A Multi-Criteria Approach to Assess the Performance of the Brazilian Unified Health System
Abstract
:1. Introduction
2. Unified Health System (SUS)
3. Materials and Methods
- The use of an additional input parameter called a domain, i.e., a numerical value (integer or real) that represents the range of possible values that each criterion could take;
- A change in the normalization procedure. The R-TOPSIS uses Max–Min normalization or Max normalization to fix the ideal solutions and ensure that there is no change in the values of the normalized and weighted decision matrices after modifications are introduced to the initial decision problem.
4. Results and Discussion
Sensitivity Analysis
- Alternatives and inverted their rankings when the weight of sub-criterion changed;
- Alternatives and inverted their rankings when the weight of sub-criterion decreased;
- Alternatives and and and inverted their rankings when the weight of sub-criterion increased;
- Alternatives and inverted their rankings when the weight of sub-criterion changed.
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Category | Criterion | Sub-Criterion | Abbreviation | Estimation Parameter |
---|---|---|---|---|
Potential or Obtained Access | Basic Care | Population coverage estimated by basic health teams | C1 | 100% |
Population coverage estimated by basic oral health teams | C2 | 50% | ||
Proportion born live from mothers with 7 or more prenatal consultations | C3 | 90% | ||
Medium-Complexity Outpatient and Hospital Care | Ratio of mammograms performed on women aged 50 to 69 years and the population in the same age range | C4 | 70 examinations for every 100 women in two years | |
Ratio of cytopathological examination of the uterine cervix in women aged 25 to 59 years and the population in the same age range | C5 | 90 examinations for every 100 women in 3 years | ||
Ratio of medium-complexity clinical–surgical hospitalizations and the resident population | C6 | 6.3 hospitalizations/100 inhabitants per year | ||
Ratio of medium-complexity outpatient procedures selected and the resident population | C7 | 2.6 procedures/100 inhabitants per year | ||
High-Complexity Outpatient and Hospital Care Reference for Medium- and High-Complexity and Urgency and Emergency Care | Ratio of high-complexity clinical–surgical hospitalizations and the resident population | C8 | 6.3 hospitalizations/100 inhabitants per year | |
Ratio of high-complexity outpatient procedures selected and the resident population | C9 | 7.8 procedures/100 inhabitants per year | ||
Proportion of hospital access of accidental deaths | C10 | 70% | ||
Proportion of medium-complexity hospitalizations performed for non-residents | C11 | 0.72% | ||
Proportion of high-complexity hospitalizations performed for non-residents | C12 | 1.14% | ||
Proportion of high-complexity outpatient procedures performed for non-residents | C13 | 1.17% | ||
Proportion of medium-complexity outpatient procedures for non-residents | C14 | 0.90% | ||
Effectiveness | Basic Care | Basic Care Effectiveness Index | C15 | “Proportion of basic care hospitalizations” minus 0.15 for each indicator point lost in “Incidence rate of congenital syphilis” and “Proportion of new bacilipherous pulmonary tuberculosis cases cured” minus 0.1 for each indicator point lost in “Proportion of new Hansen’s disease cases cured” and “Vaccine coverage with the tetravalent vaccine” |
Medium- and High-complexity, Urgency, and Emergency | Proportion of normal deliveries | C16 | 70% | |
Proportion of deaths in the intensive care unit of individuals younger than 15 years old | C17 | 10% | ||
Proportion of deaths in those hospitalized for acute myocardial infection | C18 | 10% |
Specialist 1 | Specialist 2 | Final Weight | ||||||
---|---|---|---|---|---|---|---|---|
Categories | Criteria | Sub-Criteria | Categories | Criteria | Sub-Criteria | Categories | Criteria | Sub-Criteria |
0.355 | 0.169 | 0.072 | 0.444 | 0.185 | 0.082 | 0.400 | 0.177 | 0.077 |
0.032 | 0.045 | 0.039 | ||||||
0.065 | 0.058 | 0.061 | ||||||
0.084 | 0.029 | 0.148 | 0.049 | 0.116 | 0.039 | |||
0.026 | 0.042 | 0.034 | ||||||
0.006 | 0.017 | 0.012 | ||||||
0.024 | 0.040 | 0.032 | ||||||
0.101 | 0.027 | 0.111 | 0.030 | 0.106 | 0.028 | |||
0.024 | 0.027 | 0.025 | ||||||
0.008 | 0.009 | 0.008 | ||||||
0.016 | 0.018 | 0.017 | ||||||
0.007 | 0.007 | 0.007 | ||||||
0.005 | 0.006 | 0.006 | ||||||
0.014 | 0.015 | 0.014 | ||||||
0.645 | 0.430 | 0.430 | 0.556 | 0.208 | 0.208 | 0.600 | 0.319 | 0.319 |
0.215 | 0.092 | 0.347 | 0.148 | 0.281 | 0.120 | |||
0.041 | 0.081 | 0.061 | ||||||
0.082 | 0.118 | 0.100 |
Alt | C1 | C2 | C3 | C4 | C5 | C6 | C7 | C8 | C9 | C10 | C11 | C12 | C13 | C14 | C15 | C16 | C17 | C18 |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
A1 | 5.45 | 5.18 | 9.18 | 3.62 | 6.19 | 4.31 | 5.05 | 5.07 | 8.00 | 9.07 | 10.00 | 10.00 | 10.0 | 10.00 | 9.19 | 5.29 | 10.00 | 6.75 |
A2 | 4.13 | 5.81 | 8.72 | 3.80 | 5.37 | 5.89 | 3.82 | 7.77 | 8.91 | 7.92 | 10.00 | 10.00 | 10.0 | 7.86 | 9.85 | 5.91 | 10.00 | 10.00 |
A3 | 3.48 | 5.87 | 9.42 | 3.08 | 6.79 | 3.64 | 3.15 | 2.98 | 5.99 | 8.93 | 7.23 | 3.20 | 10.0 | 1.72 | 9.03 | 4.86 | 8.89 | 5.75 |
A4 | 4.31 | 5.99 | 9.80 | 5.37 | 5.96 | 7.94 | 7.25 | 10.00 | 10.00 | 7.21 | 10.00 | 9.75 | 10.0 | 7.32 | 9.84 | 2.23 | 9.68 | 7.55 |
A5 | 4.60 | 3.42 | 8.46 | 3.68 | 5.84 | 4.81 | 5.28 | 5.31 | 7.79 | 10.00 | 10.00 | 10.00 | 10.0 | 10.00 | 8.85 | 6.74 | 10.00 | 6.03 |
A6 | 3.43 | 4.15 | 10.00 | 5.13 | 6.46 | 4.24 | 3.50 | 4.17 | 6.04 | 9.51 | 6.49 | 5.31 | 10.0 | 4.79 | 9.91 | 6.31 | 5.95 | 5.46 |
Alt | DPIS | DNIS | Closeness Coefficient | Ranking |
---|---|---|---|---|
A1 | 0.0883 | 0.3254 | 0.7865 | 2 |
A2 | 0.0781 | 0.3525 | 0.8187 | 1 |
A3 | 0.1071 | 0.3141 | 0.7457 | 6 |
A4 | 0.1098 | 0.3424 | 0.7572 | 5 |
A5 | 0.0906 | 0.3163 | 0.7774 | 4 |
A6 | 0.0958 | 0.3414 | 0.7808 | 3 |
Alt | Proposed Model | Proposed Model with IDSUS Weights | IDSUS | |||
---|---|---|---|---|---|---|
CCi | Ranking | CCi | Ranking | Index | Ranking | |
A1 | 0.7865 | 2 | 0.5389 | 3 | 6.0585 | 3 |
A2 | 0.8187 | 1 | 0.5564 | 1 | 6.3170 | 2 |
A3 | 0.7457 | 6 | 0.4715 | 5 | 5.1631 | 6 |
A4 | 0.7572 | 5 | 0.5288 | 4 | 6.4708 | 1 |
A5 | 0.7774 | 4 | 0.5471 | 2 | 6.0281 | 4 |
A6 | 0.7808 | 3 | 0.5320 | 4 | 5.5698 | 5 |
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Aires, R.F.d.F.; Salgado, C.C.R. A Multi-Criteria Approach to Assess the Performance of the Brazilian Unified Health System. Int. J. Environ. Res. Public Health 2022, 19, 11478. https://doi.org/10.3390/ijerph191811478
Aires RFdF, Salgado CCR. A Multi-Criteria Approach to Assess the Performance of the Brazilian Unified Health System. International Journal of Environmental Research and Public Health. 2022; 19(18):11478. https://doi.org/10.3390/ijerph191811478
Chicago/Turabian StyleAires, Renan Felinto de Farias, and Camila Cristina Rodrigues Salgado. 2022. "A Multi-Criteria Approach to Assess the Performance of the Brazilian Unified Health System" International Journal of Environmental Research and Public Health 19, no. 18: 11478. https://doi.org/10.3390/ijerph191811478