Table of contents for Hospital performance in Brazil : the search for excellence / Gerard M. La Forgia, Bernard F. Couttolenc.


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Introduction                                                                1
Why This Book?                                                           2
Objectives, Approach, and Conceptual Framework                           3
Audience and Policy Enbvironment                                        7
Chapter Smunmaries                                                       8
Sources and CaI,eats                                                    15
Notes                                                                   16
T2 he Brazilian Hospital Sector: Structure, Financing, Spending, and Outcomes   17
'hOw Br,zilian Hlealth Sector                                           17
The BRazilian Hospital Sector                                          28
I lospital Finance and Spending                                        36
Sulnnay Assessment                                                    40
ANNEX 2A: An Indirect Method for Estimating Hospital Spending           43
ANNEX 2B: Supplementary Data                                           44
Notes                                                                   47
S    Comparative Analysis of Costs and Efficiency                               51
I Hopital Costs: NMeasurement Challenges and Findings                  53
Efficiency Analysis                                                     66
Conclustions and Recommendations                                        92
ANNEX 3A: Cost Analysis Methodology: The De Matos Cost Study Methodology  96
ANNEX 313: Supplementary Data                                          100
ANNLEX -C: Average Cost and Coefficient of Variation
for Sample Hospital Procedures                                         102
ANNEX 3D): DEA Methodology                                             106
ANNEX 3E: Brazilian Studies on Hospital Efficiency                     112
Notes                                                                  115
4    lospital Payment Mechanisms and Contracting Arrangements                  121
I'an'ment Mechanisms otr H ospital Care in Brazil                      122
Criitical Review ot PlMs in Brazil                                    125
The Plight of Private Hospitals under the SEUS                         132
Paymenzt Mechantsms and etf ortn Ianm c                                    134
Hospital Conta nlt ing Arr in Atngcmen  in tilh SIiS                      1 38
Conclusions and Re om merndations                                         146
ANNEX 4A: Charaa teristcs and Effects of Main Provide Panyment
Mechanisms                                                                 151
ANNEX 4B: History of Governmcnt PPMs fo0r  ospitals in Biazil              1 54
ANNEX 4C(: Provide IP'ayment Mecihanisms lUsed by the SUS                  1356
ANNEX 41): Differential Increases in Reimburscmnnt Rates, 1995 2001       158
ANNEX 4E: From the A 11 to I)RGs                                           1 59
Notes                                                                      162
S    Organizational Arrangements and Performance of Brazilian Hlospitals           167
Organizational Arranęgein?lrts: .l-anuework and l.iterature                168
Organizational Arian gemint, its  liiblic Hospital. in Brazil             171
Coiparative Revieuw o Og anizzational Features in Public Hospitals         1 81
Private Secto Ovrganizational Stru turs alnd G;ol,erna nce Ar rangemntCi Is  18 4
C(omparative Perfotmance olf HMs pitl under Diff)el nt Owner,shiip
antd ( )ganizational Arrangements                                         19 1
Sun Inar), Assrssmn en                                                     ] 98
AN N EX 5A: Organizational Arrangemntcns in Public and h ivat(
Hospitals in Brazil: Summary                                              20l
ANNEX 5B: Matrix: Features of Organizational Arrangw'ienis iI
Public Hospitals in Brazil                                                208
ANNEX (C: Methods for Analysis (of Altwrnativ' and ITraditional lHospitals  2 1
ANNEX 51): Methods for (Comparativec Analysis of OSS aind
Direct Administratiosn t lospiitls                                        218
ANNEX 5E: Matrix: Organizational Arrangements in Europeaia Hospitals     219
Notes                                                                     221
SInside the Black Box: Linkiing Organizational Arlangecinents,
Managerial Behaviors, and Pe'rformance in Public and Private lilospitals     227
Management Piartices in Public I/ospitals                                 228
Brazil's Experienceni with lopitalI Caovlersioil: ()Ot'ctomilht 1jnuan Rescrmt (
alnd Financial Obstacles                                                  24(
International ['Aperience with q' Hospital C(omnvesion                    2 3
Managerial IPactices in thie Privat' Nonvpofit Sector                     2
Sum nmary Assessmient and Recommcndations,                                261
ANNEX 6A: Striengths and Weaknesscs of the Public Se-tor ReginuIe
for Procurement, Labor, and Budgeting                                     267
ANNEX 6B. Comparison of Stimmary Labor Regime (ICharactriT it(s
for Physicians by Organizational Arrangement in P'ubli and
Private Nonprofit Hospitals                                               209
Notes                                                                     2
S    Qtuality of Carc: Still the Forgotteln (omponent?                            27
Quality, (ualiti fi proveimenrt, atd Cosis                                 75
Qoualit) in Braizilimt Hoipitals                                          278
Summattin  Aott'io tcnt
ANNEX 7A: Policy and Managerial Innovations Across Medical
Disciplines, 2000-2005                                                  300
ANNEX 78: Process Shortcormings in Brazilian I ospitals and Possible Causes  301
Notes                                                                   303
S      LQuality Assessment and Improvement                                       305
I lospital Accreditation and Certification in Brazil: Adoption, Challenges,
,ad Opportunities                                                       305
()Ohir Quality Assessmnent and linprovement Initiatives                 319
Ctare Coordination Across Provider levels                               323
Sumnmariy Assessment and Recommendations: A Franmeworkl lir Systematic
Quaility ImpirovemnaHt                                                  328
ANNEX BA: An Example of ONA Standards and Performance
IElenments: Obstetrics                                                  335
ANNEX 8B: Government Initiatives to Build National Capacity Ior
Continuous Quality improvement, 1997-2001                               336
ANNEX 8C(: Setting the Policy and Institutional Framework for Systematic
Quality Measurement and Improvement: Examples from the United States,
the iUnited Kingdom, and Australia                                      337
ANNEX 81): Hlospital Report Cards: Motivating Hospitals to Perform?     339
AN NEX 8E: Quality-Based Purchasing in OECD Countries                    140
Notes                                                                   342
Conclusions and Recommendations                                             345
Problents in Braz-il's -fospital Sector                                 346
P?ulding on Brzilin Innovations and Experience                         351
What Can be Done? Key Phliy Priorities                                  354
v1in,g PIrTonvId with inplementation                                    366
ANNEX 9A: Recommended Policies and Actionis                             369
trotes                                                                  374



Library of Congress subject headings for this publication: Hospitals Standards Brazil, Hospital care Brazil Evaluation, Hospital care Brazil Quality control, Hospitals standards Brazil, Quality Assurance, Health Care Brazil