Identificação de ineficiências na cadeia de valor da saúde, a partir da análise da gestão de compras de quatro hospitais privados do município de São Paulo

Os estudos e pesquisas sobre as razões do crescimento dos custos na Saúde apontam um conjunto de fatores, como o aumento dos preços dos materiais e medicamentos, os avanços tecnológicos, o envelhecimento da população, entre outros. Porém, poucos são os estudos que procuram analisar como a interação entre as partes que constituem o sistema de saúde pode resultar em ineficiências, ou que procuram desvendar a lógica de como se dão as trocas de valores entre os players desse mercado e sua racionalidade, a fim de identificar fatores que elevem os custos no sistema sem um aumento de benefícios aos usuários finais. Sabe-se que grande parte dos gastos na saúde ocorre dentro dos hospitais. Sendo assim, este trabalho buscou analisar a gestão de compras dos hospitais, para descrever aspectos relevantes no relacionamento entre algumas partes envolvidas na dinâmica da compra hospitalar, conhecer especificidades da gestão de compras destas organizações, e verificar algumas ineficiências na cadeia de valor da saúde. Foram escolhidos quatro hospitais privados do município de São Paulo, onde foram entrevistados um executivo da alta administração, um gestor de compras e um médico. A partir da percepção destes entrevistados foram identificadas algumas ineficiências, como a dependência de alguns hospitais nas margens de comercialização de materiais e medicamentos, que mostra a existência de um custo no sistema, desvinculado do real valor agregado pelos hospitais; a dificuldade em se padronizar os materiais cirúrgicos que representam um dos maiores gastos em compras nestas instituições; a existência práticas de marketing dos fornecedores que tentam anular a racionalidade da compra, a dificuldade de alinhamento de objetivos entre hospitais, operadoras de planos de saúde, médico e fornecedores, entre outros.

Sistemas de custos em organizações hospitalares: estudo de casos

Esta pesquisa objetivou analisar os sistemas de custos implantados em seis hospitais gerais da cidade do Rio de Janeiro, quanto a sua estrutura e funcionamento, em relação à literatura sobre contabilidade de custos, incluindo os manuais de alguns órgãos governamentais do Brasil. Na revisão de literatura, foram abordados os aspectos e propósitos dos sistemas de custos, as regras para sua implantação, os diferentes sistemas, os métodos de custeio e, finalmente, os enfoques específicos dos sistemas de custos hospitalares (Capítulo II). Para a realização do trabalho, escolheu-se o método de estudo de casos, em razão da carência de verificações empíricas nesta área e a necessidade de uma descrição profunda dos sistemas de custos encontracos (Capítulo III). A seguir, apresentou-se a descrição dos casos, abordando-se as características individuais das unidades hospitalares e a estrutura e o mecanismo dos seus sistemas de custos (Capítulo IV). Os resultados obtidos possibilitaram analisar os tipos de sistemas implantados quanto à natureza dos custos, à forma de acumulação e aos métodos de custeio. Permitiram tambem uma análise dos procedimentos e utilização dos sistemas para fins administrativos (Capítulo V). Relacionando-se os resultados à literatura, chegou-se a importates conclusões e finalmente sugeriu-se novos estudos nesta área.

A metodologia do valor

A análise de valor constitui uma abordagem muito original para reduzir custos de produção de bens e serviços. Consiste basicamente em identificar as funções de um determinado produto, avaliá-las e finalmente propor uma forma alternativa de desempenhá-las a um custo menor que da maneira conhecida. Trata-se de uma ferramenta potente, originando reduções de custos da ordem de ate 60% em media. Por ter trazido resultados muito bons nos E.U.A, seu uso foi difundido rapidamente no Canadá, na Europa e no Japão. Sua introdução ocorreu também em outros países, como África do Sul, índia e Brasil, onde tentativas isoladas foram feitas desde a década de setenta. Atualmente, várias empresas em nosso país iniciaram seu uso com grande sucesso

O efeito da diversificação na mineração

Neste trabalho, medimos os efeitos da diversificação sob o aspecto de risco e retorno entre os grandes players globais de mineração. Para avaliar a diversificação, primeiramente, foi criado um ranking que relaciona risco, grau de diversificação e retorno das empresas. Foi necessário montar um banco de dados com séries de receita e de proxies de geração de caixa por negócios, o qual não se encontra prontamente disponível na Bloomberg, Economática ou em outras bases de dados públicas. Estimamos os efeitos da diversificação fazendo o uso do CAPM para calcular o beta das empresas e das estatísticas básicas das séries históricas de retornos para encontrar o Índice de Sharpe. Examinamos os demonstrativos financeiros das empresas para entender com maior profundidade seus negócios para uma amostra equivalente a 50% do valor de mercado das top 100 empresas de mineração do mundo para o período entre 2002 e 2014. Por fim, abordamos, sob a forma de estudo de caso, questões relevantes na diversificação como a eficiência e a disciplina na alocação de capital. Nosso estudo confirmou que existe uma correlação negativa entre o risco e o grau de diversificação e que há sinais que sugerem que as companhias mais focadas possuem maior disciplina na alocação do capital, e, com isso geram mais valor para seus acionistas.

Análise econômica da produção de pepino (Cucumis sativus) tipo alongado em projeto de assentamento

Pós-graduação em Agronomia (Energia na Agricultura) - FCA

Formulação não linear de ração para frangos de corte: modelagem e otimização

Pós-graduação em Ciência Animal - FMVA

Avaliação dos custos da assistência de recém nascidos de mães diabéticas no Hospital das Clínicas -UNESP – Botucatu

The present work had as objective to calculate and to analyze the costs of the assistance of just born of diabetic mothers interned in the units of Joint Lodging of the Maternity and Nursery and UTI Neonatology of the HC - FMB - Unesp. This is a exploratory, descriptive study with quantitative analysis of the data, with just born of carrying mothers of gestational diabetes and of light hyperglycemia, that had carried through the prenatal assistance in the HC - FMB - Unesp, in the period of 1o of January the 31 of December of 2009. The analysis of the data disclosed that the costs indirect and of the assistance to the just born in joint lodging had been of: R$ 160,20 for the group of RN of mothers with light hyperglycemia, R$204,10 for the group with diabetes and R$100,57 for the control. The costs indirect and of the assistance to the just born in Nursery had been of: R$ 494,94 for the group of RN of mothers with light hyperglycemia, R$565,89 for the group with diabetes and R$262,98 for the control. The weighed average cost of the assistance to the just born in Joint Lodging, Nursery and UTI of Neonatology was of: R$ 191,33 for the group of RN of mothers with light hyperglycemia, R$458,58 for the group with diabetes and R$210,48 for the control. It can be concluded that the costs of just born of diabetic mothers and with light hyperglycemia were higher and had similar perinatal results to the one of the control group

Redução de desperdícios no serviço de atendimento ao consumidor: estudo de caso do orçamento base zero em uma empresa de linha branca

The self-evaluation is increasingly necessary in a competitive environment, and a way for companies to self-evaluate is through your budget. Knowing the importance of this budgetary process, this study aimed to observe and analyze the developing process of a zero-based budgeting (ZBB) highlighting its best practices and difficulties and propose recommendations for other companies in general. This goal was achieved through a case study in an area responsible for the budgeting process in the customer services department from a white-goods company. Also was required to review the literature regarding the customer services area, waste reduction, cost management, budgets in general and the zero-based budgeting. After reviewing the literature and the study, we can highlight good practices and difficulties observed in the studied company, and also propose recommendations on how to develop a zero-based budget and evidence what plans, analyzes and justifications are essential in a good budget process execution

Análise e redução de custos e peso em veículo rodoviário de carga reboque linha de eixos

Load transportation in brazilian territory is made difficult by a deficient highway network, result of low maintenance and lack of government supervision. The problem aggravates when we consider the transportation of indivisible loads, mainly because the brazilian highways are not prepared for such task and few companies in Brazil have the necessary equipment suited for this kind of transport. In this dissertation it will be shown the analysis of a specific equipment to transport overweight indivisible loads, called hydraulic modular multi axle trailer. From an existing project (RB.04LE-01), manufactured and homologated in Brazil, it has been studied how the components in this trailer work so it could have been possible to elaborate a new model (RB.04LE-02), with two main objectives: reduction of costs and weight with subsequent increase in the liquid load for roadway transportation. The trailer’s components analyses were made utilizing the theory of fatigue strength of materials and finite element method with the von Misses criteria for a more safety when realizing the calculations

Determinação de genes mórbidos e drogáveis a partir da construção e análise da rede integrada de interações moleculares entre genes humanos

The discovering process of new morbid genes and new target proteins for drugs have been shown to be very costly and laborious. Having in view cutting costs and speeding up this process, we propose, in this work, a new method to determine the gene druggability score and morbidity score, the probabilities of the protein encoded by the gene have the characteristics that make it a new target for drugs and in case of an alteration in that gene, we observed a phenotype that characterizes a genetic based illness. To determine these characteristics, we built, analyzed and determined the characteristics of the topology of the integrated molecular interactions network among human genes containing physical interactions between proteins, metabolic interactions and interactions of transcriptional regulation, and included other data such as level of gene transcription and cellular localization of the protein encoded by the gene. We tested our model in training sets and achieved results equal or better than the ones achieved by similar methods in the literature. Finally, with the purpose of investigating whether the assigned scores resembles the potential druggabilities and morbities of the previously unclassi ed genes, we looked for evidences in biomedical literature supporting the potential druggability and morbidity status of genes with the 10 highest scores. We found clear evidences for 73% and 90% of potential druggable and morbid genes respectively

Cogeração em uma indústria automobilística

The search for energy efficiency improvement is a common concern in many companies. Cogeneration is a well known technique but not so spread in Brazil, despite its potential for energy costs reduction through heat recovery from prime movers. In this work, a preliminary technical and economic study is carried out for a cogeneration plant application in an automotive industry of São Paulo. Though mathematics modeling, three 2435 kW internal combustion engines are selected. When compared to the current status (no cogeneration), annual savings of about 2,2 MR$ are obtained, resulting a almost 3 years payback

Projeto DMAIC com ferramentas six sigma para redução de custos logísticos de uma multinacional

This work has a focus on project execution DMAIC ( Define Measure Analyze Implement Control) , using the statistical and quality tools to identify , analyze and implement improvements in a given process in order to reduce costs telephony transport of a multinational consumer goods . The multinational consumer goods to be studied has outsourced carriers who perform the distribution of its products , which may lead them straight to their factories or one of its distribution centers to the points of sale ( supermarkets , bakeries , gas stations , convenience cafeterias , among others ) . Whenever there is an unexpected situation or some problem at the time of delivery of the goods to the customer opens an occurrence , ie , the carrier responsible for contacts ( 0800 ) with the contact center company of consumer goods which in turn registers the occurrence, analyzes and sends a response action to the carrier . This work will study the problem with a high number of connections to handle occurrence , through analysis and data collection , identify improvement opportunities, implement them and monitor the results to ensure that the gain and loss reduction are sustainable

Enfermagem e o gerenciamento de custos: revisão sistemática nacional e internacional

Objectives: conduct a systematic review of national and international literature, to classify the types of production, comparing the two literatures and synthesize knowledge in the area. Method: Systematic Review of Literature, in the databases LILACS, CINAHL and MEDLINE for selection of articles in their entirety, the data extracted from the articles selected were: the study of bibliographic information (title, author, journal, place of study and year of publication), and general information (multidisciplinary production or specific area, language, type of study, type of population and contributions of the study). The categories established for classification of publications were: raising the cost of procedures/ interventions, economic evaluation of specific intervention, inclusion of nursing in the economic context, using cost as an important variable in the study. Results: The study included 39 publications, with 31% of national production and the remaining 69%, internationally. Most publications were classified according to category of economic evaluation of specific intervention, followed by the category of raising the cost of procedure / intervention, which fits the majority of national production. Human resources is shaped as an important variable for obtaining cost studies that proposed to make this calculation. Conclusion: The production of literature in nursing cost management is relevant in number of publications within the proposed period and is directed to different areas within this theme. There are significant differences in national and international literature: these last use more accurate methods, have more content theorized, use more the economic evaluation tools and related more costs with a amplified context. The production of such knowledge should continue as far as possible and putting that knowledge relating the current reality, in order to amplify the field of nursing and add value

Análise do funcionamento e a evolução de um programa de sugestões de ideias e seus benefícios

The competition for markets have created extreme challenges for companies that need an efficient management system. The transformational system involve all the employees in the task of eliminating waste, add value to products, reduce variations in processes, increase reliability and discover customer needs. The collaborative management is one of the focuses of this research. It was based on the analysis of the Fleury's suggestion program called Central de Ideias, The Fleury Group is one of the most traditional organizations of medical and health in the country. We pointed out the evolution of the program and we also showed the results of the changed of the management tool ideas. An extensive theoretical study was conducted in order to enhance the benefits that a suggestion system provides to the organizations. The Programa Central de Ideias has saved millions for Fleury and it has been made processes more efficient. The increasing of employees participation, the improvement of the internal communication and the refinement of the quality services are one of the suggestion system benefits

Análise do funcionamento e a evolução de um programa de sugestões de ideias e seus benefícios

The competition for markets have created extreme challenges for companies that need an efficient management system. The transformational system involve all the employees in the task of eliminating waste, add value to products, reduce variations in processes, increase reliability and discover customer needs. The collaborative management is one of the focuses of this research. It was based on the analysis of the Fleury's suggestion program called Central de Ideias, The Fleury Group is one of the most traditional organizations of medical and health in the country. We pointed out the evolution of the program and we also showed the results of the changed of the management tool ideas. An extensive theoretical study was conducted in order to enhance the benefits that a suggestion system provides to the organizations. The Programa Central de Ideias has saved millions for Fleury and it has been made processes more efficient. The increasing of employees participation, the improvement of the internal communication and the refinement of the quality services are one of the suggestion system benefits