Eficiência relativa da gestão pública: uma análise das microrregiões do estado de Minas Gerais

Abstract

Public health assistance is a citizen's right and a duty of the State, being instituted in Brazil by the Federal Constitution of 1,988 through the Unified Health System (SUS), of solidary and participative management by the Union, States and Municipalities. Through decentralization, municipalities are responsible for investing their own resources and those transferred by the State and the Union. Assistance, on the other hand, is organized in a regionalized network aimed at guaranteeing universality, integrality and equality. However, considering that public resources are limited in view of the demands of the population, it is necessary to discuss efficiency. Thus, the objective of this work is to analyze the relative efficiency of public management of the health micro-regions of the State of Minas Gerais from the applied resources. The sample used was the 77 micro-regions of the State of Minas Gerais and the analysis period was 2015, 2016, 2017 and 2018. The data analysis took place in two stages. The first was the estimate of efficiency through Data Envelopment Analysis (DEA), variable scale returns model (BCC) and output orientation. For DEA inputs, the expense paid per capita per subfunction and the Primary Care Coverage were used, and the Child Mortality Rate and the Premature Mortality Rate were used as outputs. The second stage of the data analysis aimed to verify the impact of exogenous variables, percentage of people who do not know how to read and write, GDP per capita, aging index and population density, on efficiency. The Tobit econometric model was used for panel data, since the dependent variable (efficiency scores) is censored or limited to 1. The results showed differences between the micro-regions regarding the use of resources, with the average spending on Primary Care was lower than the average expenditure on Hospital and Outpatient Care in all years. Primary Care Coverage averaged close to 90% in all years, but some micro-regions did not reach 60% of population coverage. The different Premature Mortality Rates and Infant Mortality Rates showed that the results obtained between the micro-regions are heterogeneous and that regionalization is not reaching its main function is to ensure that a region reaches the same objectives as the other micro-regions (SES-MG, 2011). The different characteristics related to population density, aging and GDP per capita, show the need for public policies aimed at minimizing regional inequalities. The efficiency analysis showed that the share of micro-regions with maximum efficiency was a minority, pointing out that much can be done to improve the management of public health resources. The difference in efficiency scores in all the years analyzed shows the inequalities between inputs and outputs in the micro-regions. The micro-regions with the lowest efficiency scores are located more in the center and south of the state. The analysis of the projection of units with low efficiency at the efficiency frontier showed that public health actions and services are well below real capacity. The Premature Mortality Rate in view of the available capacity of resources could be reduced by an average of 36%, 26.1%, 34% and 32.9%, for the years 2015, 2016, 2017 and 2018, respectively. The Infant Mortality Rate, considering the availability of resources, could be reduced by an average of 37.8%, 26.1%, 39% and 33.1% for the years 2015, 2016, 2017 and 2018, respectively. The regression showed that population density and the aging index negatively impact the relative efficiency of public health, whereas GDP per capita had a positive impact. Finally, the results indicated that the formation of Health Care Networks (RAS) needs to be revised, in order to keep up with the growing demands of society. Thus, the planning and management of resources must be directed at the regional level, overcoming local disparities.