The Model Explained ^[1]

The first step consists of applying non-parametric frontier estimations for the full production capacity of the health service units (the maximum feasible production configuration for each hospital) based on hospital internments as the main output and hospital beds as one of the many discretionary resources. Similar to many assessments of health systems efficiency, the number of beds is considered a proxy for hospital capital ^[2][3][4]. That way, the lower the usage of this resource means the higher efficiency for the health service unit. The objective in this assessment, however, is to provide an optimal number of beds to be evacuated and allocated for potential COVID-19 cases, instead of reduced.

For the second step, the optimal number of beds to be reallocated (based on the best practices) are prioritized according to the Complexity of Needs for each medical specialty. The Complexity of Needs in the Brazilian health system is the degree of complexity each health problem presents, and the requirement for specialized knowledge. There are three categories: Basic Care, Moderate Complexity and High Complexity. Each category is defined in the Box 1.

Box 1: Complexity of Needs Categories

Hospitalizations have moderate () or high () Complexity of Needs admissions. Consider a set of j = 1, 2, 3, … m health service units using  | i = 1, 2, 3, …, n hospital inputs to produce | r = 1, 2, 3, …, s outputs. Consider ‘o’ the service unit under evaluation and ‘e’, the sum of both moderate and high Complexity of Needs hospitalizations, a proxy for the prioritization of beds evacuation. The optimal feasible contraction (evacuations) of high complexity hospitalization beds is:

 The optimal feasible contraction (evacuations) of moderate complexity beds is:

 Where: is the efficiency score for the production technology under variable returns to scale ^[5][6].

Equation (1) and (2) states that the optimal number for bed evacuations of high complexity internments depends on the number of evacuated beds of moderate complexity. In other words, the optimal number for bed evacuations of high complexity internments is the remaining feasible contraction of beds after all moderate complexity internments are evacuated. As an example, considering an efficiency score = 0.8, the service unit may improve efficiency by producing the same result using (1 – 0.8) = 20% fewer resources. Considering 100 hospital beds allocated to internments of both Complexity of Needs as the discretionary input |  = 15 & = 85, the number of beds to be evacuated having moderate complexity is =  = 15 beds; and the number of beds to be evacuated having high complexity is =   = 20 – 15 = 5 beds.

Full concepts and definitions concerning the Complexity of Needs assistance in the Brazilian Health System and a list with the related medical specialties can be accessed in CONASS (2020) ^[7].

This entry refers to 10.1155/2020/8857553