Investimentos em saúde pública no estado de Minas Gerais: uma análise da eficiência dos recursos públicos
Arquivos
Data
2019-02-19
Autores
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Federal de Viçosa
Resumo
Neste estudo propôs-se avaliar a gestão dos recursos públicos na área da saúde, de forma a compreender o desempenho e a qualidade do serviço de saúde pública dos municípios mineiros, considerando a análise de eficiência e eficácia. Para atender o objetivo proposto, o estudo foi dividido em três etapas metodológicas. A primeira etapa consistiu na avaliação da eficiência, em que foram avaliados 602 municípios mineiros, no ano de 2015, utilizando duas variações do modelo Análise Envoltória de Dados. O primeiro se chama Modelo de Medidas Específicas (MME), no qual utilizou-se o desenvolvimento municipal como variável não-discricionária, e o segundo modelo utilizado foi a Fronteira Invertida, com o intuito de diferenciar os municípios mais eficientes. Na segunda etapa foi realizada uma Regressão Logística Multinomial, avaliando 544 municípios de Minas Gerais, em que a variável dependente foi o score de eficiência, estratificado em três categorias: Baixa Eficiência, Eficiência Média e Alta Eficiência. As variáveis independentes foram baseadas em elementos condicionantes da saúde. Na terceira etapa, foi realizado um estudo mais aprofundado, em que se escolheu o município com maior eficiência e o de menor eficiência da mesorregião da Zona da Mata mineira. Para esta etapa, os dados foram coletados por meio de entrevistas semiestruturadas com atores envolvidos na implementação das políticas de saúde, e analisados utilizando a técnica de Análise de Conteúdo. Os resultados, possibilitaram perceber que municípios vizinhos tendem a possuir valores de eficiência próximos, devido à regionalidade. Portanto, os municípios de regiões mais carentes necessitam da formulação de políticas públicas capazes de atender à população e melhorar o desempenho dos serviços de saúde pública. Nesse sentido, destaca-se a mesorregião de Jequitinhonha, que apresentou efeito negativo em relação à análise de eficiência. Pôde-se perceber a interferência de políticos locais nos serviços de saúde, executando atos clientelistas nas cidades. Também foi possível identificar elementos que contribuíram para que os municípios selecionados para a pesquisa em campo alcançassem suas respectivas posições no ranking de eficiência. Concluiu-se que municípios de localização próxima apresentaram desempenhos semelhantes, sendo influenciados por suas mesorregiões. Percebeu-se que elementos externos pouco influenciam na eficiência dos investimentos para a saúde, o que torna o gerenciamento das atividades de saúde e a liderança das equipes fundamentais para a eficiência dos municípios.
Faced with the limitations of public health financing, such as the scarcity and distribution of resources, which compromise the provision of quality public services, it is fundamental to seek the efficiency of health services in order to achieve better results. This study aimed to evaluate the management of public resources in the health area, in order to understand the performance and quality of the public health service of the municipalities of Minas Gerais, considering the analysis of efficiency and effectiveness. To meet the proposed goal, the study was divided into three methodological steps. The first step consisted in the evaluation of efficiency, in which 602 municipalities of Minas Gerais were evaluated in the year 2015, using two variations of the Data Envelopment Analysis model. The first one is called the Model of Specific Measures (MME), in which municipal development was used as a non-discretionary variable, and the second model used was the Inverted Frontier, in order to differentiate the most efficient municipalities. In the second stage a Multinomial Logistic Regression was evaluated, evaluating 544 municipalities in Minas Gerais, where the dependent variable was the efficiency score, stratified into three categories: Low Efficiency, Average Efficiency and High Efficiency. The independent variables were based on health conditioning elements. In the third stage, a more detailed study was carried out, in which the municipality with the highest efficiency and the lowest efficiency of the mesoregion of the Zona da Mata was chosen. For this stage, data were collected through semi-structured interviews with actors involved in the implementation of health policies, and analyzed using the Content Analysis technique. The results made it possible to perceive that neighboring municipalities tend to have close efficiency values due to regionality. Therefore, municipalities in the most needy regions need the formulation of public policies capable of serving the population and improving the performance of public health services. In this sense, we highlight the Jequitinhonha mesoregion, which had a negative effect in relation to the efficiency analysis. It was possible to perceive the interference of local politicians in the health services, executing clientelistic acts in the cities. It was also possible to identify elements that contributed to the municipalities selected for field research reaching their respective positions in the efficiency ranking. It was concluded that nearby municipalities presented similar performances, being influenced by their mesoregions. It was noticed that external elements have little influence on the efficiency of investments for health, which makes the management of health activities and leadership of the teams fundamental for the efficiency of municipalities.
Faced with the limitations of public health financing, such as the scarcity and distribution of resources, which compromise the provision of quality public services, it is fundamental to seek the efficiency of health services in order to achieve better results. This study aimed to evaluate the management of public resources in the health area, in order to understand the performance and quality of the public health service of the municipalities of Minas Gerais, considering the analysis of efficiency and effectiveness. To meet the proposed goal, the study was divided into three methodological steps. The first step consisted in the evaluation of efficiency, in which 602 municipalities of Minas Gerais were evaluated in the year 2015, using two variations of the Data Envelopment Analysis model. The first one is called the Model of Specific Measures (MME), in which municipal development was used as a non-discretionary variable, and the second model used was the Inverted Frontier, in order to differentiate the most efficient municipalities. In the second stage a Multinomial Logistic Regression was evaluated, evaluating 544 municipalities in Minas Gerais, where the dependent variable was the efficiency score, stratified into three categories: Low Efficiency, Average Efficiency and High Efficiency. The independent variables were based on health conditioning elements. In the third stage, a more detailed study was carried out, in which the municipality with the highest efficiency and the lowest efficiency of the mesoregion of the Zona da Mata was chosen. For this stage, data were collected through semi-structured interviews with actors involved in the implementation of health policies, and analyzed using the Content Analysis technique. The results made it possible to perceive that neighboring municipalities tend to have close efficiency values due to regionality. Therefore, municipalities in the most needy regions need the formulation of public policies capable of serving the population and improving the performance of public health services. In this sense, we highlight the Jequitinhonha mesoregion, which had a negative effect in relation to the efficiency analysis. It was possible to perceive the interference of local politicians in the health services, executing clientelistic acts in the cities. It was also possible to identify elements that contributed to the municipalities selected for field research reaching their respective positions in the efficiency ranking. It was concluded that nearby municipalities presented similar performances, being influenced by their mesoregions. It was noticed that external elements have little influence on the efficiency of investments for health, which makes the management of health activities and leadership of the teams fundamental for the efficiency of municipalities.
Descrição
Palavras-chave
Administração Pública - Minas Gerais, Saúde Pública - Minas Gerais, Saúde Pública - Administração
Citação
MENDES, Wanderson de Almeida. Investimentos em saúde pública no estado de Minas Gerais: uma análise da eficiência dos recursos públicos. 2019. 82 f. Dissertação (Mestrado em Administração) - Universidade Federal de Viçosa, Viçosa. 2019.