This research study aimed to build a performance assessment method to evaluate the technical efficiency of São Paulo State municipalities regarding the use of public resources for primary healthcare and to analyze the influence of non-controllable variables in the production process in this area. Technical efficiency is one of the performance assessment variables for public managers, reflecting an entity's ability to maximize outputs with the lowest consumption of inputs. Achieving this may be impaired or favored by environmental or non-controllable variables. These can give rise to biases if they are not considered in the performance assessment. Therefore, using two-stage Data Envelopment Analysis (DEA), the cities' efficiency scores were estimated and later adjusted through regression analysis. The results indicated that a considerable increase of health services for the population is possible with no added healthcare budget in most cities. Furthermore, the study found that a larger elderly population within a jurisdiction makes service delivery more expensive, while higher population density, urbanization level and scale of health establishments enhance efficient public spending. The five cities that were found to be most efficient were: Tuiuti, Nova Guataporanga, Sabino, Lins and Santos.
controllership; performance evaluation; efficiency; primary health care; municipalities
