Outsourcing of public hospital services in the region of GRANDE VITÓRIA/ES

Abstract

It is the aim of this inquiry to analyze and present the outsourcing of services as a governance framework for the state public hospitals of Grande Vitória/ES. An empirical study was utilized, in which research was conducted along with the State Health Department (Secretaria de Estado da Saúde), the Espirito Santo State Court of Auditors (Tribunal de Contas do Estado do Espirito Santo), and the Ministry of Labor (Ministério Público do Trabalho). Questionnaires were administered to seven hospitals, which were completed by the heads of services. The re search was based on the Economy of Transaction Costs, and attempted to study the probability relation of outsourcing with the following variables: asset specificity, frequency, and uncertainty. As expected, the results show that the contractual risks are not the principal drivers behind the outsourcing of public hospitals, nor is the current legislation, since, due to low enforcement, the existence of processes diverging from the established law were verified. Furthermore, it was observed that the hospital administrator manages toward non-failure in critical areas, setting efficient transaction costs aside. Thus, the lack of government resources, inefficiency in the hiring of public employees, as well as the lack of incentives toward the performance of the government agent, may lead to distant situations in the efficient organization of the activity.