Social health organizations and their role in the diffusion of minimally invasive surgery in Brazil.

BACKGROUND

In Brazil, Social Health Organizations (SHOs), a form of public-private partnership, manage a growing number of public hospitals. This study assessed their role in the diffusion of laparoscopic cholecystectomy.

METHODS

In a nationwide study, the rates of laparoscopy were compared over time between SHO and non-SHO hospitals. We applied fixed-effects, Cox, and logistic regression models to examine the association between SHO and laparoscopy use, as well as the speed of laparoscopy adoption.

RESULTS

Of the 2208 hospitals assessed, 83 were SHO-managed. These hospitals exhibited higher laparoscopy rates for both elective and urgent procedures. SHO hospitals had a higher likelihood of reaching ≥ 30% laparoscopy adoption earlier (HR = 2.03; 95% CI: 1.84-2.23), and they reached the adoption threshold approximately one year earlier than non-SHO hospitals (mean time to adoption: 3.7 ± 5 vs. 4.5 ± 4.7 years, respectively).

CONCLUSION

SHO-managed hospitals were associated with faster and broader adoption of laparoscopic surgery within the Brazilian public healthcare system. These findings support the potential of hybrid governance models to enhance the delivery of care in low- and middle-income settings, while acknowledging that residual confounding and selection bias cannot be fully excluded.