Efficiency of primary care in Brazilian capitals and management models: 2008-2019

To analyze efficiency in primary health care in Brazilian state capitals in the period 2008-2019, considering the management model: direct public administration or administration assigned to third parties.

This is an evaluative study with an analytical objective, using publicly available secondary data, analyzed cross-sectionally (2019) and longitudinally (2008, 2012, 2016, and 2019). Demographic and socioeconomic data and seven indicators related to primary health care were used to characterize the cities and their primary health care (primary care coverage, hospitalizations for primary care-sensitive conditions, tuberculosis cures, infant, maternal, and premature mortality due to chronic conditions, incidence of congenital syphilis). To these indicators were added health and primary health care expenditures and data envelopment analysis focused on outputs (without admitting a reduction in expenditures) to calculate efficiency in 2008, 2012, 2016, and 2019. The Malmquist index was used to identify possible productivity gains between 2008 and 2019.

Four capitals identified as being managed by third parties (São Paulo, Rio de Janeiro, Porto Alegre, and Fortaleza) did not achieve greater efficiency compared to direct public administration, nor did they evolve when comparing their own results over time. In 2019, and in the longitudinal approach, only capitals managed by direct public administration obtained the maximum relative efficiency index in the comparison between capitals. Twelve capitals with direct public administration remained efficient in all years, while those with third-party administration consistently showed weak inefficiency in primary health care, i.e. in the period studied, the relationship between investments in primary health care and results obtained is lower than that achieved by the efficient capitals.

We found no evidence of efficiency gains with the adoption of third-party management. It should be noted that productive efficiency does not necessarily mean that health needs are met.