Relationship between performance and hospital size in the state of São Paulo (Brazil)

The objective of the study was to identify relationships between performance and hospital size in general hospitals that attend the Unified Health System (UHS) in the State of São Paulo, Brazil. The study was quantitative and the sample was composed of 420 general hospitals that provided service to the Unified Health System from 2008 to 2013. Hospital indicators selected to evaluate performance included, production, productivity and quality. Sources of secondary information from the health information systems were been used, with Internet access at the electronic addresses of the Department of Information Technology of UHS and the State Department of Health of São Paulo. It was been observed that of the total of general hospitals in the sample, 45% are small, 33.8% are medium-sized, 19.3% are large and 1.9% are of special size. Large hospitals obtained better productivity and quality results for cesarean section rates. Small hospitals had the lowest rates of productivity indicators. The performance of general hospitals suggests different standards regarding the production, productivity and the quality that can be define according to hospital size characteristics. These differences correspond to the technological resources, specializations, complexity and location of hospitals.