (SUS)Avaliação comparativa de desempenhoEficiência dos gastos públicosRegião Metropolitana de São PauloFinançasSaúde pública - São Paulo, Região Metropolitana de (SP)Sistema Único de Saúde (Brasil)Despesa pública