In countries like ours, it is somewhat unusual for a Public Service institution to remain constant in its functions for 100 years or more. In Venezuela, such circumstance deserves no other qualification than being an exceptional event.
The construction of the Vargas Hospital was decreed by President Juan Pablo Rojas Paúl on August 16, 1888; It was inaugurated on January 1, 1891, during the presidency of Raimundo Andueza Palacio and commissioned on July 5 of the same year. Since then and in the course of more than a hundred years it has yielded countless benefits to the country, which has ratified the reason for its creation, the reason for its existence and its justification as a Health Institution.
For many, this feat of the Hospital Vargas in the field of medical care, teaching and research is not only exceptional but heroic. In the course of one hundred and six years, to achieve the aforementioned achievements, the Institution and its men have had to fight against multiple adverse factors. In recent years, such factors have been magnified in such a way that even the most optimistic have been skeptical about the future.
In this way, it is necessary that the Executive does not continue trying to use paternalistic and centralist schemes in regards to the provision of services, which is why it is necessary to give a total turn towards Administrative Decentralization, which in some way will help to solve the crisis that the Vargas Hospital in Caracas is going through.
For this, it will be tried to study if the Self-management process started by the Hospital Vargas de Caracas, belonging to the Sanitary District Nº 1, of the Federal District Government (GDF); as a pilot regarding the Decentralization process of the GDF Health Administration, it will help to reduce the effects caused by the crisis in said Hospital; and at the same time try to observe if this model has applicability to the other Hospital Centers that make up the General Directorate of Health of the Federal District Government.
JUSTIFICATION
According to studies carried out by the Commission for State Reform (COPRE) and the United Nations Development Program (UNDP) in the framework of Public Sector Decentralization and based on current reality, it has been seen that “the best way To alleviate the effects of the administrative congestion of the Centralist State and the crises caused by it, it is the administrative DECENTRALIZATION that must be promoted by the State itself ”.
In this preliminary project we find a proposal to promote administrative decentralization, which is SELF-MANAGEMENT. One of the sectors that is most congested is Health, that is why it has been decided to relate the concepts of Administrative Crisis, Self-management and Decentralization; which marks another milestone in the process of Decentralization that is currently underway.
"Social policy must have clear objectives and an investment aimed at achieving them, we should take that step for the good of the country."
PROBLEM STATEMENT
With the beginning of the exploitation of oil in Venezuela in 1936, important internal migrations of population emerged from the rural sectors to the oil and central states, these migrations were driven by the search for better living conditions, in terms of wages, education and health.
These migrations caused that over the years, the population of the Capital of the Nation, increased considerably. With the advent of this oil economy; With the Nationalization of Black Gold in 1976, Venezuelans had the possibility of having a health service provision in a fairly reliable way.
But, from this moment, when the State begins to take charge of the administration of all the services, in an attempt to centralize absolutely all the Public Power; the Administration of the different Hospitals become a direct part of the Ministry of Health and Social Assistance; to then delegate its administration to the different State Governments. "Those in charge and responsible for the Health Administration should be the Governors and the Mayors, this to promote Decentralization."
This crisis began to permeate all levels, including services and therefore the Health Sector, which now in charge of the Health Administrations of the Governments, would begin to suffer one of the longest ordeals in the history of this country.
Mikel De Viana sj, indicated in 1981 that there were some causes of the hospital crisis, and that it would worsen as the years passed, if measures were not taken to solve the causes:
Strikes, Lack of Inputs, Inefficiency, Deficit Budgets, High input costs due to the rise in currencies, Bureaucracy, Endless labor conflicts, etc., made this sector gradually sink more and more into a bottomless pit, from which you would only get out with the help of the government, help that, of course, almost never came.
"Today, these great Hospital Centers… die, collapse. The causes have already been diagnosed: laziness, clientelism, corruption. These stale vices are currently joined by sabotage, trying to prevent the Government, under the recommendations of the International Monetary Fund, from restructuring the public health system. "
It is important to note that the Crisis Problem as such is extended to all Hospital Institutions in the Country, especially Hospitals located in large urban areas (Caracas, Maracaibo, etc.).
“The country's National Health System is no longer sustained and began its collapse in the capital, plagued by marginality and violence. When the hospitals began to close their doors they dragged their crisis to the other hospital centers that could barely attend to their own emergencies. ”
LIMITATION OF THE PROBLEM
This project will be limited to the Decentralization of the Health Administration of the Federal District Government, seen as a Self-Management Process, therefore, the most important modifications that occur within the Hospital Service dependent on the General Health Directorate will be taken as a reference of the Federal District Government (SU SALUD DF), which groups the Hospitals and Dispensaries dependent on the GDF and the Ministry of Health and Social Assistance.
This dependency is divided into six (6) Health Districts:
- Maripérez: 3 Hospitals. Catia: 4 Hospitals. Antímano: 4 Hospitals. El Valle: 3 Hospitals. Peteta: 3 Hospitals. La Guaira: 5 Hospitals.
The Project will be limited to two Hospitals belonging to the General Directorate of Health of the Federal District Government; the first will be the Vargas Hospital in Caracas, belonging to the Sanitary District No. 1 (Maripérez) of the aforementioned dependency and cataloged as a Type IV Hospital, this category refers to a Hospital that provides all services, has great infrastructure and a greater capacity to 350 beds. This Hospital is chosen, for being the pioneer in what refers to Hospital Self-management.
The second will be the "Leopoldo Manrique Terrero" Hospital or also called the Car Peripheral, belonging to the Sanitary District No. 4 (El Valle) and located in a category III, this refers to a medium-sized Hospital, which provides 75% of the services offered by a type IV hospital and with a capacity between 100 and 350 beds, this Hospital is chosen to make a comparison, because there was a Restructuring Process, started by the same General Directorate of Health in early 1994, through the hiring of a multidisciplinary team belonging to the private sector to carry out the pertinent modifications. An attempt will be made to see if there has been an improvement in the Service provided, manifested in an increase in efficiency.
OBJECTIVES
GENERAL:
To determine to what degree the Decentralization, through the figure of the Self-management affects the efficiency in the provision of the services of the Hospital Vargas de Caracas.
SPECIFIC :
Identify if the self-managed process grants enough Administrative and Legal Autonomy to the Vargas Hospital in Caracas, to be considered a self-managed entity.
To determine if the Self-management process of the Vargas Hospital in Caracas generates better management of resources and contributes to increasing efficiency in the performance of the activities of said institution.
Evaluate to what extent the Self-management process of the Vargas Hospital in Caracas contributes to a better provision of its services.
Evaluate whether the Hospital Self-Management process contributes to the Administrative Decentralization carried out by the National Government.
HYPOTHESIS
Decentralization, through the figure of Self-management developed at the Vargas Hospital in Caracas, allows better management of the Economic Resources available to it, which translates into increased efficiency through better operation and increase in the quality of the services provided.
VARIABLES
Dependent Variables:
Efficiency.
Independent variables:
Self-management
Intervening Variables:
Inflation.
Implementation of new Exchange Policies.
Implementation of new Social Policies.
Increase of the Constitutional Located of the States.
Budget from the GDF
M ARCO THEORETICAL
GEOGRAPHIC-POPULATION SITUATION
The Federal District has an area of 1930 km 2, representing 0.2% of the national territory; for 1990, the population of the DF. it reached approximately 2,265,768 inhabitants, equivalent to 11.7% of the total, with a population density of 1,173.97 inhabitants per km 2.
In 1997, the population (according to OCEI projections) would reach 2,279,676, of which 2,255,838 are urban population. Of this amount, 1,974,572 inhabitants live in the Autonomous Libertador Municipality, representing 86.81%.
The Hospital Vargas de Caracas is located in the Parroquia San José, with a population for 1995 of 63,665 inhabitants (3.22%); The nearby or neighboring parishes are: Altagracia with 45,830 inhabitants (2.32%); Cathedral with 4,516 inhabitants (0.22%); Santa Rosalía with 132,912 inhabitants (6.73%) and Santa Teresa with 35,029 (1.77%).
This is equivalent to a total of 281,952 inhabitants (14.97%), this number represents the potential patients of the Hospital Vargas de Caracas; it should be noted that in these 5 parishes in Caracas the majority of the population is divided between social classes C, D and E. To this must be added the population transferred from hospital centers belonging to Health Districts 2, 3, 4 and 5. "Emergency patients who are not insured in the newly opened hospitals (Magallanes, Pérez Carreño) will be referred to the other hospitals in Caracas that are still able to function (Vargas and Coche)."
In addition, this is a quite peculiar area since here is the Historic Center of the City and the Political Power Centers of the Country: Miraflores Palace, Congress of the Republic, Supreme Court of Justice, some Ministries, Federal District Government, Mayor's Office from Caracas, among others; apart from being a commercial sector with a lot of activity.
BASIC TERMS
In order to carry out this research, it was necessary to use a certain number of basic terms, essential for its theoretical foundation. Among them we have the Self-management, the crisis, the decentralization and the criteria of effectiveness and efficiency.
Self-management
Self-management consists of the possibility and capacity of an organized entity to manage itself. Self-management involves the workers and employees of the organization, without the need to be supervised or supervised by external authorities outside the organization as such. Self-management is something extremely favorable, if it can be carried out seriously, for the operation of public institutions, especially in the case of those organizations that are more difficult to manage. The entities that handle a larger budget, with a greater number of employees and especially those that have their own sources of income, are those that, by self-managing, free the central administration from greater problems, reverting it to better service to the community. On the other hand,Self-management of companies and public entities allows a greater involvement of the population in the performance of such organizations.
Certain requirements are necessary to carry out Self-management. Among them we can mention the incorporation of workers as a sector in the decision-making processes of the organization (for which an acceptable level of maturity and commitment to the overall objectives of the organization is required), efficient management of the budget and income own and the appointment of internal authorities to ensure compliance with the decisions made. As basic foundations for the success of Self-management we can define three factors: the organized participation of all the actors involved, the adoption of a system or model of Self-management appropriate to the peculiarities of the case and the commitment of the parties to achieve the objectives operating as a community.
Crisis
In general terms, we understand crisis as a particular period in the development, development or evolution of something, characterized by profound and significant changes that cause imbalances and instability. In the field that concerns us we will refer to the crisis that the hospital sector has suffered, a crisis that involves political, economic, organizational and managerial aspects.
After the fall in oil resources, the entire Venezuelan public apparatus was affected by the cut or insufficient budgets, and the health sector was no exception. However, this is not the only cause of the deterioration of hospitals; moreover, it may not be the main one. According to other analysts, factors such as the absence of an adequate management system, mismanagement or corruption could even be more important than the lack of resources (if it really happened). Likewise, we could include the loss of ethics of many doctors, without a doubt one of the factors to take into account in the deterioration of medical-healthcare institutions.The ex-Governor of Carabobo Henrique Salas Römer alludes to all this situation when he points out that "the fundamental cause of the hospital crisis is managerial incapacity and the moral breakdown of the medical care institution", and that this is "more of corruption problems than of resource problems ”.
In short, we can define the main causes of the hospital crisis (1) the lack of resources by the central administration and the concentration in it of an excessive number of competences in health, (2) the inefficiency of organizational systems and management and (3) administrative corruption.
Decentralization
In legal terms, decentralization is the transfer of powers from one legal person to another, specifically in the sphere of public institutions.
In the field of health, decentralization plays a fundamental role, since medical-healthcare institutions merit an enormous amount of resources and specialized personnel, which is very difficult to manage and administer for the central administration agencies. Since the beginning of the decentralization process in 1989, numerous agreements for the transfer of competences have been given in the area of health, especially at the state level.
The Carabobo state has been the pioneer in this process, and other hospitals in other states have tried to follow the model of transfer of competencies that that state carried out. In the case of Carabobo, the planning, organization and administration of the agencies and services of the regional health system were transferred to the state, in accordance with the national plans and policies in the health sector defined by the MSAS, which formally assumes the role of the governing body of the sector and reserves the institutional powers such as the planning and definition of national health policies, the establishment of technical standards in all programs and the supervision and control of the service. Until now, the states that have joined the health decentralization process are Anzoátegui, Aragua, Bolívar, Falcón, Lara,Mérida, Miranda, Monagas, Sucre, Táchira, Trujillo and Zulia.
Efficiency and effectiveness
These are two concepts that express two of the basic requirements of any organization. An organization and a management scheme that does not meet such requirements is unlikely to be successful.
Efficacy is the achievement of the objectives regardless of the cost necessary for it. Efficiency is achieving the maximum of the goals set or maximizing benefits through the use of minimum resources. Both concepts are related, but their implementation responds to different objectives and guidelines. Sometimes the use of one of these criteria is more successful than that of the other, depending on the circumstances of the case. It is necessary to consider factors such as time, money, personnel, etc.
According to Katz and Kahn, some of the most accepted principles around administrative efficiency are the following:
- It increases with the specialization of tasks among the elements of the group. It increases by arranging the members of the group in a determined hierarchy of authority.
- It is increased by reducing the scope of control, at any point in the hierarchy to a small number.
- It is increased by grouping the workers for their control according to the purpose, the process, the clientele and the place.
DECENTRALIZATION OF HEALTH
In Venezuela, the institutions that provide health services are numerous, mostly independent and detached from each other. The Ministry of Health and Social Assistance (MSAS) created in 1936, is the agency with the greatest interference in health-related matters in the country. From its beginnings until 1987, when the National Health System (SNS) was enacted, it was oriented within a policy of normative centralization and attempts at administrative deconcentration.
On the one hand, it has tended to integrate institutions and services at the regional and national levels, and to centralize health care functions and activities. On the other hand, it has tried to decentralize other administrative functions and activities of the health services in the various entities of the country. As an example of this we find the creation in 1945 of the health regions, with which an attempt was made to decentralize health programs administratively; the creation in 1961 of cooperative health services, through which the welfare services and state health budgets would be unified under the MSAS; as well as the health district in 1982, with which powers and power would be transferred locally.Despite the fact that the health districts are an operational reality within the organization of the Ministry of Health, which arises as a result of the deconcentration process, their existence has not guaranteed (and could not guarantee) the success of the decentralization process.
The way in which health issues have been handled in the country has been such in the course of the last 30 years, that there has been a disorganized growth of supposedly decentralized entities, with innumerable legal regimes and with a significant lack of coordination of functions. and activities.
Health management in Venezuela can be studied, starting in the 1940s, delimiting four different historical periods:
The first covers approximately the first 30 years, characterized by the fight against endemics and by the emphasis on rural sanitation.
The second occupies until the beginning of the 1970s, associated with the development of a national network of preventive and curative services for the Venezuelan State.
The third, referring to the 1970s, in which social spending on health was slowed down, the private sector was strengthened, the coverage of the Venezuelan Institute of Social Insurance (IVSS) was expanded, and an attempt was made to consolidate a National Service of Health to rationalize spending and increase your productivity. Likewise, first-rate services are simplified and made cheaper through the creation of service modules in marginal urban areas, through which it is intended to meet large demand at low cost. Likewise, for this period, an increase in the coverage of birth control programs was observed. The fundamental tendency of this stage is aimed at trying to delegate the responsibility of the State for the health of citizens to the private sector and family groups,fact that is manifested by the accentuation of the social stratification of the services in such a way that, to each social class, there corresponds a form of attention.
Finally, the fourth period, among whose most outstanding characteristics are: the decrease in the proportion of the national budget allocated to this sector, particularly the MSAS, and the systematic reduction of per capita spending on health, at constant prices; the approval, in mid-1987, of the Organic Law of the National Health System (LOSNS), whose objective of creating a single health system has not been achieved in practice. This Law collides with the Organic Law of Decentralization, Delimitation and Transfer of Competences (LOD) promulgated in 1989; the formulation of requests for transfer of services by some governorates, especially in the areas of health and education, based on the country's political situation, which points to decentralization.
DRAFT PRESIDENTIAL INSTRUCTION ON THE DECENTRALIZATION LAW.
This legal instrument is presented within the framework that is required to advance in decentralization, it was dictated by President Carlos Andrés Pérez, during his previous mandate, specifically it is inserted in this project, the Instructions on the Transfer to the States of Services provided by the National Power. Chapter XI is especially related to the Health sector:
28th provision. The agreements for the transfer of services in health matters must respect the distribution of competences between the National Power and the States that, in accordance with number 16 of article 4 of the Organic Law of Decentralization, Delimitation and Transfer of Powers of the Public Power, is established in the following articles:
HOSPITAL SELF-MANAGEMENT PROJECT
The fundamental causes that gave rise to the project can be summarized in the multifactorial nature of the crisis and in the failure of the state model of hospital administration. The fundamental aspects of the proposal are based on administrative autonomy and the structuring of a Governing Council independent of the Executive, where members of the hospital community, neighborhood community, Central University of Venezuela, Ministry of Health and Social Assistance and the Government would be represented. Federal District.
The general objectives of the project are aimed at: increasing the effectiveness and efficiency of hospital services, improving the financial situation of the Hospital, increasing primary health care, morally and economically encouraging hospital staff and reducing the flight of prestigious professionals to the private sector.
The specific objectives are, on the other hand, aimed at establishing fair budgets, generating supplementary income through self-management, stimulating the active participation of the neighborhood community, reorganizing the services to improve their efficiency and effectiveness, reducing costly hospital care by incorporating the Institution's personnel into outpatients, increasing the ambulatory surgery plan and reducing the period of stay, select, train, promote and remunerate all hospital personnel fairly and adequately and control their internal and external audit of the uses and destinations of income and movable assets of the Institution.
The project itself is therefore a proposal for change aimed at directing the Hospital definitively towards prevention, care, teaching and modern medical research. "A people does not evolve with the song of its past glories, nor with only the accusation as a system, nor with apathy as a response to the disappointment caused by the behavior of those who, with their responsibilities and duties to fulfill, betray the homeland. The obligatory and obligatory answer is the intelligent, reasoned, scientific, continuous action that leads us to the desired end «.
SELF-MANAGEMENT CASES
The deterioration of the public health services in Venezuela seems to have reached the point where there are no outlets for its improvement or transformation, within the current institutional frameworks and operating restrictions. It is because of this that alternative ways of organization have been sought in order to improve the quality of service of public health centers, this being the case of ASCARDIO, ASOCORAZÓN, etc.
ASCARDIO experience
The Central Western Cardiovascular Association (ASCARDIO) is a private non-profit Association that administers the medical care services of the MSAS Regional Cardiovascular Center in Barquisimeto, which charges for the services according to estimates of the patient's ability to pay and whose operation is based on in cooperation mechanisms between the government, the private sector and the community.
Ascardio has managed to create high quality services through the figure of Self-Management, since it has innovated in management matters in the health field, the main features of its model being the following:
Then different meetings were held with the staff, to try to improve the organizational and administrative systems. Finally, the economic resources arrive, the accumulated debts with the providers are settled. However, the 'chronic crisis' persists, medical and surgical supplies are lacking.
METHODOLOGICAL FRAMEWORK
A crucial element in the implementation of a self-management efficiency model is that of possessing a certain capacity of performance indicators. In the case of Hospital Self-Management, it is of vital importance to have measurements and evaluations of the performance of the different hospital activities and functions so that it can be verified, to what extent the effort made has as a counterpart an improvement in the efficiency of service provision, which is, after all, the ultimate goal of the reform. Eventually, a comparison of the performance of the two hospital entities studied should say a lot about the efficiency of the self-management process undertaken.
Obviously, a study of efficiency in the performance of hospital activities cannot equally assess each of the indicators studied. In other words, efficiency indices are often made for each indicator, but the primary importance of some and the secondary importance of others is rarely noticed. In order to carry out a true analysis of the management of a hospital, it is necessary to distinguish between indicators of a priority order and others of a secondary order, asserting the relevance of the former in the study of management. Likewise, it is convenient to study and assess similar indicators, those related to the same subject, together, since they give a global idea of the operation of the hospital in each sector.
In the present work it has been considered pertinent to involve these two mentioned factors in the analysis (different valuation of the indicators and valuation of those that are related to each other jointly), with a view to incorporating a different and novel perspective in the study of management in the hospital field.
For this, the following indicators (which have the same weight and weight in the construction of the efficiency index used by SU SALUD GDF):
- - Existence at the beginning of the year. - Income of Patients. - Medical Discharges. - Deaths. - Existence at the end of the year. - Current Capacity. - Percentage of Occupation. - Average Stay. - External Consultation. - Emergency. External. - Average Emergency. - Major Operations. - Minor Operations. - Blood Transfusions. - Laboratory.
They will be grouped into four categories, namely:
- Hospitalization Service: groups the following indicators: 1.- Existence at the beginning of the year. 2.- Patient Income. 3.- Medical Discharges. 4.- Deaths and 5.- Existence at the end of the year. This grouping is due to the fact that these indicators are related to the volume of people who manage the hospitalization area annually, how many enter, how many die, etc. Operational Capacity of the Hospitalization area: groups the following indicators: 6.- Current Capacity. 7.- Percentage of Occupancy and 8.- Average Stay. This group is due to the real capacity of the Hospital to care for patients, how many beds are occupied and how long (average) they remain occupied.
- External Consultation and Emergency Service: groups the following indicators: 9.- External Consultation. 10- Emergency. 11- Average External Consultation. and 12- Emergency Average. This category is related to the volume of patients attending the Outpatient Consultation and the Hospital Emergency.
- Surgical and Laboratory Service: groups the following indicators: 13.- Major Operations. 14.- Minor Operations. - Blood Transfusions and 16.- Laboratory. This grouping is due to the volume of both Major and Minor Surgical Operations, Transfusions and Laboratory examinations carried out at the Hospital annually.
Of these categories, the first was considered as more important, for the following reasons: the hospitalization service concentrates the most critical cases, those ailments that by their nature require more prolonged, expensive and specialized treatment. This involves a greater expense in aspects such as, supplies, food, specialized personnel (doctors, nurses, nutritionists, workers, administrative personnel, etc.). In this category the other three categories studied are combined, since a patient to enter the area of hospitalization, you need to have previously gone through an emergency or outpatient consultation. In addition, during the time of hospitalization, frequent use of the hospitalization service is essential.
The evolution of efficiency in each of the 4 sectors or categories was analyzed, from 1991 to 1996, divided into before (91-93) and after (94-96) of Self-management, at the Hospital Vargas de Caracas and at the Hospital de Coche, before and after the Restructuring (same years). Then, both hospitals were compared in order to determine which process was more efficient.
This information about the index was provided by the Department of Health Statistics of the Vargas Hospital in Caracas, the index in question was used by the Governing Board of said Hospital during the Self-Management Process. The Hospital Car Index was constructed according to indications from the Staff of the Statistics Department of the Unified Health Service of the GDF (YOUR HEALTH GDF). Below are the four categories created as follows:
- Name of the Indicator. Histogram of the Indicator in the two Hospitals. Theoretical description of what the Indicator measures. Data from 1991 to 1996 of the Indicator in the two Hospitals. Efficiency Index for that Indicator in the two Hospitals. Application of the Efficiency index to the data of the two Hospitals.
CATEGORY I: HOSPITALIZATION SERVICE
- Existence at the beginning of the year: Number of patients hospitalized at the beginning of the administrative year.
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 87 | 87 | 46 | 70 | 59 | 65 |
| Vargas | 146 | 38 | 111 | 182 | 156 | 99 |
| 1 (- efficiency) | 2 (+/- efficiency) | 3 (+ efficiency) | |
| Car | More than 80 | 61-79 | Less than 60 |
| Vargas | More than 180 | 101-179 | Less than 100 |
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | one | one | 3 | two | 3 | two |
| Vargas | two | 3 | two | one | two | 3 |
- Patient Admissions: Number of patients admitted during the administrative year.
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 3759 | 3352 | 3147 | 2991 | 3173 | 3,500 |
| Vargas | 5565 | 5202 | 6430 | 6042 | 7311 | 7908 |
| 1 (- efficiency) | 2 (+/- efficiency) | 3 (+ efficiency) | |
| Car | Less than 3000 | 3001-3500 | More than 3501 |
| Vargas | Less than 4000 | 4001-6000 | More than 6001 |
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 3 | two | two | one | two | two |
| Vargas | two | two | 3 | 3 | 3 | 3 |
- Medical Discharges: Number of patients discharged after their illness has healed.
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 3535 | 3125 | 2924 | 2800 | 2939 | 3349 |
| Vargas | 5325 | 4741 | 5892 | 5793 | 6843 | 7503 |
| 1 (- efficiency) | 2 (+/- efficiency) | 3 (+ efficiency) | |
| Car | Less than 2800 | 2801-3200 | More than 3201 |
| Vargas | Less than 3500 | 3501-5000 | More than 5000 |
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 3 | two | two | one | two | 3 |
| Vargas | two | two | 3 | 3 | 3 | 3 |
- Deaths: Number of patients killed by natural causes (disease), accidents, entered the emergency due to theft, etc., during the year.
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 129 | 130 | 90 | 95 | 101 | 151 |
| Vargas | 348 | 388 | 429 | 486 | 463 | 405 |
| 1 (- efficiency) | 2 (+/- efficiency) | 3 (+ efficiency) | |
| Car | More than 120 | 100-119 | Less than 99 |
| Vargas | More than 450 | 351-450 | Less than 350 |
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | one | one | 3 | 3 | two | one |
| Vargas | 3 | two | two | one | one | two |
- Existence at the end of the year: Number of patients hospitalized at the end of the administrative year.
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 87 | 46 | 70 | 59 | 78 | 82 |
| Vargas | 38 | 111 | 182 | 156 | 190 | 95 |
| 1 (- efficiency) | 2 (+/- efficiency) | 3 (+ efficiency) | |
| Car | More than 80 | 61-79 | Less than 60 |
| Vargas | More than 180 | 101-179 | Less than 100 |
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | one | 3 | two | two | two | one |
| Vargas | 3 | two | one | two | one | 3 |
CATEGORY II: OPERATIONAL CAPACITY OF THE HOSPITALIZATION AREA
- Current Capacity: Number of beds available in the hospitalization area.
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 151 | 151 | 151 | 151 | 147 | 131 |
| Vargas | 514 | 514 | 514 | 514 | 498 | 521 |
| 1 (- efficiency) | 2 (+/- efficiency) | 3 (+ efficiency) | |
| Car | Less than 140 | 141-145 | More than 146 |
| Vargas | Less than 489 | 490-509 | More than 510 |
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 3 | 3 | 3 | 3 | 3 | one |
| Vargas | 3 | 3 | 3 | 3 | two | 3 |
- Occupancy Percentage: Percentage of bed occupancy during the administrative year.
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 63.74% | 63.28% | 60.5% | 58.17% | 58.86% | 56.12% |
| Vargas | 57.46% | 52.45% | 64.09% | 57.95% | 61.96% | 70.85% |
| 1 (- efficiency) | 2 (+/- efficiency) | 3 (+ efficiency) | ||||||||
| Car | Less than 55% | 55.01% -60% | More than 60.01% | |||||||
| Vargas | Less than 55% | 55.01% -60% | More than 60.01% | |||||||
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |||||
| Car | 3 | 3 | 3 | two | two | two | ||||
| Vargas | two | one | 3 | two | 3 | 3 | ||||
- Average Stay: Average number of days that a hospitalized patient remains.
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 9 | 10 | eleven | eleven | 10 | eleven |
| Vargas | 19 | 19 | 19 | 18 | 16 | fifteen |
| 1 (- efficiency) | 2 (+/- efficiency) | 3 (+ efficiency) | |
| Car | More than 13 | 10-12 | Less than 9 |
| Vargas | More than 20 | 16-19 | Less than 15 |
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 3 | two | two | two | two | two |
| Vargas | two | two | two | two | two | 3 |
CATEGORY III: EXTERNAL CONSULTATION AND EMERGENCY SERVICES
- 9. External Consultation: Number of patients attended to External Consultation of the different dependencies during the administrative year.
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 30299 | 23894 | 12866 | 16034 | 13565 | 14097 |
| Vargas | 142205 | 117167 | 85185 | 83871 | 79935 | 89355 |
| 1 (- efficiency) | 2 (+/- efficiency) | 3 (+ efficiency) | |
| Car | Less than 13000 | 13001-18000 | More than 18001 |
| Vargas | Less than 80,000 | 80001-120000 | More than 120001 |
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 3 | 3 | one | two | two | two |
| Vargas | 3 | two | two | two | one | two |
- Emergency: Number of patients attended by the emergency service during the year.
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 137086 | 115262 | 72854 | 72837 | 78948 | 75497 |
| Vargas | 37077 | 29791 | 64483 | 46112 | 77074 | 80940 |
| 1 (- efficiency) | 2 (+/- efficiency) | 3 (+ efficiency) | |
| Car | Less than 30000 | 30001-50000 | More than 50001 |
| Vargas | Less than 40,000 | 40001-60000 | More than 60001 |
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 3 | 3 | 3 | 3 | 3 | 3 |
| Vargas | one | one | 3 | two | 3 | 3 |
- Average External Consultation: Average of patients attended daily.
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 121 | 95 | 51 | 64 | 54 | 60 |
| Vargas | 569 | 465 | 329 | 335 | 320 | 387 |
| 1 (- efficiency) | 2 (+/- efficiency) | 3 (+ efficiency) | |
| Car | Less than 70 | 71-100 | More than 101 |
| Vargas | Less than 315 | 316-416 | More than 417 |
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 3 | two | one | one | one | one |
| Vargas | 3 | 3 | two | two | two | two |
- Average Emergency: Average number of patients attended in emergency daily.
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 376 | 315 | 197 | 200 | 216 | 219 |
| Vargas | 102 | 81 | 177 | 126 | 211 | 225 |
| 1 (- efficiency) | 2 (+/- efficiency) | 3 (+ efficiency) | |
| Car | Less than 100 | 101-200 | More than 201 |
| Vargas | Less than 100 | 101-200 | More than 201 |
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 3 | 3 | 3 | two | 3 | 3 |
| Vargas | two | two | two | two | 3 | 3 |
CATEGORY IV: SURGICAL AND LABORATORY SERVICE
- Major Operations: Number of surgical operations performed in the operating room in which the patient requires hospitalization.
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 1311 | 1191 | 1031 | 984 | 1196 | 1015 |
| Vargas | 2562 | 3079 | 3629 | 3377 | 4038 | 4125 |
| 1 (- efficiency) | 2 (+/- efficiency) | 3 (+ efficiency) | |
| Car | Less than 1000 | 1001-1100 | More than 1101 |
| Vargas | Less than 3000 | 3001-3500 | More than 3501 |
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 3 | 3 | two | one | 3 | two |
| Vargas | one | two | 3 | two | 3 | 3 |
- Minor Operations: Number of surgical operations performed in offices or small operating rooms, in which the patient does not require hospitalization (Outpatient).
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 5677 | 6423 | 4527 | 3975 | 4497 | 4656 |
| Vargas | 9805 | 2601 | 6356 | 9550 | 12935 | 8952 |
| 1 (- efficiency) | 2 (+/- efficiency) | 3 (+ efficiency) | |
| Car | Less than 3500 | 3501-4000 | More than 4001 |
| Vargas | Less than 5000 | 5001-9000 | More than 9001 |
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 3 | 3 | 3 | two | 3 | 3 |
| Vargas | 3 | one | two | 3 | 3 | two |
- Blood Transfusions: Number of blood transfusions performed during the administrative year.
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 2057 | 1549 | 741 | 2001 | 2299 | 2015 |
| Vargas | 17746 | 10974 | 12037 | 13922 | 15140 | 18365 |
| 1 (- efficiency) | 2 (+/- efficiency) | 3 (+ efficiency) | |
| Car | Less than 1000 | 1001-2000 | More than 2001 |
| Vargas | Less than 10,000 | 10001-15000 | More than 15001 |
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 3 | two | one | 3 | 3 | 3 |
| Vargas | 3 | two | two | two | 3 | 3 |
- Laboratory: Number of laboratory tests carried out during the administrative year.
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 165130 | 157120 | 163771 | 372063 | 361352 | 370995 |
| Vargas | 655940 | 505758 | 611196 | 596880 | 786554 | 803945 |
| 1 (- efficiency) | 2 (+/- efficiency) | 3 (+ efficiency) | |
| Car | Less than 200000 | 200001-300000 | More than 300001 |
| Vargas | Less than 550,000 | 550001-600000 | More than 600 001 |
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | one | one | one | 3 | 3 | 3 |
| Vargas | 3 | one | 3 | two | 3 | 3 |
CALCULATION OF THE EFFICIENCY INDICATORS.
Category I, years 91-93, before the Self-management of the Hospital Vargas:
| 1991 | 1992 | 1993 | |
| one | two | 3 | two |
| two | two | two | two |
| 3 | 3 | two | 3 |
| 4 | 3 | two | two |
| 5 | 3 | two | one |
| X = | 2 + 2 + 3 + 3 + 3 + 3 + 2 + 2 + 2 + 2 + 2 + 3 + 3 + 2 + 1 = | 35 | = | 2.33 |
| fifteen | fifteen |
Category I, years 94-96, after the Self-management of the Vargas Hospital:
| 1994 | nineteen ninety five | nineteen ninety six | |
| one | one | two | 3 |
| two | 3 | 3 | 3 |
| 3 | 3 | 3 | 3 |
| 4 | one | one | two |
| 5 | two | one | 3 |
| X = | 1 + 3 + 3 + 1 + 2 + 2 + 3 + 3 + 1 + 1 + 3 + 3 + 3 + 2 + 3 = | 3. 4 | = | 2.26 |
| fifteen | fifteen |
Category II, years 91-93, before the Self-management of the Vargas Hospital.
| 1991 | 1992 | 1993 | |
| 6 | 3 | 3 | 3 |
| 7 | two | one | 3 |
| 8 | one | one | one |
| X = | 3 + 2 + 1 + 3 + 1 + 1 + 3 + 3 + 1 = | 18 | = | two |
| 9 | 9 |
Category II, years 94-96, after the Self-management of the Vargas Hospital:
| 1994 | nineteen ninety five | nineteen ninety six | |
| 6 | 3 | two | 3 |
| 7 | two | 3 | 3 |
| 8 | two | two | 3 |
| X = | 3 + 2 + 2 + 2 + 3 + 2 + 3 + 3 + 3 = | 2. 3 | = | 2.55 |
| 9 | 9 |
Category III, years 91-93, before the Self-management of the Hospital Vargas:
| 1991 | 1992 | 1993 | |
| 9 | 3 | two | two |
| 10 | one | one | 3 |
| eleven | 3 | 3 | two |
| 12 | two | one | two |
| X = | 3 + 2 + 2 + 1 + 1 + 3 + 3 + 3 + 2 + 2 + 1 + 2 = | 38 | = | 2.08 |
| 12 | 12 |
Category III, years 94-96, after the Self-management of the Vargas Hospital:
| 1994 | nineteen ninety five | nineteen ninety six | |
| 9 | two | one | two |
| 10 | two | 3 | 3 |
| eleven | two | two | two |
| 12 | two | 3 | 3 |
| X = | 2 + 1 + 2 + 2 + 3 + 3 + 2 + 2 + 2 + 2 + 3 + 3 = | 27 | = | 2.25 |
| 12 | 12 |
Category IV years 91-93, before the Self-management of the Vargas Hospital:
| 1991 | 1992 | 1993 | |
| 13 | one | two | 3 |
| 14 | 3 | one | two |
| fifteen | 3 | two | two |
| 16 | 3 | one | 3 |
| X = | 1 + 2 + 3 + 3 + 1 + 2 + 3 + 2 + 2 + 3 + 1 + 3 = | 26 | = | 2.16 |
| 12 | 12 |
Category IV, years 94-96, after the Self-management of the Vargas Hospital:
| 1994 | nineteen ninety five | nineteen ninety six | |
| 13 | two | 3 | 3 |
| 14 | 3 | 3 | two |
| fifteen | two | 3 | 3 |
| 16 | two | 3 | 3 |
| X = | 2 + 3 + 3 + 3 + 3 + 2 + 2 + 3 + 3 + 2 + 3 + 3 = | 32 | = | 2.66 |
| 12 | 12 |
Category I, years 91-93, before the Restructuring of the Hospital de Coche:
| 1991 | 1992 | 1993 | |
| one | one | one | 3 |
| two | 3 | two | two |
| 3 | 3 | two | two |
| 4 | one | one | 3 |
| 5 | one | 3 | two |
| X = | 1 + 1 + 3 + 2 + 2 + 3 + 2 + 2 + 1 + 1 + 3 + 1 + 3 + 2 = | 30 | = | two |
| fifteen | fifteen |
Category I, years 94-96, after the Restructuring of the Hospital de Coche:
| 1994 | nineteen ninety five | nineteen ninety six | |
| one | two | 3 | two |
| two | one | two | two |
| 3 | one | two | 3 |
| 4 | 3 | two | one |
| 5 | 3 | two | one |
| X = | 2 + 3 + 2 + 1 + 2 + 2 + 1 + 2 + 3 + 3 + 2 + 1 + 3 + 2 + 1 = | 30 | = | two |
| fifteen | fifteen |
Category II, years 91-93, before the Restructuring of the Hospital de Coche:
| 1991 | 1992 | 1993 | |
| 6 | 3 | 3 | 3 |
| 7 | 3 | 3 | 3 |
| 8 | 3 | 3 | two |
| X = | 3 + 3 + 3 + 3 + 3 + 3 + 3 + 3 + 2 = | 18 | = | 2.88 |
| 9 | 9 |
Category II, years 94-96, after the Restructuring of the Hospital de Coche:
| 1994 | nineteen ninety five | nineteen ninety six | |
| 6 | 3 | 3 | one |
| 7 | two | two | two |
| 8 | two | 3 | two |
| X = | 3 + 3 + 1 + 2 + 2 + 2 + 2 + 3 + 2 = | twenty | = | 2.22 |
| 9 | 9 |
Category III, years 91-93, before the Restructuring of the Hospital de Coche:
| 1991 | 1992 | 1993 | |
| 9 | 3 | 3 | one |
| 10 | two | one | 3 |
| eleven | 3 | 3 | one |
| 12 | 3 | 3 | two |
| X = | 3 + 3 + 1 + 2 + 1 + 3 + 3 + 3 + 1 + 3 + 3 + 2 = | 28 | = | 2.33 |
| 12 | 12 |
Category III, years 94-96, after the Restructuring of the Hospital de Coche:
| 1994 | nineteen ninety five | nineteen ninety six | |
| 9 | two | two | two |
| 10 | two | 3 | 3 |
| eleven | one | one | one |
| 12 | two | 3 | 3 |
| X = | 2 + 2 + 2 + 2 + 3 + 3 + 1 + 1 + 1 + 2 + 3 + 3 = | 25 | = | 2.08 |
| 12 | 12 |
Category IV years 91-93, before the Restructuring of the Hospital de Coche:
| 1991 | 1992 | 1993 | |
| 13 | 3 | 3 | two |
| 14 | 3 | 3 | 3 |
| fifteen | 3 | two | one |
| 16 | one | one | one |
| X = | 3 + 3 + 2 + 3 + 3 + 3 + 3 + 2 + 1 + 1 + 1 + 1 = | 26 | = | 2.16 |
| 12 | 12 |
Category IV, years 94-96, after the Restructuring of the Hospital de Coche:
| 1994 | nineteen ninety five | nineteen ninety six | |
| 13 | one | 3 | two |
| 14 | two | 3 | 3 |
| fifteen | 3 | 3 | 3 |
| 16 | 3 | 3 | 3 |
| X = | 1 + 3 + 3 + 2 + 2 + 3 + 3 + 3 + 3 + 3 + 3 + 3 = | 32 | = | 2.66 |
| 12 | 12 |
Efficiency Indexes of the Hospital Vargas de Caracas (Self-management):
| Before | After | |
| Category I | 2.33 | 2.26 |
| Category II | 2.00 | 2.55 |
| Category III | 2.08 | 2.25 |
| Category IV | 2.16 | 2.66 |
Car Hospital Efficiency Indexes (Restructuring):
| Before | After | |
| Category I | 2.00 | 2.00 |
| Category II | 2.88 | 2.22 |
| Category III | 2.33 | 2.08 |
| Category IV | 2.16 | 2.66 |
ANALYSIS OF RESULTS
According to the results obtained, the efficiency in this category for the Hospital Vargas de Caracas went from an index of 2.33 to 2.26, which indicates a very slight decrease, almost insignificant. However, it is necessary to draw attention to the fact that these indices reflect a level of efficiency above the acceptable level, which we can consider as medium-high.
In the same category, Hospital de Coche maintained an efficiency index of 2.00. According to these results, the Restructuring process did not appreciably influence the efficiency of the Hospital.
We can see then that Self-management was not in this case a decisive factor in the variation in efficiency; rather it experienced a slight decrease. Compared to a different experience like the Hospital de Coche, we do not see a change either; a process other than Self-management did not really overcome it.
However, the level of efficiency in the Vargas Hospital in Caracas continues to be higher than that of the Hospital de Coche, but this is not due to self-management, but to other factors not known to us.
In this category, the Vargas Hospital experienced a notable increase in efficiency, going from an index of 2.00 (medium) to one of 2.55 (high).
In the Hospital de Coche the opposite happened, since it went from an efficiency level of 2.88 (high), to one of 2.22 (medium high). The decrease in efficiency was really significant, expressed in more than half a point.
Self-management was truly successful, both in relation to the parameters that the Vargas Hospital previously had, and in relation to a different experience such as the Hospital de Coche, where a significant decrease in efficiency occurred. The efficiency of Hospital Vargas continues to be greater than that of Hospital de Coche.
In this case, something similar happened to those in category II, but to a greater degree. The efficiency of the Vargas Hospital in Caracas increased from 2.08 to 2.25, which is a positive change but not in a large proportion.
At the Hospital de Coche, efficiency decreased, but not in a large proportion either, since it went from 2.33 to 2.08. Self-management was again satisfactory, both in relation to the values of the Hospital Vargas, and in relation to the experience of the Hospital de Coche. The final values of the efficiency indices are almost similar in both hospitals.
Efficiency in this category for the Vargas Hospital in Caracas increased by half a point, from 2.16 to 2.66, thereby acquiring a high level of efficiency. The same occurred in the Hospital de Coche, where the indices were identical in both the previous and subsequent periods (2.16 to 2.66).
Self-management was useful in the Vargas Hospital, increasing efficiency in a significant proportion with respect to the previous indices, although in relation to the experience of the Hospital de Coche, this was not a significant differentiating element. This is because the indices after the Self-management and restructuring processes (Hospital Vargas and Hospital de Coche respectively) were identical (2.66).
Despite the fact that efficiency in categories II and III of the Vargas Hospital in Caracas increased considerably after the Self-management experience, both in relation to the previous indices and with those of the Hospital Hospital experience, category IV increased only with respect to the before-after dimension, but did not vary in the Vargas-Car dimension.
However, based on what is stated in the Methodological Framework, we must consider category I as the most important. And in this sector, Self-management was neither successful nor significant, since the efficiency levels remained almost the same.
LIMITATIONS
Due to the short time that has elapsed between the decree issued by the GDF, on 09/20/93, and the current moments, it is difficult to pinpoint the achievements achieved in such a short period, coupled with the few publications on the results of the Process Self-management
Currently there is little bibliography about the topics covered here such as, Self-management, Decentralization, and Autonomy in the Hospital area, which leads us to apply knowledge from other areas not related to the Health Sector.
There were limitations regarding access to information by the authorities of the Federal District Government.
Also, it is necessary to emphasize that none of the members of the research team have extensive operational knowledge about the Health area, which made it difficult at times to understand certain elements used during the course of this study.
CONCLUSIONS
Based on the study carried out, we can conclude that, regarding the General Objective: To determine to what degree Decentralization, through the figure of Self-management, affects the efficiency in the provision of services of the Vargas Hospital in Caracas; It can be said that a self-managed process does affect the provision of the different services offered by the Hospital; This translates into an increase in efficiency for categories II, III and IV, but a decrease (although not very significant) in category I, which at the end of this study was considered more important.
In contrast, the car hospital, which served in this case, to make a model comparison, (Self-management vs. Restructuring), showed a decrease in categories II and II, an increase in category IV and in category I, there was no variability; This leads us to conclude that the Restructuring process, instead of helping to improve the provision of services (translated into increased efficiency rates) resulted in a decrease in it.
As for the specific objectives; Objective # 1: Identify if the self-management process grants enough Administrative and Legal Autonomy to the Vargas Hospital in Caracas to be considered a self-managed entity; It can be concluded that based on the investigation carried out, that the Vargas Hospital in Caracas is a self-managed entity, since it has both administrative and legal autonomy.
In objective # 2: Determine if the Self-management process of the Vargas Hospital in Caracas generates better management of resources and contributes to increasing efficiency in the performance of the activities of said institution; We were able to show that there is a better administration of resources, but that this improvement only allows an increase in efficiency in categories II (operating capacity of the Hospitalization area, III (External Consultation and Emergency service) and IV (Surgical and laboratory), but does not lead to increased efficiency in category I (hospitalization service), which was considered more important than the other three categories.
Regarding objective # 3: Evaluate to what extent the Self-management process of the Vargas Hospital in Caracas contributes to a better provision of its services; The Self-management process has only allowed a better provision of surgical, laboratory, Outpatient and emergency services, but not the hospitalization service (which is more important).
Objective # 4: Evaluate whether the Hospital Self-Management process contributes to the Administrative Decentralization carried out by the National Government; allows us to conclude that the Self-management process does contribute to Administrative Decentralization, and this affirmation is strengthened by contrasting the self-management process with the Restructuring process carried out at the Hospital de Coche, where efficiency tended to decrease.
Additionally, it can be said regarding the hypothesis proposed: Decentralization, through the figure of Self-management developed at the Hospital Vargas de Caracas, allows a better administration of the Economic Resources available to it, which translates into an increase efficiency through better operation and increased quality of services provided; that this increase in efficiency has not been total, but partial, 3 of 4 categories, but the residual category is the most important, so it can be said that perhaps Self-management has not been well managed, or that others have even been present factors (which we do not know) that have influenced the development of the self-management process and therefore the increase in efficiency of category I; but,It is still too early to determine the total effects that the Self-management of the Hospital Vargas de Caracas has had on the increase or decrease of efficiency.
ANNEXED DATA
Population of the Parishes surrounding the Vargas Hospital in Caracas.
| Population | |
| High grace | 45830 |
| Saint Joseph | 63655 |
| Cathedral | 4516 |
| Santa Rosalia | 132912 |
| Santa Teresa | 35029 |
- Personnel belonging to the DF Health System
| 1985 | 1989 | 1994 | |
| Doctors | 7196 | 10072 | 11171 |
| Registered Nurses | 4065 | 4065 | 4109 |
| Nursing assistants | 10706 | 10706 | 11706 |
- Budgetary Allocation of the Hospitals in Study (in millions of Bolívares).
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 127.3 | 151.5 | 207.1 | 378.4 | 645.5 | 1046.3 |
| Vargas | 412.5 | 490.9 | 670.8 | 1225.8 | 2091.1 | 3389.1 |
- Budget Allocation in Dollars.
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Car | 2226206 | 2226206 | 2226206 | 2226206 | 2226206 | 2226206 |
| Vargas | 7211034 | 7211034 | 7211034 | 7211034 | 7211034 | 7211034 |
- Dollar Price.
| 1991 | 1992 | 1993 | 1994 | nineteen ninety five | nineteen ninety six | |
| Bs./ $ parity | 57.21 | 68.08 | 93.03 | 170 | 290 | 470 |
BIBLIOGRAPHIC REFERENCES
AGUIRRE, M.
| 06/09/1996 | The Hospital Crisis is at its crucial moment, El Universal, 1-28, Caracas. |
| 05/05/1996 | The 14 programs do not constitute a social policy. El Nacional, D-1, Caracas. |
| 1987 | Foundations of Public Administration. Venezuelan Legal Editorial. Caracas. |
| nineteen ninety five | Varguista Chronicle, Archives of the Hospital Vargas, Vol. 37. Nos. 1-2. Caracas, pp. 91-95. |
| 1992 | The Maintenance of State Hospitals, IESA Study Cases. IESA editions. Caracas. |
| 1992 | Decentralization. Governance. Democracy. COPRE-UNDP. Caracas. |
| nineteen ninety five | Route to Efficiency. Decentralization of Social Services. IESA editions. Caracas. |
ECONOMIC COMMISSION FOR LATIN AMERICA AND THE CARIBBEAN
| nineteen ninety six | Statistical Yearbook for Latin America and the Caribbean, UN, New York. February. |
| 1993 | Small Illustrated Larousse, Larousse, Madrid. |
| 1994 | Newsletter, Year 1, No. 1. |
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| 1991 | Social Psychology of Organizations. Editorial Trillas. Mexico. |
| 06/26/1996 | Two hospitals half open, El Universal, 2-22, Caracas. |
| 1992 | Legal instruments to advance decentralization. Editorial Nueva Sociedad. Caracas. |
| 12/1981 | Towards a Self-managed Medicine, SIC, Centro Gumilla, Year XLIV, No. 440, Caracas. |
| nineteen ninety five | Health Management, an Innovative Model. , IESA Editions / Antonio Cisneros Bermúdez Foundation, Caracas. |
| 06/30/1996 | "Massive interventions" start hospitals. The Universal. 1-26. Caracas. |
| 1993 | Agreement of Transfer to the Carabobo state of the health services provided by the MSAS and by affiliated organizations. Caracas. |
| 1994 | Statistical Yearbook of Venezuela, Presidency of the Republic, Caracas. |
| 1990 | Census of Hospital Health Care Establishments in the Health Sector. Presidency of the Republic, Caracas. |
| 1990 | Health situation of the Federal District. Presidency of the Republic, Caracas. |
| 1988 | Document CD33 / 14, Resolution XV-XXX of the Executive Committee. Washington, DC |
| 09/20/1994 | Decree 315, Statute of the Vargas Hospital, in the Official Gazette of the Republic of Venezuela, No. 35,550, Caracas. |
| 1993 | Organic Law of Decentralization, Delimitation and Transfer of Powers of the Public Power and its Partial Regulation No. 1. Dabosan CA Caracas. |
| 1987 | Organic Law of the National Health System. Eduven. Caracas. |
| 09/20/1972 | Decree No. 1096, Regulation on Hospitalization Clinics, Hospitals, Health Homes, Sanatoriums, Infirmaries and the like, In the Official Gazette of the Republic of Venezuela, Caracas. |
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| 1991 | Vargas Hospital of Caracas. Partial Statistics Period: December 1989-November 1990. Archives of the Hospital Vargas, Vol. 33. Nos. 3-4, pp-125-134. Caracas. |
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Salcedo, Pablo. El Nacional, 06/02/1996.
Rondón, Roberto, p. 7. 1993.
Altimari, Carlos. The National 05/05/1996.
Salcedo, Pablo. Ibid.
De Viana, Mikel, December 1981.
Altimari, Carlos. Ibid.
Pan American Health Organization. 1988.
Aguirre, Marta. El Universal, 06/09/1996.
Idem.
Idem.
Sources: OCEI: Statistical Yearbook of Venezuela 1994. Census of Hospital Health Care Establishments of the Health Sector 1990. Health situation of the Federal District 1990.
The Source, Sandra. The universal. 06/26/1996.
De la Cruz, Rafael. nineteen ninety five.
Idem.
Brewer-Carías, Allan. 1987.
Source: MRI, MSAS and Government of Carabobo, 1993.
Source: MRI, Regional Sectorial Directorate for Development, May 1997
Linares, Gustavo. P. 115-116. 1992.
”It can be seen that what is really sought is to increase efficiency, and for this purpose, the budget will have to be increased, in order to make economic and infrastructure improvements, better manage human resources, in order to carry out a good self-management process ”. Salcedo, Pablo. The National. 06/02/1996.
Coronil, Fernando cp Vargas-Arenas, Rafael. 1992.
Malavé, José. Page 17. 1995.
Vargas Hospital of Caracas. Information Bulletin No. 1. 1994.
NOTE: It is important to note that these proposals have already been accepted, by the GDF, and that they are already being implemented in the Hospital.
Vargas-Arenas, Rafael. 1992.
Aguirre, Marta. The universal. 06/09/1996.
Sánchez, William cp Chacín, Luis. nineteen ninety five.
See pages 41 and 42.
Source: Central Bank of Venezuela.
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