EFFICIENCY EVALUATION OF PRIVATE HOSPITALS IN BRAZIL: A TWO-STAGE ANALYSIS

ABSTRACT Purpose: This study aims to describe the efficiency of private hospitals in Brazil and to understand the influence of property structure, specialization, accreditation, and teaching activity on the efficiency of private hospitals. Originality/value: Our findings suggested that private hospitals’ efficiency stands out due to their quest for quality and safety certification and investigates controversial factors in the hospital efficiency literature. Besides, it contributes to the development of the national literature as regards hospitals efficiency in Brazil through a two-stage analysis. Design/methodology/approach: The efficiencies of 98 hospitals of the National Association of Private Hospitals (ANAHP) were estimated through the modeling Data Envelopment Analysis (DEA). Three inputs and three outputs were selected referring to the performance of hospitals in the year 2017. In the first stage, the input-oriented efficiencies were analyzed using a non-discretionary variable. In the second, bootstrapped measures were estimated, and the influences of hospital efficiency factors were investigated through econometric models. Findings: The results enabled the description of resource management aspects related to the inputs and outputs investigated, to improve efficiency in private hospitals in Brazil, and to understand the influence of ownership, specialization, and accreditation factors on the efficiency of private hospitals.

摘要
研究目的：本研究旨在剖析巴西私立医院的运营效率，并探究产权结构、专科定位、认证资质与教学活动对其效率的影响。
研究创新与学术价值：本研究发现，私立医院的效率优势源于其对质量与安全认证的不懈追求，同时针对医院效率研究领域中颇具争议的若干影响因素展开了深入探讨。此外，本研究通过两阶段分析框架，为巴西本土关于医院效率的学术研究发展提供了新的实证支撑。
研究设计与方法：选取巴西全国私立医院协会（ANAHP, National Association of Private Hospitals）旗下的98家医院作为研究样本，通过构建数据包络分析（Data Envelopment Analysis, DEA）模型测算其运营效率。研究选取2017年医院运营的3项投入指标与3项产出指标，用以表征其运营绩效。第一阶段采用非自由处置变量，开展投入导向型效率分析；第二阶段则通过Bootstrap自助法（Bootstrap）测算效率值，并借助计量经济学模型探究医院效率的各类影响因素。
研究结果：本研究结果可明确与所选投入、产出指标相关的资源管理要点，为优化巴西私立医院的运营效率提供实践参考；同时厘清了产权结构、专科定位与认证资质等因素对私立医院效率的影响路径。