Philanthropic hospitals benefited by financial incentive program: a performance analysis

Barros, Tanira Gomes de Toledo; Luppi, Carla Gianna

doi:10.1590/0103-1104201811604

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ORIGINAL ARTICLE • Saúde debate 42 (116) • Jan-Mar 2018 • https://doi.org/10.1590/0103-1104201811604 copy

Philanthropic hospitals benefited by financial incentive program: a performance analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The state of São Paulo has adopted a financial incentive program for philanthropic hospitals. The objective of this study was to analyze the performance of the hospitals participating in this program in 2012. Performance indicators were analyzed according to hospital size and municipal size, using the Proadess performance model (Evaluation of Health System Performance). There was a difference in the performance of the hospitals according to the size: small hospitals presented unfavorable results in relation to the indicators of access, efficiency and effectiveness. This result corroborates the need to reassess financial incentive programs for small hospitals configured as general hospitals.

KEYWORDS
Hospital administration; Health services; Service indicators; Health management; Hospital services

Dimension	Indicator	Method of calculation	Data source	Reliability/availability
Access	Number of outpatient procedures/month	Number of outpatient procedures (monthly average in 2012) per hospital unit	Ambulatory Information System (SIA/SUS)	Outpatient information is processed by SIA/SUS, with the Consolidated Ambulatory Production Bulletin (BPA-C), the Individualized Ambulatory Production Bulletin (BPA-I) and the Authorization of High Complexity Procedures (Apac) as data sources. They include all consultations, follow-ups and individual consultations performed by doctors, including when performed in multi-professional care.
Access	Number of hospitalizations/month	Number of hospital admissions (monthly average in 2012) per hospital unit	Hospital Information System (SIH/SUS).	The information about hospitalization has as data sources the Hospitalization Authorizations - AIH (SIH/SUS). This is, for most brazilian states and municipalities, the only source of hospitalization data. It includes only the paid hospitalizations, not all those that were effectively performed by the SUS, according to the limits defined in the physical and financial programming of the SUS. There is a possibility of underreporting of the number of hospitalizations performed in public hospitals financed by direct transfer of resources, and not by production of services.
Access	Number of births/month	Number of hospital deliveries SUS (monthly average in 2012) per hospital unit
Effectiveness	Percentage of Hospitalizations for Conditions Sensitive to Basic Care(ICSAB)	$\frac{N ° ICSAB}{Total of h o s p i t a l i z a t i o n s .} \times 100$
Adequação	Hospital mortality rate	$\frac{\begin{matrix} N ° of Deaths \\ (after 24 h s hospitalization) \end{matrix}}{N ° of hospital e x i t s .}$
Adequação	Hospital mortality rate	$\frac{\begin{matrix} N ° of cesarean \\ deliveries occured \end{matrix}}{Total of deliveries} \times 100$
Eficiência	Hospital Occupancy Rate	$\frac{N ° of patients per day}{Total of beds per d a y .} \times 100$
Eficiência	Average stay	$\frac{N ° of patients per day}{Total of outputs} \times 100$
Efficiency	Proportion between the value set by the Incentive Program and the amount paid by the SUS per institution.	$\frac{Value pro - Holy House II}{Billing value SUS} \times 100$	Hospital Information System(SIH/SUS).	The amounts set by the Regional Interagency Commissions by institution are approved by the BIC and published in the Official State Gazette (DOE). The values paid by SUS production are based on Datasus, which for most municipalities is the only source of data on SUS production.

Population Range	Number of beds
Population Range	≤ 50	%	51 to 150	%	150	%
< 10.000	1	7,69	0	0	0	0
10.000 a 20.000	9	69,23	5	6,94	0	0
20.000 a 50.000	2	15,38	26	36,11	1	3,70
50.000 a 100.000	0	0,00	24	33,33	5	18,52
> 100.000	1	7,69	17	23,61	21	77,78
Total	13	100,00	72	100,00	27	100,00

Indicators	Hospital size (by number of beds)
	≤50		51 to 150		>150		Total
	Median	(P25%; P75%)	Median	(P25%; P75%)	Median	(P25%; P75%)	Median	(P25; P75)
Acess
Nº of outpatient procedures/month	4.731	(2.286; 7.153)	9.307	(6.120; 15.926)	28.909	(18.124; 46.867)	12.449	(6.338; 22.873)
Nº of hospitalizations/month	101	(79; 143)	306	(207; 404)	772	(564; 937)	333	(201; 498)
Nº of births/month	13	(8; 17)	39	(22; 61)	107	(69; 162)	40	(21; 86)
Effectiveness
Percentage of ICSAB	27,7	(22,1; 37,1)	21,5	(15,8; 29,4)	16,5	(12,76; 20,5)	20,9	(15,5; 27,8)
Efficiency
Proportion of the value set by the incentive program and the amount paid by the SUS per institution	40,2	(21,9; 55,8)	25,0	(16,7; 39,9)	9,9	(6,8; 13,1)	21,9	(11,9; 36,4)
Occupancy rate	37,5	(30,1; 47,4)	49,9	(38,8;66,1)	79,6	(69,8; 87,5)	52,7	(38,8; 73,9)
Average stay	3,0	(2,6; 3,2)	3,3	(3,0; 3,8)	4,4	(3,83; 4,9)	3,4	(3,1; 4,1)
Adequacy
Cesarean rate	51,5	(42,8; 77,9)	56,3	(44,4; 70,4)	57,4	(44,36; 68,8)	56,2	(44,3; 70,4)
Hospital mortality rate	3	(2,2; 3,3)	4,4	(3,1; 5,7)	5,7	(4,6; 6,8)	4,5	(3,1; 5,7)

Indicators	Municipal Size
	Up to 50.000 hab.			50.001 to 100.000 hab.			<100.000 hab.
	Hospital size			Hospital size			Hospital size
	≤ 50	51-150	>150	≤50	51-150	>150	≤ 50	51-150	>150
Access
Nº of outpatient procedures/month	4.264	7.609	13.479	-	10.921	27.383	20.380	28.481	32.248
Nº of hospitalizations/month	94	204	298	-	354	652	279	464	808
Nº of births/month	13	21	25	-	45	63	84	90	116
Effectiveness
Percentage of ICSAB	27,8	29,5	35,2	-	20,8	16,9	22,1	13,2	15,3
Efficiency
Occupancy rate	36,1	39,0	31,3	-	54,4	80,0	74,2	83,9	79,6
Average stay	2,9	3,0	3,8	-	3,4	4,0	3,9	4,1	4,5
Proportion of the value set by the incentive program and the amount paid by the SUS per institution	37,7	26,0	17,3	-	25,3	9,4	54,5	16,8	9,9
Adequacy
Cesarean rate	52,3	61,7	86,5	-	58,0	45,2	37,5	42,9	57,4
Hospital mortality rate	2,8	3,9	5,4	-	4,6	5,7	6,3	5,7	5,7

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E-mail: revista@saudeemdebate.org.br

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[1] Collaborators

Tanira Gomes de Toledo Barros: organized the project and the planning. Performed the analysis and interpretation of the data. Elaborated the draft and revised the content. Participated in the final approval of the manuscript. Carla Gianna Luppi: organized the project and the planning. Performed the analysis and interpretation of the data. Elaborated the draft and revised the content. Participated in the final approval of the manuscript.