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Improving Performance in Brazil’s Health Sector: Comparing Different Models of Hospitals

Jeffrey Rinne

In the late 1990s the government of São Paulo created Social Organizations in Health -Organizações Sociais em Saúde (OSS)- to enable a formal partnership between the state and nonprofit, private-sector organizations for the management of public hospitals. The State Secretariat of Health (SES) negotiates and signs a performance contract with each OSS hospital manager, granting them greater flexibility than their counterparts in traditional state hospitals to run the hospital in the manner they consider best-suited to meet their performance targets. A systematic comparison of 12 OSS hospitals and 10 direct administration hospitals in the state of São Paulo found OSS hospitals were more efficient and provided services of equal or higher quality than direct administration hospitals.

This study asks: What accounts for OSS hospitals’ superior performance? Our data and focus-group discussions with healthcare personnel in 20 São Paulo hospitals provide little or no support for the contention that higher salaries, performance pay, superior career development opportunities, or even formal supervision mechanisms are responsible for the superior performance of OSS hospitals. Our research did find, however, that OSS hospital managers enjoyed greater freedom in choosing a particular mix of staff/skills, and in selecting specific individuals through less rigid recruitment processes. This paper highlights the nuanced, context-specific tactics used to improve performance management within Brazil’s existing institutional constraints.

 

Key words: Health Administration; Non-Governmental Public; Comparative Analysis; Case Analysis; Brazil

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