Dynamic Data Envelopment Analysis, Vaccination, Efficiency, Brazilian municipalities.

The present work proposes a new model for the analysis of the efficiency of the Brazilian public health system based on the evaluation of the vaccination expenditures of the municipalities. Considering that health functions interconnectedly among its agents, overall efficiency can be affected by underlying problems such as vaccination in which it contributes to the control of communicable diseases and death. Thus, immunization can influence the efficiency of the health system as a whole. It is important to highlight that the research method used was predominantly descriptive with the application of Dynamic Data Envelopment Analysis (DDEA) to determine the efficiency of the decision making units (DMU) between the years of 2013 and 2015. The collected sample contemplates the metropolitan regions in which they are composed by 631 municipalities and Brasília since it is not considered a municipality. It should be noted that 2 municipalities were excluded from the analysis because they did not present sufficient information. According to the Ministry of Health, the variables that make up the mathematical modeling are classified as performance indicators, and are organized in the conceptual research model as follows: inputs (expenditure per capita with health and percentage applied with prophylactic and therapeutic expenditure) ; carry - over (percentage of vaccination coverage) and outputs (percentage applied with hospital, outpatient, and medication assistance). Assuming the great territorial extension of Brazil and its demographic and socioeconomic differences between regions, the data analysis is systematized in 4 stages. In the first stage, the data were rotated and grouped with all DMU's. In the second, by regions. In the third by states and the last by ports of the municipalities. According to the analyzes, the results indicated different levels of efficiencies at each stage between the global analyzes and by periods between the municipalities. Still in the analyzes carried out by municipalities, which is considered the highest stage of homogeneity level of the sample, it is pointed out that the larger the municipality, the greater its efficiency. This result demonstrates the importance of investments in health, since the larger the municipality, the higher will be its own collection and its current net revenue. In this way, there will be an increase in the application of resources in health due to legal obligation and also an increase in the transfers of the state and federal government, since the funds are distributed according to the number of inhabitants per municipality. However, it is important to emphasize that it is up to managers to analyze and mirror the management and financial reports of municipalities with a higher level of efficiency so that they can improve their performance.