Ensaios sobre a economia dos transplantes renais no Brasil : incentivos e eficiência

AUTOR(ES)
FONTE

IBICT - Instituto Brasileiro de Informação em Ciência e Tecnologia

DATA DE PUBLICAÇÃO

2012

RESUMO

The thesis is about the economy of kidney transplants, focusing on the institutional mechanisms and incentives related to organ harvesting in Brazil, as well as the efficiency of the Brazilian states that perform such transplants. The essays investigated the effects and implications of the incentives structure on the number of organs (including kidney) harvested by the transplants public system. The efficiency of this system and its performance over the 2006-2011 period was also evaluated. Firstly some stylized facts related to the subject were presented, among which stand out: i) the size of queues and waiting times for organ transplantation in recent years have grown; ii) Brazil ranks second in the absolute number of kidney transplants, behind only the United States, iii) the country has the largest public program for solid organs transplantation, iv) the process of organ harvesting has high variability among Brazilian states, creating an imbalance between supply and demand for organs and v) the kidney transplantation system is as an effective therapeutic modality. In the second essay the mechanisms of incentives offered to hospitals that perform kidney harvesting in Brazil were analyzed. The theoretical model used was the Principal-Agent in a context of asymmetric information. In the model, SUS was rated as the Principal (receptor of harvested organs) and the harvesting hospitals, as agents. SUS seeks to maximize the number of organs for transplantation in a contract through which it delegates the harvesting to hospitals. Agents decide whether they are interested in creating a framework and conditions for harvesting organs. The results of the Principal-Agent model indicate that SUS (the Principal) has adopted various incentives to hospitals that perform organ harvesting, such as creating a specific fund to finance transplants (FCSA - Fund for Compensation and Strategic Actions); same payment for university and non-university hospitals, expanding the types of hospital procedures to be paid by SUS; frequent remuneration raises of the amount paid by the procedures in Table of Procedures of the Hospital Information System of the Unified Health System; courses and / or meetings with health professionals working in the donation-transplantation process and creation of new financial incentives to hospitals that perform transplants for the public system. So, if the professional receives stronger incentives, he will act more effectively in the organ harvesting and will thereby contribute to a reduction in waiting lines for transplantation. In order to evaluate the efficiency of the Brazilian states in kidney transplant and their productivity over time, the Data Envelopment Analysis-DEA was used and the Malmquist index and its decomposition (Pairing effect and Boundary Displacement) to a sample of 22 states over five years (2006-2011). The DEA model with variable returns to scale (BCC) directed towards the product was applied in this study. Each state was considered a Decision Making Unit (DMU). Data classified as inputs (resources) were the following: total amount spent (nominal) with kidney transplants, amount spent (nominal) with hospital services and amount spent (nominal) with the professional services related to that sector. As output (product) was used the number of transplanted kidneys. The results indicated that there is a significant discrepancy among the Brazilian states in harvesting and transplanting kidneys. This fact has led to inefficiency in the country¿s kidney transplant system and it may be so due to inadequate management, to ignoring natiimmunosuppressants; forwarding not used organs to nearby states, implementation of HLA exam to the entire waiting list for kidney transplant) causing harm to patients; to inactive in-hospital committees and to overloaded hospital staff. Therefore, some states in the process of kidney harvesting and transplantation are showing operational and managerial inefficiencies.onal directives (eg, vinculating teams to transplant centers; proper distribution of immunosuppressants; forwarding not used organs to nearby states, implementation of HLA exam to the entire waiting list for kidney transplant) causing harm to patients; to inactive in-hospital committees and to overloaded hospital staff. Therefore, some states in the process of kidney harvesting and transplantation are showing operational and managerial inefficiencies.

ASSUNTO(S)

economy of organ transplantation desenvolvimento econômico transplantes principal-agent theory efficiency of organ transplantation transplante de rim data envelopment analysis (dea) economia da saúde análise econômica malmquist index transplante de órgãos brasil

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