On the choice of public or private management models in the Brazilian Unified Health System (SUS)

Abstract

Different research studies about healthcare organizations in the public and private sectors display several opposite values. Therefore, there are several gaps that make consensual generalizations over the best management model as the only choice for the entire sector unlikely. Considering the importance and complexity of the Brazilian Unified Health System – SUS, the objective of this research study is to propose a framework to aid the choice between public and/or private management models for SUS using a benchmarking of multicriteria methods. Fuzzy TOPSIS, Fuzzy VIKOR, and a group method based on Game Theory were applied to a group of regional experts with different qualifications and perspectives concerning the management models to be selected as alternatives for the city of Ribeirão Preto. Two decision matrices were constructed for that complex problem, one for Primary Care and another for Secondary Care, considering criteria from four dimensions. The alternatives were assessed through sensibility and robustness analysis. Ranking reversal, the perceptions of experts as decision-makers, and similarities to the reality of the city were also evaluated. It has been demonstrated that the framework shows potential in aiding group decision analysis, involving the public agents of each geographical territory covered by the healthcare management models, to endorse the use of proper methods that promote transparency and the use of scientific arguments.