Três ensaios em economia hospitalar

Abstract

This thesis presents three essays related to the quality of hospital care in Brazil, made using data from 2008 to 2014 from the Hospital Information System of the Unified Health System (SIH-SUS) and the National Registry of Health Establishments (CNES). In the first essay, the objective was to verify if the health outcome of patients undergoing hip replacement are better as the hospital performs more of this procedure. In other words, we tried to verify the existence of the so-called volume-outcome effect in the Brazilian hospital sector. Evidences pointed to the existence of a volume-outcome effect in Brazil. Exploring the geographical distribution of patient residences and hospitals as a source of exogenous variation for volume, we could identify that the effect is a result of the practice-makes-perfect hypothesis, occurring through static scale economies. In the second essay, the objective was to verify if the probability of death of patients submitted to percutaneous coronary intervention is lower if it was treated in a specialized hospital in cardiovascular diseases instead of general hospital. The use of the instrumental variables model allowed us to evaluate the relationship from a causal perspective. The findings pointed out that the health outcomes of patients treated in specialized hospitals are better than the results of patients treated in general hospitals. Finally, the third essay aimed to investigate the existence of a weekend effect in the Brazilian hospital sector. Considering the patients admitted in an emergency with a diagnosis of acute myocardial infarction (AMI), odds ratios for hospital death were estimated using logistic regression. The results were consistent with the existence of the weekend effect, even controlling a series of factors, including hospital effect.