Auditoria interna e eficiência das políticas públicas de saúde: estudo de caso da aplicação da gestão do desempenho em órgãos subnacionais Brasil e Portugal

Abstract

Contemporary society, worldwide, finds itself in a political, economic and social scenario of many uncertainties and future challenges. On the other hand, it is immersed in a globalised era, with rising technology, where information circulates in an agile and dynamic way, só this context demands differentiated action from public and private institutions. As far as public management is concerned, the maturing of democracy has led to greater social participation in the control of public spending, as well as a high level of public demand for the provision of quality, fair and timely public services. In this context, this research presents an empirical investigation into three categories of analysis that correlate and reverberate in the performance of public administration: performance management, internal auditing and the efficiency of public policies, with the context of analysing public health management in Brazil and Portugal. The general aim of the study is to analyse the application of performance management in sub-national internal auditing bodies in the universal health systems of Brazil, the Unified Health System (SUS), and Portugal, the National Health Service (SNS). The research is characterised as qualitative and quantitative, of an applied nature, with exploratory and descriptive objectives. In terms of methodological procedures, the study used bibliographical and documentary reviews to provide theoretical support and used the case study technique to investigate the SUS Audit Department of Rio Grande do Sul (DEASUS/RS), in Brazil, and the Audit and Internal Control Unit of the Northern Regional Health Administration (UACI/ARSN), in Portugal. To collect the data, a questionnaire (survey) was applied to 68 (sixty-eight) DEASUS/RS employees, and a semi-structured interview was carried out with the organisation’s senior management. In Portugal, semi-structured interviews were carried out with key players, selected using the Snowball technique. Workers from the UACI/ARSN, a specialist in public health management and a municipal manager took part in the interviews. The main results were that DEASUS/RS has an established level of maturity, but with weaknesses in the feedback stage. In Portugal, the level of maturity of the internal audit body was not identified due to the structural changes underway in the NHS. The research identified a difference in performance between the internal audit bodies: in Brazil, the priority is to verify the efficiency and effectiveness of public health policies, while in Portugal, the aim is to implement a working model that is closer to verifying compliance.