Uma comparação entre os custos atuais, custos por pacote e reembolso hospitalar para o procedimento de revascularização miocárdica

In Brazil, the supplemental healthcare system is going through a transition period from the traditional Fee-for-service reimbursement system to the Package reimbursement system, similar to the American model known as the Diagnoses Related Groups (DRG) system. Although the Package concept is nothing new to the hospital environment, it is still seldom used since this system calls for a level of control and analytical knowledge of hospital costs that are poorly developed in Brazilian institutions. This study focuses on determining how much the reimbursement for a Myocardial Revascularization Package actually covers of the current costs for patients submitted to this procedure. A prospective analysis method for determining the cost per patient has been developed and 13 patients were individually followed-up during all their hospitalization period. The expenses with intensive care unit and in-patient clinical care, as well as the type of admittance - whether elective or emergency - were determined for each patient. Additionally, all the resources and materials for the surgical procedure were included, comprising specialized personnel, surgical fees, procedures and tests, biomedical equipment, and all the materials and medication used during the hospital stay. Based on this data, the current total costs were calculated and compared to the reimbursement for the Package previously agreed upon by the institution and the healthcare carriers. The study found an average cost of BR$ 8,826 for a Myocardial Revascularization surgical procedure, while the respective reimbursement for the Package is of BR$ 7,476. Therefore, the reimbursement does not cover the current costs of the procedure.

Relação entre os atributos de qualidade de um serviço de reabilitação ambulatorial e os padrões do modelo de acreditação Joint Commission on Accreditation of Healthcare Organizations : a visão do cliente

Mostra evidências de relação entre os atributos de qualidade de um serviço de realibilitação ambulatorial sob a percepção do cliente e os padrões do modelo internacional de acreditação de serviço de saúde.

Courts as healthcare policy-makers: the problem, the responses to the problem and problems in the responses

This article starts by analysing healthcare litigation in Brazil by means of a literature review of articles that contribute with empirical findings on this phenomenon. Based on this review, I argue that health care litigation in Brazil makes the public health system less fair and rational. In the second part of this article, I discuss the three most overarching responses to control the level of litigation and its impact on the public health system: (i) the public hearing held by the Supreme Federal Court and the criteria the court established thereafter; (ii) the recommendations by the National Council of Justice aimed at building courts’ institutional capacity; and (iii) the enactment of the Federal Law 12.401/11, which created a new health technology assessment system. I argue that latter is the best response because it keeps the substantive decisions on the allocation of healthcare resources in the institution that is in the best position to make them. Moreover, this legislation will make the decisions about provision of health treatments more explicit, making easier for courts to control the procedure and the reasons for these decisions.