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The determinants of efficiency in Primary Health Care in São Paulo municipalities: a georeferenced model

Abstract

This research aimed to measure the efficiency of expenditures on primary health care in the municipalities of São Paulo and to evaluate their correlation with demographic density and population size of municipalities, as well as with their geographic location and GDP per capita. An ex-post, quantitative, and descriptive valuation of the efficiency of SPS spending was carried out for a sample of the municipalities of São Paulo (n = 509), considering the data for the year 2015. The present research made use of a Data Envelopment Analysis model with Superefficiency to detect and remove outliers. Finally, the magnitude of the relationship between calculated efficiency scores and non-discretionary variables was verified. The average of the efficiency scores after the exclusion of the outliers municipalities became greater (IC99%: 0.127; 0.213). On average, São Paulo municipalities are moderately inefficient in terms of spending on APS (ϴ = 0.488). The municipalities located in the East range of the State of São Paulo tend to have higher levels of efficiency and that the efficiency is inversely proportional to the population size. The SUS has noticed underfunding; however, there is room for improvements in the management of expenses and increase efficiency in the service provided.

Keywords:
Primary Health Care; efficiency; robust scores; determinants

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