Multimethod modeling to analyze the relationship between public health efficiency and social determinants management: a longitudinal study in Brazil

Purpose This study investigates the long-term relationship between management efficiency and representative indicators of the social determinants of public health across 390 municipalities in Paraná, Brazil. Design/methodology/approach The research employed multimethod modeling with a five-phase variable selection process, based on a systematic review of 90 articles that identified 269 variables, reduced to 47 after content analysis and statistical tests. Management efficiency was evaluated using exploratory factor analysis and data envelopment analysis. The effect of efficiency on social health determinants was examined via Tobit Regression, with marginal effects reported. Findings The results demonstrated the relevance of the federal government’s role in transferring resources to municipalities while revealing concerns about sanitation and financial indicators, whose long-term impact proved inefficient. Research limitations/implications The study highlights the need for public policies that optimize the use of federal resources and improve the efficiency of both sanitation and financial management. Limitations include reliance on secondary data and the specificity of the Paraná context, which may limit the generalizability of the results. Practical implications The results offer public managers insights into the importance of resource management efficiency and the need to address sanitation and financial indicators to improve the social determinants of health. Originality/value The research offers a robust methodological criterion for variable selection in public health studies and employs a multimethod approach to examine the relationship between management efficiency and social determinants of health, identifying variables not previously explored in the literature.