The Brazilian Unified National Health System: Proposal of a Cost-effectiveness Evaluation Model

Abstract The Brazilian Unified National Health System (Sistema Único de Saúde [SUS]) is in a prominent position compared to the existing social policies. One of the new tools used by SUS is known as Performance Index of the Unified Health System (Índice de Desempenho do Sistema Único de Saúde [IDSUS]), which is intended to measure the performance of each municipality. Therefore, the aim of this study was to propose a model of cost-effectiveness to compare IDSUS performance against total revenues achieved in Homogeneous Group 2, consisting of 94 municipalities and analysed using data from IDSUS and the System Information of the Public Budget for Health Care (Sistema de Informação do Orçamento Público em Saúde [SIOPS]) for the year 2011. After structuring this data, we carried out descriptive statistical and cluster analysis in order to group similar municipalities in accordance with established variables: IDSUS performance, population and total revenue in health per capita. Even with the division of municipalities into homogeneous groups and after using variables such as population and revenue to regroup them, the results showed there are municipalities with heterogeneous characteristics. Another finding is in the use and intersection of two distinct databases (IDSUS and SIOPS), which allowed for visualizing the impact of health care revenue on the municipalities performance.

摘要 巴西统一国家卫生系统（Sistema Único de Saúde，缩写SUS）在当前社会政策体系中占据重要地位。该系统所采用的新型工具之一为统一卫生系统绩效指数（Índice de Desempenho do Sistema Único de Saúde，缩写IDSUS），其核心目标为衡量各市政辖区的卫生系统运行绩效。本研究旨在构建成本效益模型，针对包含94个市政辖区的同质组2，对比其IDSUS绩效与总营收水平；研究采用2011年IDSUS数据集与公共卫生预算信息系统（Sistema de Informação do Orçamento Público em Saúde，缩写SIOPS）的相关数据开展分析。完成数据结构化处理后，本研究开展描述性统计与聚类分析，依据预设变量（IDSUS绩效、人口规模及人均卫生总营收）对特征相似的市政辖区进行分组。尽管已将市政辖区划分为同质组，并通过人口、营收等变量完成重新分组，分析结果仍显示部分市政辖区存在异质性特征。本研究另一项关键发现为：通过整合并交叉分析IDSUS与SIOPS两个独立数据库，可直观展现卫生营收对市政辖区绩效的影响。