Avaliação econômica da implantação de um novo processo nos pedidos de exames laboratoriais no HCU : um estudo de caso

Abstract

In Brazil public hospitals have suffered from cyclical financial crises, leading to lack of assistance in health of the poor and the dependent on the Unified Health System (SUS). Among these hospitals, of the teaching, fundamental elements in two Brazilian public policies of a social nature – education and hospital care of high complexity – have been penalized financially. Lack of resources closes beds, suspends surgeries and stops procedures because of the difficulty of replacement medicines and hospital supplies. Hospital managers indicated that the main causes: i) low remuneration of SUS table for procedures; ii) delays in financial transferences from the provision of services; and, iii) contingency resources for programs, projects and agreements with federal, state and municipal agencies. Government agencies claim, in turn, those resources have increased year by year, as the growth of Gross Domestic Product (GDP) and that these transferences have been passed in full and in a timely manner. They also state that the mismanagement of resources by hospital managers has been the main reason for the crisis. This impasse led to the question of how the public service innovation process, implementing changes in the modus operandi (processes of internal work), could contribute to equate or minimize the financial deficit of the university hospitals. In order to answer this question, this research assessed the implementation of a new work process (technological apparatus) called "tests filter" in Internal Medicine (CM) of Uberlândia Clinical Hospital (HCU) in April 2004. Another objective of the research is validate the process scientifically and make it paradigm. This validation was based methodologically on the submission of the results of the apparatus to the theoretical assumptions of: i) theory of innovation; ii) of Hegel's dialectic; and, iii) economic health. The results pointed to meet the requirements of the effectiveness, efficiency and effectively of the theory of economics in health; to improve performance and control of the new modus operandi in the theory of innovation; and in the passage from quantity to quality exams with direct and indirect positive economic impacts on AIH (Hospitalization Authorization) of patients in the Hegelian theory. The new process was qualified as innovative scientific paradigm has enabled savings in process, improved service quality and minimizes the financial crisis, rationalizing and reducing costs in medical procedures.