COVID Health Structure Index: The Vulnerability of Brazilian Microregions.

Many developing countries have highly unequal health systems across their regions. The pandemic of COVID-19 brought an additional challenge, as hospital structures equipped with doctors, intensive care units and respirators are not available to a sufficient extent in all regions. Using Data Envelopment Analysis, we create a COVID Index to verify whether the hospital structures in 543 Brazilian microregions are adequate to deal with COVID-19 and to verify whether public policies were implemented in the right direction. The results indicate that hospital structures in the poorest microregions were the most vulnerable, although the peak of COVID-19 occurred in the richest microregions (Sao Paulo). The Southeast states could relocate hospital resources or even patients between their regions. The relocation was not possible in many states in the Northeast, as the health system poorly assisted the interior of these states. These findings reveal that the heterogeneity of microregions' hospital structures follows the patterns of socioeconomic inequalities. We conclude that it is easier for the wealthier regions to reallocate hospital resources internally than for the poorest regions. By using the COVID Index, policymakers and hospital managers have straightforward information to decide which regions must receive new investments and reallocate underutilized resources.

From income inequality to social inequity: impact on health levels in an international efficiency comparison panel.

BACKGROUND: Health equity, although addressed in several publications dealing with health efficiency analysis, is not easily translated into the operationalization of variables, mainly due to technical difficulties. Some studies provide evidence that it does not influence health outcomes; others demonstrate that its effect is an indirect one, with the hegemony of material living conditions over its social connotation. The aim of this article is to evaluate the role of health equity in determining health outcomes, in an international comparative analysis of the effectiveness and efficiency of health systems. METHOD: Fixed Effects Model Panel and Data Envelopment Analysis, a dynamic and network model, in addition to comparative analysis between methods and health impacts. The effect variables considered in the study were life expectancy at birth and infant mortality, in 2010 and 2015, according to the sociocultural regions of the selected countries. Inequity was assessed both economically and socially. The following dimensions were considered: physical and financial resources, health production (access, coverage and prevention) and intersectoral variables: demographic, socioeconomic, governance and health risks. RESULTS: Both methods demonstrated that countries with higher inequity levels (regarding income, education and health dimensions), associated or not with poverty, are the least efficient, not reaching the potential for effective health outcomes. The outcome life expectancy at birth exhibited, in the final model, the following variables: social inequity and per capita health expenditure. The outcome infant mortality comprehended the level of education variable, in association with the following healthcare variabels: care seeking due to diarrhea in children under five, births attended by skilled health professionals and the reduction in the incidence of HIV. CONCLUSION: The dissociation between the distribution of health outcomes and the overall level of health of the population characterizes a devastating political choice for society, as it is associated with high levels of segregation, disrespect and violence from within. Countries should prioritize health equity, adding value to its resources, since health inequties affect society altogether, generating mistrust and reduced social cohesion.

A Data Envelopment Analysis of the Impact of European Funds on Environmental Indicators.

The European Union (EU) has launched two regional investment programs of European Funds (FE) in the last decade. One covers the period of 2007 to 2013, and the second from 2014 to 2020. Among the goals contained in FE regulations is that of achieving sustainable growth through the conversion of fossil energy production systems to renewable energy. This research has had a goal to determine whether the countries of the Eurozone maintain homogeneous levels of efficiency in the use of these resources to improve the levels of environmental quality related to the use of this type of energy. The adopted research method for efficiency analyses was Data Envelopment Analysis (DEA). Findings revealed that the efficiency in the use of renewable energies is very uneven among the analyzed countries and that these differences are maintained throughout the analyzed period. These results suggest that the criteria for the distribution of the funds should be modified. The current distribution is mainly based on the per capita income of the countries and/or regions. In this way, compliance with the European Green Pact approved in September 2020 would be guaranteed.

Eficiencia en la educación superior. Estudio empírico en universidades públicas de Colombia y España / Eficiência no ensino superior. Estudo empírico em universidades públicas da Colômbia e Espanha / Efficiency in higher education. Empirical study in public universities of Colombia and Spain

Resumen En las últimas décadas, las universidades de Iberoamérica han introducido nuevos esquemas de evaluación de calidad y rendición de cuentas, inspirados en el modelo de la nueva gestión pública (NGP). En este contexto, la eficiencia en el reparto de los fondos públicos y la obtención del máximo rendimiento posible son una prioridad. Así, medir la eficiencia en el sector público, y específicamente en la educación superior, se ha convertido en un desafío para la ciencia contable. El objetivo de este trabajo es una propuesta para el cálculo de índices de eficiencia con modelos de análisis envolvente de datos (DEA), introduciendo un paso previo a través del análisis de correlación canónica (ACC). A través de esta técnica se pretende mejorar la capacidad de discriminación y superar la monodimensionalidad y falta de confiabilidad en la representatividad de las variables input y output elegidas. El estudio se aplicó en las universidades públicas de Colombia y España durante los años 2015 y 2016. Los resultados obtenidos demuestran la conveniencia de aplicar este paso preliminar en el análisis multivariante. Con ello, se refuerza la necesidad de explorar metodologías más rigurosas en etapas previas y posteriores al cálculo de los índices de eficiencia, que permitan generar confianza, a efectos de ser utilizados en la formulación de políticas y gestión de recursos para el sector.

Resumo Nas últimas décadas, as universidades iberoamericanas introduziram novos esquemas de avaliação e prestação de contas, inspirados no modelo da Nova Gestão Pública (NGP). Nesse contexto, a eficiência na distribuição de recursos públicos e a obtenção do máximo retorno possível são uma prioridade. Assim, medir a eficiência no setor público, e especificamente no ensino superior, tornou-se um desafio para a ciência contábil. O objetivo deste trabalho é uma proposta para o cálculo de índices de eficiência com os modelos DEA (Data Envelopment Analysis), introduzindo uma etapa anterior da Análise de Correlação Canônica (ACC). O objetivo dessa técnica é melhorar a capacidade de discriminação e superar a monodimensionalidade e a falta de confiabilidade no quão representativas são as variáveis de entrada e saída escolhidas. O estudo é aplicado nas universidades públicas da Colômbia e Espanha durante os anos de 2015 e 2016. Os resultados obtidos demonstram a conveniência de aplicar esta etapa preliminar na análise multivariada. Isso reforça a necessidade de explorar metodologias mais rigorosas nas etapas antes e depois do cálculo dos índices de eficiência, os quais gerarão confiança, para serem utilizados na formulação de políticas e gestão de recursos para o setor.

Abstract In recent decades, Iberoamerican universities have introduced new quality assessment and accountability schemes, inspired by the New Public Management (NGP) model. In this context, efficiency in the distribution of public funds and obtaining the maximum possible return are a priority. Thus, measuring efficiency in the public sector, and specifically in higher education, has become a challenge for accounting science. The objective of this work is a proposal to calculate efficiency indices with Data Envelopment Analysis (DEA) models, introducing a previous step through the Analysis of Canonical Correlation (ACC). Using this technique, the aim is to improve discrimination capacity and overcome monodimensionality and lack of reliability in the representativeness of the chosen input and output variables. The study is applied in the public universities of Colombia and Spain during the years 2015 and 2016. The results obtained demonstrate the convenience of applying this preliminary step in the multivariate analysis. This reinforces the need to explore more rigorous methodologies in stages before and after the calculation of the efficiency indices. This practice increases confidence when using the indices to formulate policies and manage resources for the sector.

Brazilian hospitals' performance: an assessment of the unified health system (SUS).

This paper assesses the economic efficiency of Brazilian general hospitals that provide inpatient care for the Unified Health System (SUS). We combined data envelopment analysis (DEA) and spatial analysis to identify predominant clusters, measure hospital inefficiency and analyze the spatial pattern of inefficiency throughout the country. Our findings pointed to a high level of hospital inefficiency, mostly associated with small size and distributed across all Brazilian states. Many of these hospitals could increase production and reduce inputs to achieve higher efficiency standards. These findings suggest room for optimization, but inequalities in access and the matching of demand and supply must be carefully considered in any attempt to reorganize the hospital system in Brazil.

Assessing the environmental management and operational efficiency of Brazilian public ports that export soybeans / Evaluación de la eficiencia de la gestión ambiental y eficiencia operacional de puertos públicos brasileños que exportan soja / Avaliação da eficiência da gestão ambiental e eficiência operacional de portos públicos brasileiros que exportam soja

Abstract Using Data Envelopment Analysis (DEA), seven public ports in Brazil that trade soybeans had their environmental management assessed. Data regarding the management of sewage, solid waste, and of the presence of synanthropic fauna in public ports was used along with the port environmental index created by ANTAQ in the analysis. The results show that the quality of the environmental management needs to be addressed, so the efficiency of the system can be reached, and that DEA can be a useful tool.

Resumen Se evaluaron siete puertos públicos brasileños de embarque de soja en cuanto a su gestión ambiental usando el análisis por envoltura de datos (DEA). Para el análisis, los datos referentes a la gestión de efluentes líquidos, residuos sólidos, y presencia de fauna sinantrópica en esos puertos se utilizaron en conjunto con el Índice de Desempeño Ambiental de la ANTAQ (Agencia Nacional de Transportes Acuáticos). Los resultados muestran que la calidad de la gestión ambiental debe abordarse para que el sistema sea eficiente en su totalidad, y para ello, el DEA puede ser una herramienta útil.

Resumo Sete portos públicos brasileiros que movimentam soja foram avaliados quanto a sua gestão ambiental usando-se Análise por Envelopamento de Dados (DEA). Para a análise, os dados referentes ao gerenciamento de efluentes líquidos, resíduos sólidos, e presença de fauna sinantrópica nesses portos foram utilizados em conjunto com o Índice de Desempenho Ambiental da ANTAQ. Os resultados mostram que a qualidade da gestão ambiental precisa ser abordada para que o sistema seja eficiente como um todo, e para isso, DEA pode ser uma ferramenta útil.

Multimethodology applied to the evaluation of Healthcare in Brazilian municipalities.

The integration of quantitative indicators with qualitative descriptions of context is a noticeable demand from many different scientific disciplines, since it contributes to linking theoretical and practical approaches to problem solving. Amongst them are the problem structuring methods, systems thinking and multimethodology. This work presents a mixed quantitative and qualitative methodological approach to aid formulation and structuring of performance measurement of health care in 5565 Brazilian municipalities. Data mining and data envelopment analysis (DEA) are applied in the context of conceptual mapping, thus shedding light on both quantitative and qualitative factors that influence health performance. Our aim is to propose a methodology for performance indicators to support health care policy making in Brazil, using quantitative indicators. However, the approach does not lose track of the role of important qualitative factors in the attribution of meaning to performance assessments. The methodological and analytical results can strengthen mutual understanding by analysts and stakeholders of the problem at hand. Quantitative results allow inefficient municipalities to understand the causes of their overall efficiency in terms of particular low partial DEA efficiencies combined with high deathrates.

Efficiency and productivity in access to Colombian public universities / Eficiencia y productividad en la cobertura de las universidades públicas colombianas

RESUMEN Este artículo analiza la eficiencia y los cambios productivos en la cobertura de las 32 instituciones de educación superior colombianas pertenecientes al Sistema de Universidades Estatales durante el periodo 2003-2012. Para tal fin, se empleó el análisis envolvente de datos y el índice de productividad de Malmquist para analizar los datos sobre matrícula de pregrado y posgrado, número docentes de tiempo completo, gasto en personal administrativo y recursos financieros y físicos. Los resultados muestran que, aproximadamente, todas las instituciones evaluadas obtienen eficiencias por encima de 70 % y crecimientos promedios de su productividad a una tasa aproximada de 9 %. Sin embargo, se observan profundas diferencias entre los desempeños interregionales, sobre todo entre la región andina y la región caribe.

ABSTRACT This article analyzes the efficiency and the productive changes in the coverage of the 32 Colombian Higher Education Institutions belonging to the System of State Universities (SUE), during the period 2003-2012. Data Envelopment Analysis and the Malmquist Productivity Index were used to analyze data on students enrolled in undergraduate and postgraduate programs, number of full-time teachers, administrative expenses, and financial and infrastructure resources. The results show that, on average, all the institutions of higher education obtained efficiencies above 70%, as well as increases in their productivity at an average rate of 9%. However, it was observed deep differences between the regions of Colombia, especially the central region and the north of Colombia.

Assessing the relative efficiency of water companies in the English and Welsh water industry: a metafrontier approach.

The assessment of relative efficiency of water companies is essential for managers and authorities. This is evident in the UK water sector where there are companies with different services such as water and sewerage companies (WaSCs) and water-only companies (WoCs). Therefore, it is a critical limitation to estimate a common production frontier for both types of companies, as it might lead to biased efficiency estimates. In this paper, a robust and reliable methodology, the metafrontier model, is applied to compare the efficiency of water companies providing different services. The results illustrate the superior performance of WaSCs compared to WoCs. It also confirms the presence of economies of scope in the UK water industry. The methodology and results of this study are of great interest for both regulators and water utility managers to make informed decisions.

Scale and scope economies in Mexican private medical units / Economías de escala y alcance en unidades médicas privadas en México

Objective. To evaluate technical efficiency and potential presence of scale and scope economies in Mexican private medical units (PMU) that will improve management decisions. Materials and methods. We used data envelopment analysis methods with inputs and outputs for 2 105 Mexican PMU published in 2010 by the Instituto Nacional de Estadística y Geografía from the "Estadística de Unidades Médicas Privadas con Servicio de Hospitalización (PEC-6-20-A)" questionnaire. Results. The application of the models used in the paper found that there is a marginal presence of economies of scale and scope in Mexican PMU. Conclusions. PMU in Mexico must focus to deliver their services on a diversified structure to achieve technical efficiency.

Objetivo. Evaluar la eficiencia técnica y la presencia de potenciales economías de escala y alcance en unidades médicas privadas (UMP) mexicanas, de forma que sea posible establecer planes para la mejora de su gestión. Material y métodos. Se utilizó el método de Análisis Envolvente de Datos con información de insumos y productos para 2 105 UMP del año 2010 publicada por el Instituto Nacional de Estadística y Geografía a través del cuestionario denominado "Estadística de Unidades Médicas Privadas con Servicio de Hospitalización (PEC-6-20-A)". Resultados. La aplicación de los modelos encuentra una presencia marginal de economías de escala y alcance en las UMP mexicanas. Conclusiones. La operación de las UMP en México debe enfocarse a prestar servicios bajo un modelo diversificado para alcanzar mejores niveles de eficiencia técnica.