Desenvolvimento de um sistema para gestão de custos indiretos em empresas de serviços de saúde suplementar : o caso de uma operadora de planos de saúde

Esse estudo tem por finalidade contribuir para a discussão e o aprimoramento da gestão econômica e do desenvolvimento de ferramentas de apoio à decisão estratégica para empresas de serviços de saúde suplementar. Com base nos fundamentos teóricos sobre serviços, serviços de saúde suplementar, gerenciamento estratégico de custos e sistemas ABC/ABM, o estudo propõe um modelo de sistema de gestão de custos indiretos em planos de saúde sob a óptica do ABC/ABM, que visa proporcionar aos gestores uma visão ampla sobre o desempenho econômico dos planos e dos clientes. Assim, este estudo pretende colaborar com o desenvolvimento desse setor, que tem sofrido nos últimos anos o impacto da evolução da tecnologia e da medicina, provocando a constante elevação dos custos da assistência à saúde. Com a finalidade de justificar o estudo, o modelo é testado com a sua implementação em uma operadora de planos de saúde, possibilitando a discussão sobre as conclusões obtidas em relação ao problema abordado.

Uma avaliação sobre o processo de decisão de investimento das instituições financeiras componentes do sistema de financiamento industrial

O principal objetivo desta monografia é analisar a eficiência dos instrumentos de decisão de crédito utilizados pelas instituições financeiras especializadas em financiar investimentos, de capital fixo a médio e longo prazos. Aborda de forma intensiva a sistemática de "análise de projeto" recomendada pelo Banco Nacional de Desenvolvimento Econômico e Social (BNDES) aos seus agentes financeiros, apontando as limitações existentes, tendo em vista o que estabelece a moderna teoria financeira sobre a decisão de investimento.

Integração de serviços de saúde: observações sobre o planejamento, implantação e controle de um sistema de atendimento

Historia, em linhas gerais, a formação de Sistema de Saúde, no Brasil, e o desenvolvimento da Assistência ao Escolar, no Estado de são Paulo. Descreve o Sistema de Atendimento elaborado para organizar o atendimento médico a escolares das redes estadual e municipais de ensino, do Estado de são Paulo, por meio da ação integrada de instituições dos setores saúde e educação, a nível de município. Menciona a atuação de um professor, especialmente treinado para observar aspectos da saúde de escolares. Apresenta dados de avaliação relativos à abrangência do Sistema, encaminhamento e atendimento de escolares. Tece alguns comentários sobre fatores que facilitaram ou dificultaram a implantação e execução desse Sistema.

Capabilities formadoras da resiliência em cadeias de serviços: um estudo de caso em saúde

O objetivo deste trabalho e compreender como se formam cadeias resilientes. De maneira específica esta compreensão é analisada sob o olhar das diferentes capabilities que contribuem para a formação da resiliência. Com base na revisão da literatura, este trabalho considera que as capabilities de Percepção de Risco, Colaboração, Flexibilidade, Visibilidade e Agilidade são importantes. Além disso, o trabalho coloca estas diferentes capabilities sob o olhar das fases da ruptura – mitigação, preparação, resposta e recuperação. A pesquisa foi realizada através de um estudo de caso único. A unidade de análise do trabalho se refere à cadeia de saúde, formada pelos elos do governo federal, governo estadual, indústria farmacêutica, hospital e profissionais de saúde. Esta cadeia foi analisada no contexto da pandemia de H1N1 que atingiu o país em meados de 2009, levando uma grande quantidade de pessoas a procurarem o sistema de saúde para atendimento, além de ocasionar diversos outros impactos operacionais, como, por exemplo, o aumento de absenteísmo de profissionais de saúde. A coleta de dados foi realizada a partir de 16 entrevistas realizadas com profissionais dos diferentes elos diretamente envolvidos no contexto analisado, além da utilização de dados secundários provenientes de reportagens e relatórios.

Praxiologia, representação social de menopausa e práticas educativas de enfermeiras na estratégia saúde da família

This research, whose theme is related to climacteric, aims to know the social representation of menopause developed by the nurses working for Estratégia Saúde da Família (Family Health Strategy) in João Pessoa PB, as well as identifying its structure and verifying the way it interferes with the assistance and educational practices to the climacterial user. In the theoretical level, it is based on a model that articulates the social representations theory, the central nucleus complementary theory and the central concepts of Pierre Bourdieu s praxiology: habitus, cultural capital, social field and symbolic power. A hundred and forty-seven female nurses who work for Estratégia Saúde da Família (Family Health Strategy) in João Pessoa (PB) took part in this research, and the data collection period was from February 2008 to March 2009. As to the methods and techniques, we used the method to determine the central nucleus based on the free association of words, a questionnaire to identify certain regularities that constitute the nurses habitus, and the semi-structured interview to explore opinions and attitudes when facing assistance situations and educational practices and to collect other relevant information. The data analysis was developed, when referring to the free associations, with the help of the EVOC software, which is a group of articulated programs which carry out the statistical analysis of the evocations and the identification of the possible elements of both the central nucleus and the peripheral system of the social representation. As to the questionnaire, we used the descriptive statistical analysis and the analysis of correlation between the variables. The interviews were submitted to a categorical analysis of the content. The EVOC result indicated that the cognition hormone was the only element of the central nucleus of the social representation of menopause. Due to its symbolic value and structuring power, this central nucleus ensures the strict and, at the same time, flexible character of the representational content. The analysis of the social advancement, of some fundamental features of the group habitus, as well as the analysis of its insertion in the health field and of the attitudinal opinions and dispositions concerning the assistance given to the climacterial user, and the analysis of the pedagogical dimension of this assistance, all these analyses lead to the conclusion that the nurses who took part in this research share a social representation of the menopause resulting from the association of different technical and scientific knowledge. These derive from the biomedical pattern as well as from hegemonic values which disqualify old age and overvalue youth, from pedagogical conceptions arising from patterns that are presently regarded as authoritative and old-fashioned and from cultural references (responsible for the semantic variations concerning the central nucleus) which are specific to the subgroups the nurses belong to. This research enables the creation of opportunities for discussion between active nurses working for Estratégia Saúde da Família, and the nurses who are teachers at institutions of higher education, aiming at linking theory to practice, so that they can find ways of thinking about the climacteric and working, in a more comprehensive way, with users who are experiencing this stage of life

Representações sociais sobre a prática do cuidado para enfermeiros da saúde indígena: um estudo transcultural

The desire to research on this subject arisen from the experience as nursing in the indigenous health, where I observed that many professionals from all regions of Brazil chose to work within this zone. It was notorious the nurse s difficult to settle in only one place for a long length of time. Probably due to health care in indigenous zones happens from a cultural confront. This confront materialize because both sides are imbued with their own culture: in one hand the nurse professional with its scientific knownledgment on the other the indigenous with their rituals and peculiars habits. In this context nurses should delineate and negotiate the reality through symbolic representations of life, and then make questions on the new reality. In this way, this study set out with the aim of apprehends the nurse s social representations of transcultural care in indigenous health. This knownledgment is important to avoid possible conflicts, shocks, difficulties and health care incongruence within this context. The data collect was carried out on a range of non structured interview guided by a pre-elaborated questionnaire with four questions and a hand drawing related to nurse s health care in the indigenous health. This research had a sample of 17 nurses from the Indigenous Sanitary District of Manaus in the Amazon State. To interpret data we used the Discourse of the Collective Subject, which findings were presented in three chapters: characterization of participants, discussion on themes prevalent in discourse; social representation of nursing care through infographics. The analysis revealed that the care in the indigenous health is challenging because the native people imbued in its world are perceived and processed according to the nurse s cultural lens, leading to materialize of some strangeness and adaptation difficulties, especially in the first contacts. The Social Representation on nursing practice, in many cases, is projected and contrived on the basis of scattered believes and on perception derived from common sense. The findings shows that representions are essential to mitigating the initial strangeness and help nurses to better situate themselves in the new universe. The nurse s practice in the indigenous health care should merge into each other. From the Social Representations is possible to perceive that assimilation, also comprehension on indigenous health system and its traditional knowledge are important to developing strategies to improve access and quality of care for indigenous peoples. After analysis the nurse s discourses and drawings, it is possible to represent the nurse s practice in the indigenous health as anthropophagism, since nurses should literally consuming its patients culture, digesting it and seize it as means to provide culturally congruent care. We highlight the urgent need for preparation and training of professionals to work more effectively with indigenous peoples

Modelagem de arranjos institucionais para implementação da diretriz de sistema de gestão de segurança e saúde ocupacional da organização internacional do trabalho ILO/OSH 2001 no brasil

The commitment assumed by Brazil to ILO in order to pursue actions toward the ILO/OSH-2001 adoption in the country poses the issue of modeling the institutional arrangement the set roles and relationship between government, standards organizations, health and safety organizations, professionals and other institutions to deploy the ILO/OSH-2001. This Thesis develop institutional arrangement models based on the current model and also in the ISO 9000 scheme and others. It is studied the US case with OSHA and VPP, the OHSAS 18001 and ANSI/AIHA Z-10, in addition to actual context of the regulating norms NR s. The scenarios developed are put to evaluation on feasibility, potential changes and effects on current MTE auditors work scheme. The main results are five scenarios developed and that the MTE auditors tend to be reactive to the change toward the ILO/OSH-2001.

Uma contribuição à reformulação da norma regulamentadora 13 (NR-13) na perspectiva da adoção de sistema de gestão de segurança e saúde ocupacional

This Master s Thesis deals with an analysis of the Regulatory Standards NR-9 e NR-13 on the perspective of occupational health and safety management systems (OHSMS) such as ILO deployed ILO/OSH-2001. Since the revamped OHSAS 18001:2007 complies with the ILO/OSH-2001 model it is used as benchmark to compare against the NR-9 and NR-13. The analysis suggests that the NR-9 has some important features present on the OHSAS 18001:2007 but lacks important others. The NR-13 turns out to be far from a modern model of OHSMS such as OHSAS 18001:2007 and a deep reformulation should be done in order to achieve the Brazil commitment with ILO to adopt OHSMS. Also, a small survey with companies with ISO 9000 certificates suggests that a NR-13 revised toward OHSMS would be welcome, but also that some more advanced issues present in ILO/OSH-2001 should be imposed by law in order to be achieved

SISOnt: sistema de informação em saúde baseado em ontologias

The sharing of knowledge and integration of data is one of the biggest challenges in health and essential contribution to improve the quality of health care. Since the same person receives care in various health facilities throughout his/her live, that information is distributed in different information systems which run on platforms of heterogeneous hardware and software. This paper proposes a System of Health Information Based on Ontologies (SISOnt) for knowledge sharing and integration of data on health, which allows to infer new information from the heterogeneous databases and knowledge base. For this purpose it was created three ontologies represented by the patterns and concepts proposed by the Semantic Web. The first ontology provides a representation of the concepts of diseases Secretariat of Health Surveillance (SVS) and the others are related to the representation of the concepts of databases of Health Information Systems (SIS), specifically the Information System of Notification of Diseases (SINAN) and the Information System on Mortality (SIM)