GOBERNANZA Y RENDICION DE CUENTAS EN UNA MUESTRA

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GOBERNANZA Y RENDICION DE CUENTAS EN UNA MUESTRA
GOVERNANCE &
ACCOUNTABILITY IN A
SAMPLE OF ARGENTINE
HOSPITALS
Guillermo González Prieto
Study Objectives
Assess changes in Governance and
Accountability in a sample of
“decentralized” hospitals
 Measure the level of decentralization
achieved.
 Relate the variables with hospital
performance.

Argentina
Federal Republic
 Population: 37 million
 Infant Mortality rate: 16,8
 Life expectancy: 75 years
 Fragmented health system
(Beveridge, Biskmarck & HMOs)

Background
Health Services were transfered to
provinces in the 70´.
 “Self-managed hospital” national
decree, 1993
 Health Reform Project (PRESSAL)
1995-2000

Hypothesis

Direct positive relation between level
of decentralization and
improvements in Governance and
Accountability

The level decentralization achieved
by the hospitals is very low
Methodology
Selection of 9 hospitals
 Matrix to measure level of hospital
decentralization (Alvarez & González

Prieto, 1999)
Matrix to evaluate hospital
performance
 Surveys to evaluate hospital
governce and accountability.

Hospitals profile
Dependence Hospital
Mendoza
Lagomaggiore
Central
Buenos As Evita Pueblo
Gonnet
BsAs City Argerich
Fernández
Salta
Oñativia
San Bernardo
Mix
J.P. Garrahan
Beds
390
250
149
154
384
430
54
342
500
PRESSAL
Baseline
18 month
18 month
18 month
18 month
18 month
18 meses
6 month
6 month
No
Dec Perfor G & A
Yes
Yes
No
Yes
Yes
No
Yes
Yes
No
Yes
Yes
No
Yes
Yes
No
Yes
Yes
No
Yes
Yes
No
No
Yes
No
Yes
No
No
Matrix to measure level of
hospital decentralization
• (i) Legal status
• (ii) Hospital government
• (iii) Strategic Plan
• (iv) Administration
• (v) Purchasing
• (vi) Investments
• (vii) Financial Management
• (viii) Human Resources Management
• (ix) Commercial Management.
Matrix to evaluate hospital
performance (Output changes)
 Average inpatient length of stay
 Rate of deaths vs discharges.
 Rate of emergency visits vs total visits
 Rate of cesarea vs normal delivery
 Percentaje of budget billed to third party
payers
 Percentaje of collection vs total billing to
third party payers
Matrix to evaluate hospital
performance (quality)
 Medical record at discharge
 System to evaluate patient satisfaction
 Customer Services office
 System to resolve patient claims
 Performance evaluation of personnel
 Preventive manteinance program
 “Management contracts” Program
Survey to evaluate governance
1. Legislation
2. Government structure
3. Executive Director appointed by Board
4. Board´s performance evaluation
5. Executive director performance
evaluation
6. Autonomy to appoint chief of services and
personnel
Survey to evaluate accountability
1.Evidence of positive cultural changes
2.Executive reports to the Board
3.Job stability conditioned by performance
4.Evaluation of performance by
customer/patients
5.Jerarquía de la voz de los usuarios
6.NGO´s participation in hospital
government
7. Importance of media opinion
Results
Direct positive relation between level of
decentralization and improvements in
Governance and Accountability
Group 1: 3 hospitals with high to moderate
decentralization
Group2: 2 hospitals of low to moderate
decentralization
Group 3: 2 hospitals with low decentralization
Group 4: 2 centralized hospitals.
Conclusions

The level of decentralization/autonomy is very
low
 Improvements
in
governance
and
accountability were not explicit objectives in
the Hospital reform
 The relation between performance and
governance & accountability needs to be
studied.

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