Eficiência na oferta de saúde pública no Estado do Rio de Janeiro no período 2009 a 2019: os efeitos das organizações sociais de saúde

Abstract

The instability in the resources allocated to the health sector and Social Organizations in the administration of some healthcare units expresses uncertainty in the management of public health in Rio de Janeiro. Therefore, the objective is to verify the level of health efficiency in the municipalities of Rio de Janeiro since the entry of Social Organizations in the management of the sector, from 2009 to 2019. To this end, was used the Stochastic Frontier Analysis method, precise in capture random effects that may bias the estimation. The database consist in data on health expenditures and transfers to the sector taken from the SIOPS/DATASUS, socioeconomic data taken from the SIDRA/IBGE and data referring to health production and structural capacity of the units, taken from the TABNET/DATASUS. All databases refer to the 92 municipalities of Rio de Janeiro, in the period between 2009 and 2019. Also includes the amount and value invested in contracts signed between the RJ State Health Department and private entities. Thus, in the face of the concern to lose free and quality public health services guaranteed by the Federal Constitution, the development of this research sought to verify the role of Social Organizations and investigate the effectiveness of the publicprivate partnership in management of health in Rio de Janeiro, contributing with an analysis of the SHO performance and with the observation of the pros and cons of this management model. The results obtained by the research showed a notable relevance of personnel expenses in converting the sector's resources into the production of health services, in addition to a positive relationship between the presence of Social Organizations and technical inefficiency. The estimated efficiency scores revealed an average of 0.85 and the municipalities that achieved optimal efficiency rely on SHO in the administration of their health units, while those with lower levels of effectiveness had only the public sector in their management. However, the model used found that even though the SHO present a direct relationship with inefficiency, the value applied in contracts favors the technical efficiency of the municipality. In view of this, it is concluded that the contracts made by the State Department of Rio de Janeiro with the SHO should be directed to municipalities that have low efficiency scores, to promote equity in the quality of the health sectors of the municipalities in the State.