Spatial reorganization of the Brazilian Unified National Health System's inpatient care supply

The joint provision of efficient and equitable healthcare service delivery is a critical factor in improving social welfare. However, healthcare services pose a particular challenge when balancing healthcare provider efficiency and eq-uity. Typically characterized by economies of scale and scope, inpatient care involves a wide variety of medical care that usually demands a broad range of health professional expertise and technological complexity to ensure health care quality. This study analyzes the current spatial organization of the Bra-zilian general hospitals and their respective flow of patients to identify the possible benefits of closing inefficient hospitals. We studied how inpatient care referrals may be reallocated without increasing access inequities following the potential closure of inefficient public hospitals. We used data from the Brazil-ian Hospital Information System of the Brazilian Unified National Health System (SIH/SUS) and the Brazilian National Register of Health Establish-ments (CNES). The smallest and least efficient hospitals were selected as units for potential closure, conditioned on an optimization criterion that minimizes patient travel distances to the nearest efficient hospital. Our results show that there is room for hospital resource reorganization in Brazil without compro-mising health care access equity.