Contents -- Foreword -- Acknowledgments -- About the Authors -- Policy Summary -- Acronyms and Abbreviations -- 1 Introduction -- Why This Book? -- Objectives, Approach, and Conceptual Framework -- Audience and Policy Environment -- Chapter Summaries -- Sources and Caveats -- Notes -- 2 The Brazilian Hospital Sector: Structure, Financing, Spending, and Outcomes -- The Brazilian Health Sector -- The Brazilian Hospital Sector -- Hospital Finance and Spending -- Summary Assessment -- ANNEX 2A: An Indirect Method for Estimating Hospital Spending -- ANNEX 2B: Supplementary Data -- Notes -- 3 Comparative Analysis of Costs and Efficiency -- Hospital Costs: Measurement Challenges and Findings -- Efficiency Analysis -- Conclusions and Recommendations -- ANNEX 3A: Cost Analysis Methodology: The De Matos Cost Study Methodology -- ANNEX 3B: Supplementary Data -- ANNEX 3C: Average Cost and Coefficient of Variation for Sample Hospital Procedures -- ANNEX 3D: DEA Methodology -- ANNEX 3E: Brazilian Studies on Hospital Efficiency -- Notes -- 4 Hospital Payment Mechanisms and Contracting Arrangements -- Payment Mechanisms for Hospital Care in Brazil -- Critical Review of PPMs in Brazil -- The Plight of Private Hospitals under the SUS -- Payment Mechanisms and Performance -- Hospital Contracting Arrangements in the SUS -- Conclusions and Recommendations -- ANNEX 4A: Characteristics and Effects of Main Provider Payment Mechanisms -- ANNEX 4B: History of Government PPMs for Hospitals in Brazil -- ANNEX 4C: Provider Payment Mechanisms Used by the SUS -- ANNEX 4D: Differential Increases in Reimbursement Rates, 1995-2001 -- ANNEX 4E: From the AIH to DRGs -- Notes -- 5 Organizational Arrangements and Performance of Brazilian Hospitals -- Organizational Arrangements: Framework and Literature -- Organizational Arrangements in Public Hospitals in Brazil.

Comparative Review of Organizational Features in Public Hospitals -- Private Sector Organizational Structures and Governance Arrangements -- Comparative Performance of Hospitals under Different Ownership and Organizational Arrangements -- Summary Assessment -- ANNEX 5A: Organizational Arrangements in Public and Private Hospitals in Brazil: Summary -- ANNEX 5B: Matrix: Features of Organizational Arrangements in Public Hospitals in Brazil -- ANNEX 5C: Methods for Analysis of Alternative and Traditional Hospitals -- ANNEX 5D: Methods for Comparative Analysis of OSS and Direct Administration Hospitals -- ANNEX 5E: Matrix: Organizational Arrangements in European Hospitals -- Notes -- 6 Inside the Black Box: Linking Organizational Arrangements, Managerial Behaviors, and Performance in Public and Private Hospitals -- Management Practices in Public Hospitals -- Brazil's Experience with Hospital Conversion: Overcoming Human Resource and Financial Obstacles -- International Experience with Hospital Conversion -- Managerial Practices in the Private Nonprofit Sector -- Summary Assessment and Recommendations -- ANNEX 6A: Strengths and Weaknesses of the Public Sector Regime for Procurement, Labor, and Budgeting -- ANNEX 6B: Comparison of Summary Labor Regime Characteristics for Physicians by Organizational Arrangement in Public and Private Nonprofit Hospitals -- Notes -- 7 Quality of Care: Still the Forgotten Component? -- Quality, Quality Improvement, and Costs -- Quality in Brazilian Hospitals -- Summary Assessment -- ANNEX 7A: Policy and Managerial Innovations Across Medical Disciplines, 2000-2005 -- ANNEX 7B: Process Shortcomings in Brazilian Hospitals and Possible Causes -- Notes -- 8 Quality Assessment and Improvement -- Hospital Accreditation and Certification in Brazil: Adoption, Challenges, and Opportunities.

Other Quality Assessment and Improvement Initiatives -- Care Coordination Across Provider Levels -- Summary Assessment and Recommendations: A Framework for Systematic Quality Improvement -- ANNEX 8A: An Example of ONA Standards and Performance Elements: Obstetrics -- ANNEX 8B: Government Initiatives to Build National Capacity for Continuous Quality Improvement, 1997-2001 -- ANNEX 8C: Setting the Policy and Institutional Framework for Systematic Quality Measurement and Improvement: Examples from the United States, the United Kingdom, and Australia -- ANNEX 8D: Hospital Report Cards: Motivating Hospitals to Perform? -- ANNEX 8E: Quality-Based Purchasing in OECD Countries -- Notes -- 9 Conclusions and Recommendations -- Problems in Brazil's Hospital Sector -- Building on Brazilian Innovations and Experience -- What Can be Done? Key Policy Priorities -- Moving Forward with Implementation -- ANNEX 9A: Recommended Policies and Actions -- Notes -- Bibliography -- Index -- Figure 1.1 Conceptual Framework for Hospital Performance -- Figure 2.1 Main Players and Fund Flows in the Brazilian Hospital Sector -- Figure 2.2 Distribution of National Health Expenditure, by Source, 2004 -- Figure 2.3 Trends in SUS Financing, by Source, 1985-2004 -- Figure 2.4 Payment and Transfer Flows for SUS Hospitals -- Figure 2.5 Hospitals, by Size and Ownership, 2002 -- Figure 2.6 Long-Term Trends in Bed Supply, 1976-2002 -- Figure 2.7 Privately Financed and SUS-Financed Patients, 2002 -- Figure 2.8 Inpatient Care, by Clientele and Hospital Ownership, 2000-3 -- Figure 2.9 Sources of Hospital Care Financing, 2002 -- Figure 2.10 Hospital Spending, by Facility Ownership, 2002 -- Figure 2.11 Hospital Spending, by Line Item, 2002 -- Figure 2.12 SUS Hospital Spending, by Type of Care, 2002 -- Figure 2B.1 Total Hospital Costs, United States, by Type of Expense, Fiscal 2003.

Figure 3.1 Distribution of Cases and Costs, by Case-Mix Index Range, 2001 -- Figure 3.2 Distribution of Procedures, by Cost Intervals, 2001 -- Figure 3.3 Costs by Hospital Type, Unadjusted and Adjusted for Case Mix, 2001 -- Figure 3.4 Main Sources of Variation in Hospital Costs, 2001 -- Figure 3.5 Coefficient of Variation for Surgical and Clinical Cases, 2001 -- Figure 3.6 Composition of Procedure Costs, by AIH Category, 2001 -- Figure 3.7 Distribution of Sample Hospitals, by Size and Ownership, 2002 -- Figure 3.8 Technological Complexity, by Ownership, 2002 -- Figure 3.9 Hospital Admissions, by Clientele, 2002 -- Figure 3.10 Total Efficiency Scores, by Hospital Size, 2002 -- Figure 3.11 Efficiency Scores, by Hospital Ownership, 2002 -- Figure 3.12 Efficiency Scores, by Technological Complexity, 2002 -- Figure 3.13 Efficiency Scores, by Teaching Status, 2002 -- Figure 3.14 Bed Turnover Rate, 2002 -- Figure 3.15 Mean Occupancy Rate for SUS Acute Care Hospitals, by Ownership, 2002 -- Figure 3.16 ALOS for SUS Acute Care Hospitals, by Ownership, 2002 -- Figure 3.17 Ratio and Composition of Personnel per Bed, 2002 -- Figure 3.18 Total Personnel per Occupied Bed Ratio, 2002 -- Figure 3.19 Surgical Patients per Operating Room per Year Ratio, 2002 -- Figure 3.20 Technological Complexity per Bed Ratio, by Ownership, 2002 -- Figure 3.21 Quality and Efficiency in Brazilian Hospitals, 2002 -- Figure 3.22 Proportion of Inpatient Conditions Sensitive to Ambulatory Care, 2002 -- Figure 3D.1 Relation Between Different Types of Efficiency -- Figure 3D.2 Technical and Allocative Efficiencies -- Figure 4.1 Hospital Funding, by Payment Mechanism, 2002 -- Figure 4.2 Mean Ratio, SUS Schedule/Cost, by Procedure Complexity, 2002 -- Figure 4.3 Total Efficiency Scores, by PPM, 2002 -- Figure 4E.1 DRG Hierarchical Structure and Classification Criteria.

Figure 5.1 Hierarchy and Flexibility Scores for Organizational Structures, Alternative and Traditional Hospitals, 2000 -- Figure 5.2 Percent of Full-Time and Volunteer Managing Executives of Nonprofit Hospitals, by Facility Category, 2000 -- Figure 5.3 Percent Change in Selected Mortality Rates, Alternative and Traditional Hospitals, 1998-2003 -- Figure 5.4 Percent Change in Selected Efficiency Indicators, Alternative and Traditional Hospitals, 1998-2003 -- Figure 5C.1 Adjusted Costs Based on AIH Values, 2003 -- Figure 5C.2 AIH Values, by Hospital Type, 2003 -- Figure 6.1 Strategic and Normative Scores for Alternative and Traditional Hospital Behaviors, 2000 -- Figure 6.2 Correlation between Flexibility and Strategic Scores, Alternative and Traditional Facilities, 2000 -- Figure 6.3 Delays in Purchasing Supplies and Services, as Reported by Public Hospital Managers, by Subnational Level, 2003 -- Figure 6.4 Principal Personnel Problems Identified by Managers, State and Municipal Hospitals, 2003 -- Figure 6.5 Financial Information at Health Facilities, 2003 -- Figure 6.6 Management Development Scores of Nonprofit Hospitals, by Category, 2001 -- Figure 7.1 PNASS Facility Assessment Scores, 2005-6 -- Figure 7.2 Hospital Infection Control, by Hospital Complexity -- Figure 8.1 Building Blocks for a National System of Quality Assessment, Management, and Improvement -- Table 2.1 Demographic and Health Trends -- Table 2.2 Financial and Economic Costs Related to the NCD Burden of Disease, 2005-9 -- Table 2.3 International Comparison of Health Expenditure, 2002 -- Table 2.4 International Comparison of Health Spending and Outcomes, 2002 -- Table 2.5 Hospital Ownership, 2002 -- Table 2.6 Disparities in Health Indicators in the Municipality of São Paulo, 2002-3 -- Table 2.7 SUS Hospital Expenditure, by Care Level, 2002.

Table 2.8 Brazilian and International Patterns of Hospital Resource Allocation, 2000-2.