0592/2011 - A contratualização nos Hospitais de Ensino no Sistema Único de Saúde brasileiro The contracting of teaching hospitals in the Brazilian Unified Health System
• Francisco Javier Uribe Rivea - Rivera, F.J.U. - Escola Nacional de Saúde Pública - <uribe@ensp.fiocruz.br>
Área Temática:
Planejamento e Gestão em Saúde
Resumo:
São discutidas as possibilidades e limites da contratualização para a melhoria do desempenho, o incremento da prestação de contas, o aprimoramento da gestão, a melhoria da assistência e a maior inserção dos hospitais de ensino na rede de serviços no âmbito do Programa de Reestruturação dos Hospitais de Ensino no Sistema Único de Saúde/SUS. Quatro hospitais contratados e suas secretarias contratantes são entrevistados. Segundo os dirigentes de hospitais, é frágil a associação entre contratualização e a presença de mecanismos de inserção na rede, de práticas e estruturas de qualificação assistencial e gerencial nos hospitais. Hospitais mais estruturados assistencial e gerencialmente apresentaram uma contratualização mais estruturada com a secretaria. Houve um aumento de produção da média complexidade ambulatorial e uma diminuição dos procedimentos de atenção básica em todos os hospitais. Sugere-se o desenvolvimento gerencial contínuo do hospital e da secretaria, a revisão do plano operativo, orçamento, mecanismos de monitoramento e sistema de incentivos, pactuação com as equipes, dentre outros.
Palavras-chave:
contratualização
hospitais de ensino
prestação de contas
melhoria gerencial
melhoria assistencial
Teoria da Agência
Abstract:
This study identifies possibilities and limitations of contracting to improve health care management, accountability and quality, and expand the participation of teaching hospitals in the health services’ network in the context of the Restructuring Program of Teaching Hospitals in the Brazilian Unified Health System. It’s a case study of four teaching hospitals and their contracting State Health Departments. According to the hospitals’ managers, the associations of contracting with the presence of mechanisms for hospitals REPLACEion into health services network, and with structures and practices for qualifying management and health care in the hospitals are weak. Hospitals more structured managerially and in terms of the health care presented more structured contracting processes. There was an increase in the production of medium complexity outpatient care and a decrease in primary health care procedures. The adjustments suggested are continuous improvement of hospitals and of State Health Departments’ management, review in the process of elaborating the Operative Plan, and others.
Keywords:
contracting
teaching hospitals
accountability
managerial improvement
quality improvement
Agency Theory
The contracting of teaching hospitals in the Brazilian Unified Health System
Resumo (abstract):
This study identifies possibilities and limitations of contracting to improve health care management, accountability and quality, and expand the participation of teaching hospitals in the health services’ network in the context of the Restructuring Program of Teaching Hospitals in the Brazilian Unified Health System. It’s a case study of four teaching hospitals and their contracting State Health Departments. According to the hospitals’ managers, the associations of contracting with the presence of mechanisms for hospitals REPLACEion into health services network, and with structures and practices for qualifying management and health care in the hospitals are weak. Hospitals more structured managerially and in terms of the health care presented more structured contracting processes. There was an increase in the production of medium complexity outpatient care and a decrease in primary health care procedures. The adjustments suggested are continuous improvement of hospitals and of State Health Departments’ management, review in the process of elaborating the Operative Plan, and others.
Palavras-chave (keywords):
contracting
teaching hospitals
accountability
managerial improvement
quality improvement
Agency Theory
Lima, S.M.L., Rivera, F.J.U.. A contratualização nos Hospitais de Ensino no Sistema Único de Saúde brasileiro. Cien Saude Colet [periódico na internet] (2011/jul). [Citado em 23/12/2024].
Está disponível em: http://cienciaesaudecoletiva.com.br/artigos/a-contratualizacao-nos-hospitais-de-ensino-no-sistema-unico-de-saude-brasileiro/7847?id=7847
