Evaluation of performance of health systems: a model for analysis

Este artigo apresenta uma revis??o da Matriz de Dimens??es da Avalia????o do Sistema de Sa??de no Brasil desenvolvida em 2003, e uma atualiza????o conceitual de parte das subdimens??es de avalia????o do desempenho dos servi??os de sa??de: efetividade, acesso, efici??ncia e adequa????o. Descreve o processo de sele????o dos indicadores utilizados e uma s??ntese dos resultados para cada subdimens??o do desempenho. O comportamento dos indicadores utilizados para avaliar o desempenho dos servi??os de sa??de no Brasil, no que se refere ??s quatro subdimens??es selecionadas, n??o ?? uniforme e as melhorias mais acentuadas s??o observadas naquelas influenciadas pela atua????o dos servi??os no campo da aten????o prim??ria, as melhorias mais significativas foram observadas nas Efetividade e Acesso. Em rela????o ?? Efici??ncia dos servi??os de sa??de coexistem situa????es de alta efici??ncia com outras de baixo desempenho. A atua????o dos servi??os de sa??de na subdimens??o Adequa????o foi pior do que nas demais apresentadas.This paper presents a review of the Dimension Matrix for Evaluation of the Brazilian Health System that was initially developed in 2003, as well as a conceptual update of some of the sub-dimensions for the evaluation of health service performance, namely effectiveness, access, efficiency and appropriateness of health care. It also describes the indicator selection process as well as the results obtained in each performance dimension. The behavior of the indicators used to assess the performance of health services in Brazil, with respect to each sub-dimension, was not uniform. Areas of marked improvement were found in indicators that are influenced by activities in the field of primary care. The most significant improvements were seen in the sub-dimensions of Effectiveness and Access. With respect to the Efficiency of health services, situations of high efficiency coexist with others with substandard performance. The performance of health services in the sub-dimension of Appropriateness of Health Care was the lowest of all indicators