Are Portuguese hospitals suitably clustered according to their activity, quality, access, and expenses? An exploratory analysis on behalf of financial sustainability

Rodrigo Amado Pascoal da Graça

Key information

Authors:

Rodrigo Amado Pascoal da Graça (Rodrigo Amado Pascoal da Graça)

Supervisors:

Rui Miguel Carrasqueiro Henriques (Rui Miguel Carrasqueiro Henriques); Diogo Filipe da Cunha Ferreira (Diogo Filipe da Cunha Ferreira)

Published in

01/20/2021

Abstract

Financial sustainability has been one of the major challenges faced by healthcare systems. Portugal adopted strategies to promote efficiency in healthcare. One strategy implied the application of the lowest price for the consultation’s activity found in each of subsets of hospitals belonging to the National Health Service, thus promoting the providers' search for efficiency. This grouping was generated by clustering methodology to the data variables that could explain the costs of their activity. However, the adequacy of the established model concerning the present reality of the hospitals is unknown, as no adjustments have been implemented proceeding its initial application in 2013. Here we show that the current classes do not adequately reflect the current reality of the units. We found that four healthcare units do not integrate the most suitable category. Furthermore, from the 20 tested clustering methodologies, the maximum achieved silhouette is 0.36, indicating that the providers are the healthcare providers are not well grouped. In this context, doubts concerning its implementation for funding and benchmarking can be raised. Our results demonstrate that a revision of the clustering process is necessary. Additionally, this procedure should also encompass variables covering environmental, quality and access of the healthcare services dimensions, since better results are obtained when these criteria are incorporated. These recommend steps are critical to ensure that the funding and benchmarking are fair. It is estimated that, due to inadequate grouping, providers receive yearly less €59 million to €110 million than the due amount.