Práticas administrativas para a sustentabilidade financeira de operadoras de planos de saúde médico-hospitalares: um estudo de múltiplos casos

No Brasil, o sistema de saúde é composto por duas estruturas: pública, representada pelo Sistema Único de Saúde (SUS) e privada suplementar, composta por 1.268 operadoras de planos de saúde, supervisionadas pela Agência Nacional de Saúde (ANS). No entanto, as operadoras têm sido consideradas ineficientes tanto na geração de resultados financeiros quanto na prestação de serviços aos beneficiários, destacando-se a necessidade e relevância para a saúde pública ao se buscar avaliar o seu desempenho sob essas perspectivas. O objetivo do trabalho foi, para um mesmo nível de eficiência na prestação de serviços, identificar as práticas administrativas que diferenciam as operadoras de planos de saúde (OPS) financeiramente sustentáveis. Para tanto, inicialmente foi aplicada a técnica da Análise Envoltória de Dados (DEA) no intuito de identificar operadoras eficientes em transformar inputs em outputs e, a partir dos escores obtidos, selecionar duas OPS de nível de serviços semelhantes e desempenho financeiro opostos para que fossem comparadas por meio de um estudo de múltiplos casos. A análise quantitativa indicou que as OPS de medicina de grupo apresentaram maior eficiência do que as demais modalidades. Já o estudo de múltiplos casos identificou que a gestão de políticas de crédito, de captação e aplicação de recursos, o planejamento tributário, a adoção de políticas de promoção e prevenção à saúde, as formas de remuneração dos médicos e a estratégia de composição de receitas diferenciaram a OPS de melhor desempenho.

Valor de marca colectiva: aproximación desde el enfoque de la eficiencia

El objetivo del trabajo consiste en analizar la eficiencia de las empresas que integran una marca colectiva en una industria productora de bienes de experiencia. El supuesto básico es que la marca colectiva tiene un impacto positivo en la eficiencia de las empresas acogidas a la misma, el cual viene explicado porque la reputación colectiva fomenta una inversión eficiente en calidad. Sin embargo, la marca colectiva también puede tener un efecto opuesto sobre los incentivos de una empresa a una inversión en calidad ya que dicha marca puede crear un incentivo a “free ride”. Nuestra propuesta defiende que la interacción entre estos factores opuestos, reputación colectiva y “free ride”, viene moderada por las características de la marca colectiva y de la propia empresa. La metodología aplicada en el contraste de estas hipótesis se apoya en el Análisis Envolvente de Datos para estimar la eficiencia, así como en modelos econométricos para explicar la eficiencia empresarial mediante características de la marca colectiva y de la empresa. Los resultados obtenidos en el ámbito de las bodegas españolas evidencian que las marcas colectivas tienen un impacto positivo sobre la eficiencia, el cual viene moderado por el tamaño de la marca colectiva generando una relación curvilínea en forma de U invertida. Adicionalmente, el volumen de producción de la marca colectiva y el tamaño de las bodegas ejercen un efecto moderador en el impacto del tamaño de la marca colectiva sobre la eficiencia. En general, los resultados ponen de manifiesto la importancia de las marcas colectivas cuando se investigan industrias donde la calidad no es solamente señalizada por una marca típica individual.

Modelling knowledge production performance of research centres with a focus on triple bottom line benchmarking

We demonstrate a portable process for developing a triple bottom line model to measure the knowledge production performance of individual research centres. For the first time, this study also empirically illustrates how a fully units-invariant model of Data Envelopment Analysis (DEA) can be used to measure the relative efficiency of research centres by capturing the interaction amongst a common set of multiple inputs and outputs. This study is particularly timely given the increasing transparency required by governments and industries that fund research activities. The process highlights the links between organisational objectives, desired outcomes and outputs while the emerging performance model represents an executive managerial view. This study brings consistency to current measures that often rely on ratios and univariate analyses that are not otherwise conducive to relative performance analysis.

DEA models for ratio data:convexity consideration

Data envelopment analysis (DEA) is defined based on observed units and by finding the distance of each unit to the border of estimated production possibility set (PPS). The convexity is one of the underlying assumptions of the PPS. This paper shows some difficulties of using standard DEA models in the presence of input-ratios and/or output-ratios. The paper defines a new convexity assumption when data includes a ratio variable. Then it proposes a series of modified DEA models which are capable to rectify this problem.

Negative data in DEA:a directional distance approach applied to bank branches

This paper is drawn from the use of data envelopment analysis (DEA) in helping a Portuguese bank to manage the performance of its branches. The bank wanted to set targets for the branches on such variables as growth in number of clients, growth in funds deposited and so on. Such variables can take positive and negative values but apart from some exceptions, traditional DEA models have hitherto been restricted to non-negative data. We report on the development of a model to handle unrestricted data in a DEA framework and illustrate the use of this model on data from the bank concerned.

A new DEA model for technology selection in the presence of ordinal data

This paper suggests a data envelopment analysis (DEA) model for selecting the most efficient alternative in advanced manufacturing technology in the presence of both cardinal and ordinal data. The paper explains the problem of using an iterative method for finding the most efficient alternative and proposes a new DEA model without the need of solving a series of LPs. A numerical example illustrates the model, and an application in technology selection with multi-inputs/multi-outputs shows the usefulness of the proposed approach. © 2012 Springer-Verlag London Limited.

Input/output deterioration in production processes

In many real applications of Data Envelopment Analysis (DEA), the decision makers have to deteriorate some inputs and some outputs. This could be because of limitation of funds available. This paper proposes a new DEA-based approach to determine highest possible reduction in the concern input variables and lowest possible deterioration in the concern output variables without reducing the efficiency in any DMU. A numerical example is used to illustrate the problem. An application in banking sector with limitation of IT investment shows the usefulness of the proposed method. © 2010 Elsevier Ltd. All rights reserved.

A new slacks-based measure of Malmquist-Luenberger index in the presence of undesirable outputs

In the majority of production processes, noticeable amounts of bad byproducts or bad outputs are produced. The negative effects of the bad outputs on efficiency cannot be handled by the standard Malmquist index to measure productivity change over time. Toward this end, the Malmquist-Luenberger index (MLI) has been introduced, when undesirable outputs are present. In this paper, we introduce a Data Envelopment Analysis (DEA) model as well as an algorithm, which can successfully eliminate a common infeasibility problem encountered in MLI mixed period problems. This model incorporates the best endogenous direction amongst all other possible directions to increase desirable output and decrease the undesirable outputs at the same time. A simple example used to illustrate the new algorithm and a real application of steam power plants is used to show the applicability of the proposed model.

CO2 emissions reduction of Chinese light manufacturing industries:a novel RAM-based global Malmquist-Luenberger productivity index

Climate change has become one of the most challenging issues facing the world. Chinese government has realized the importance of energy conservation and prevention of the climate changes for sustainable development of China's economy and set targets for CO2 emissions reduction in China. In China industry contributes 84.2% of the total CO2 emissions, especially manufacturing industries. Data envelopment analysis (DEA) and Malmquist productivity (MP) index are the widely used mathematical techniques to address the relative efficiency and productivity of a group of homogenous decision making units, e.g. industries or countries. However, in many real applications, especially those related to energy efficiency, there are often undesirable outputs, e.g. the pollutions, waste and CO2 emissions, which are produced inevitably with desirable outputs in the production. This paper introduces a novel Malmquist-Luenberger productivity (MLP) index based on directional distance function (DDF) to address the issue of productivity evolution of DMUs in the presence of undesirable outputs. The new RAM (Range-adjusted measure)-based global MLP index has been applied to evaluate CO2 emissions reduction in Chinese light manufacturing industries. Recommendations for policy makers have been discussed.

Benchmarking e regulação do setor de distribuição de energia elétrica nacional: proposta para avaliação dos custos operacionais eficientes

In Brazil, the National Agency of Electric Energy (ANEEL) represents the energy regulator. The rates review have been one of its main tasks, which establish a pricing practice at a level to cover the efficient operating costs and also the appropriate return of the distributors investments. The changes in the procedures to redefine the efficient costs and the several studies on the methodologies employed to regulate this segment denote the challenge faced by regulators about the best methodological strategy to be employed. In this context, this research aims to propose a benchmarking evaluation applied to the national regulation system in the establishment of efficient operating costs of electricity distribution utilities. The model is formulated to promote the electricity market development, partnering with government policies ant to society benefit. To conduct this research, an integration of Data Envelopment Analysis (DEA) with the Stochastic Frontier Analysis (SFA) is adopted in a three stages procedure to correct the efficiency in terms of environmental effects: (i) evaluation by means of DEA to measure operating costs slacks of the utilities, in which environmental variables are omitted; (ii) The slacks calculated in the first stage are regressed on a set of environmental variables by means of SFA and operating costs are adjusted to account the environmental impact and statistical noise effects; and, (iii) reassess the performance of the electric power distribution utilities by means of DEA. Based on this methodology it is possible to obtain a performance evaluation exclusively expressed in terms of management efficiency, in which the operating environment and statistical noise effects are controlled.

A framework for measuring global Malmquist–Luenberger productivity index with CO2 emissions on Chinese manufacturing industries

China has achieved significant progress in terms of economic and social developments since implementation of reform and open policy in 1978. However, the rapid speed of economic growth in China has also resulted in high energy consumption and serious environmental problems, which hindering the sustainability of China's economic growth. This paper provides a framework for measuring eco-efficiency with CO2 emissions in Chinese manufacturing industries. We introduce a global Malmquist-Luenberger productivity index (GMLPI) that can handle undesirable factors within Data Envelopment Analysis (DEA). This study suggested after regulations imposed by the Chinese government, in the last stage of the analysis, i.e. during 2011–2012, the contemporaneous frontier shifts towards the global technology frontier in the direction of more desirable outputs and less undesirable outputs, i.e. producing less CO2 emissions, but the GMLPI drops slightly. This is an indication that the Chinese government needs to implement more policy regulations in order to maintain productivity index while reducing CO2 emissions.

The Impact of Supervisory Monitoring On High-End Retail Sales Productivity

Based on a two-stage analysis of a panel of data on 12 outlets of a high-end retailer for 24 months, we investigate how the level of supervisory monitoring affects retail sales productivity. In the first stage, we use Data Envelopment Analysis (DEA) to compute the relative productivity of retail outlets in using their labor and capital resources to generate store sales. In the second stage, we regress the logarithm of DEA scores on contextual variables to obtain consistent estimators of the impact of contextual variables on productivity (Banker and Natarajan in Operation Research 56:48-58, 2008). Contrary to agency theoretic prediction that supervisory monitoring leads to an increase in retail sales productivity, our empirical results indicate that the higher the level of supervisory monitoring, the lower is the retail sales productivity for high-end retail outlets.

Análise da eficiência de contratos de serviços de elevada especificidade terceirizados pela petrobras

The definition of the boundaries of the firms is subject that has occupied the organizational theorists long ago, being the seminal work of Coase (1937) indicated as the trigger for one theoretical evolution, with emphasis on governance structures, which led to a modern theory of incomplete contracts. The Transaction Cost Economics (TCE) and Agency Theory arise within this evolution, being widely used in studies related to the theme. Empirically, data envelopment analysis (DEA) has established itself as a suitable tool for analysis of efficiency. Although TCE argues that specific assets must be internalized, recent studies outside the mainstream of theory show that, often, firms may decide, for various reasons, hire them on the market. Researches on transaction costs face with the unavailability of information and methodological difficulties in measuring their critical variables. There`s still the need for further methodological deepening. The theoretical framework includes classic works of TCE and Agency Theory, but also more recent works, outside the mainstream of TCE, which warn about the existence of strategies in use of specific assets that aren`t necessarily aligned with the classical ideas of TCE. The Brazilian oil industry is the focus of this thesis, that aimed to evaluate the efficiency of contracts involving high specificity service outsourced by Petrobras. In order to this, we made the categorization of outsourced services in terms of specificity, as well the description of services with higher specificity. Then, we verified the existence of relationship between the specificity of services and a number of variables, being found divergent results than those that are preached by the mainstream of TCE. Then, we designed a DEA model to analyze the efficiency in the use of onshore drilling rigs, identified among the services of highest specificity. The next step was the application of the model to evaluate the performance of drilling rigs contracts. Finally, we verified the existence of relationship between the efficiency of contracts and a number of variables, being found, again, results not consistent with the theory mainstream. Regarding to analyze of efficiency of drilling rigs contracts, the model developed is compatible with what is found in academic productions in efficiency of drilling rigs. The results on efficiency show a wide range of scores, with efficiencies ranging from 31.79% to 100%, being low the sample efficiency average. There is consonance between the model results and the practices adopted by Petrobras. The results strengthen the DEA as an important tool in studies of efficiency with possibility to use for analysis other types of contracts. In terms of theoretical findings, the results reinforce the arguments that there are situations in which the strategies of the organizations, in terms of use of assets and services of high specificity, do not necessarily follow what is recommended by the mainstream of TCE

Análise da eficiência de contratos de serviços de elevada especificidade terceirizados pela petrobras

The definition of the boundaries of the firms is subject that has occupied the organizational theorists long ago, being the seminal work of Coase (1937) indicated as the trigger for one theoretical evolution, with emphasis on governance structures, which led to a modern theory of incomplete contracts. The Transaction Cost Economics (TCE) and Agency Theory arise within this evolution, being widely used in studies related to the theme. Empirically, data envelopment analysis (DEA) has established itself as a suitable tool for analysis of efficiency. Although TCE argues that specific assets must be internalized, recent studies outside the mainstream of theory show that, often, firms may decide, for various reasons, hire them on the market. Researches on transaction costs face with the unavailability of information and methodological difficulties in measuring their critical variables. There`s still the need for further methodological deepening. The theoretical framework includes classic works of TCE and Agency Theory, but also more recent works, outside the mainstream of TCE, which warn about the existence of strategies in use of specific assets that aren`t necessarily aligned with the classical ideas of TCE. The Brazilian oil industry is the focus of this thesis, that aimed to evaluate the efficiency of contracts involving high specificity service outsourced by Petrobras. In order to this, we made the categorization of outsourced services in terms of specificity, as well the description of services with higher specificity. Then, we verified the existence of relationship between the specificity of services and a number of variables, being found divergent results than those that are preached by the mainstream of TCE. Then, we designed a DEA model to analyze the efficiency in the use of onshore drilling rigs, identified among the services of highest specificity. The next step was the application of the model to evaluate the performance of drilling rigs contracts. Finally, we verified the existence of relationship between the efficiency of contracts and a number of variables, being found, again, results not consistent with the theory mainstream. Regarding to analyze of efficiency of drilling rigs contracts, the model developed is compatible with what is found in academic productions in efficiency of drilling rigs. The results on efficiency show a wide range of scores, with efficiencies ranging from 31.79% to 100%, being low the sample efficiency average. There is consonance between the model results and the practices adopted by Petrobras. The results strengthen the DEA as an important tool in studies of efficiency with possibility to use for analysis other types of contracts. In terms of theoretical findings, the results reinforce the arguments that there are situations in which the strategies of the organizations, in terms of use of assets and services of high specificity, do not necessarily follow what is recommended by the mainstream of TCE

Reformas na gestão hospitalar:análise dos efeitos da empresarialização

Tese de Doutoramento em Ciências Sociais na Especialidade de Administração da Saúde