Eficiência das unidades básicas de saúde brasileiras: uma abordagem com fatores sociodemográficos e epidemiológicos em DEA dinâmico

Abstract

Evaluating efficiency in healthcare is essential to understanding the delivery of services and identifying areas for improvement. Although the literature often prioritizes medium- and highcomplexity levels, primary care remains underexplored. This article analyzes the efficiency of Brazilian primary healthcare units (UBS) from 2018 to 2023, considering the sociodemographic and epidemiological profiles of the population, using the Dynamic DEA model. The inputs analyzed include the number of professionals, while nondiscretionary inputs encompass epidemiological characteristics related to chronic diseases and sociodemographic profiles. Outputs include patient care records, procedures performed, home visits, and dental services. The number of registered users was considered as a carryover. The sample, comprising 15,253 UBS, was classified into four groups: Simple, Dental, Expanded, and Comprehensive. The results show that global efficiency scores ranged between 0 and 0.4, with a progressive improvement over the years, except for a decline in 2020 due to the pandemic. It was observed that considering the population profile positively impacts efficiency estimates, while the type of municipality has limited influence. To achieve full efficiency, a 16% reduction in professionals and a 127% increase in outputs, especially in dental care, would be necessary. These findings highlight the fragility of primary care as the gateway to Brazil's Unified Health System (SUS) and emphasize the importance of including environmental variables for fairer efficiency measurements. Future studies should explore strategies to address these gaps and promote greater equity in resource allocation and utilization.