TCU points to stability in national indices, but sees a risk of stagnation; audit shows disparities between regions and alert to underutilize the network
The average efficiency of SUS (Unified Health System) hospitals ranged from 32% to 50% between 2019 and 2024, according to Audit of the Federal Court of Audit (TCU) released on Monday (7.abr.2025). Although there are differences between states and regions, national performance has remained stable over the period – which, for the court, may indicate stagnation in the use of public hospital infrastructure.
The survey, reported by Minister Antonio Anastasia, evaluates the degree of use of the available structure – as beds, surgical and professional rooms – in relation to the maximum production capacity with existing resources. An efficiency of 50%, for example, indicates that the network operated with only half of its potential.
Regional differences
The report shows striking disparities between the regions. North and Northeast had the lower efficiency averages, with 28% and 30%, respectively. The Southeast had the best regional result, with 32%.
Although these rates seem incompatible with the national average of up to 50%, the TCU study explains that the national indicator is not an arithmetic average of the states. National calculation considers factors such as the volume of care, the production scale and the relative use of the structure of each hospital unit. This means that larger hospitals, which concentrate more care, end up weighing more on the aggregate result.
Among the states, São Paulo stood out for its higher stability (38%) in the period. Paraná, on the other hand, had the worst performance (22%).
The TCU attributes part of these differences to the design of the hospital network and the way services are regionalized. Hospitals under shared management between states and municipalities presented, in general, inferior performance, a reflection of the overlap of responsibilities and the difficulty of administrative coordination.
Efficiency weighted by production
In addition to the simple average, the audit also calculated the national efficiency weighted by the production volume – That is, considering the weight of each hospital in total care. By this criterion, the indices were between 53% e 68% in the period. The difference shows that larger units tend to be more efficient by operating with higher scale and concentration of services.
Still, the report points out that there is wide margin to improve the use of existing infrastructure. Many units could increase the production of care, hospitalizations and exams without proportionate to spending.
TCU recommends the adoption of management measures, such as sharing good practices between hospitals, and the revision of governance in shared management models. According to the court, the focus should be the increase in the productivity of the public hospital network with the resources already available.
