Social participation in the unified health system of Brazil: an exploratory study on the adequacy of health councils to resolution 453/2012.

INTRODUCTION: Social participation is one of the guidelines of the Brazilian health system. Health councils are collegiate instances of participation established by Law 8.142/90. The most recent legal regulation for council organization and functioning was established through Resolution 453/2021. The institution of health councils has a permanent and deliberative nature to act in the formulation, deliberation and control of health policy implementation, including in economic and financial aspects. OBJECTIVE: To evaluate the compliance of health councils with the directives for the establishment, restructuring and operation of the councils from Brazil, based on Resolution 453/2012. METHODS: An exploratory, descriptive study that used the Health Council Monitoring System as a data source. Qualitative variables were selected to identify the characteristics related to the councils' establishment (legal instruments for establishment), the strategies adopted for restructuring (budget allocation, existence of an executive secretariat, provision of a dedicated office) and the characteristics of the health councils' operation (frequency of regular meetings, existence of a board of directors, the election of the board of directors). RESULTS: The study analyzed three groups of characteristics related to the constitution, strategies adopted for restructuring and the functioning of the councils. Regarding the constitution of the councils, the findings revealed that the vast majority was constituted in accordance with the legislation and, therefore, is in compliance with Resolution 453/2021. In the second group of characteristics that describe the restructuring of councils, the study found that less than half of registered councils are in compliance with the standard. And, finally, in the third group of characteristics, it was found that the boards have adopted different frequencies for regular meetings and approximately 50% of the boards studied have a board of directors. CONCLUSIONS: The councils still do not meet the minimum conditions necessary to fulfil their role in the Unified Health System (SUS), as stipulated in Resolution 453/2021. This situation requires monitoring by public oversight agencies. Despite the increase in popular participation with the creation of the health councils, this study demonstrated that most councils still do not meet the minimum conditions for monitoring public health policy. The improvement of the Health Councils Monitoring System (SIACS) to become an instrument for monitoring the councils, with the definition of goals and results, may contribute to the organization of the councils and, therefore, to the realization of social participation in Brazil.

Social participation: a look at the representativeness of health councils in Brazil, from Resolution 453/2012 / Participação social: um olhar sobre a representatividade nos conselhos de saúde no Brasil, a partir da Resolução 453/2012

Abstract The text addresses the representativeness in health councils in Brazil, based on guidelines proposed by the National Health Council. This study aimed to verify the adequacy of the councils to the criteria described in Resolution 453/2012, which demonstrate the representativeness of the segments that make up the collective. A descriptive cross-sectional study was conducted during May and June 2017. The study population was composed of health councils registered in the Health Councils Monitoring System, with public access and available on the Internet. The results obtained were organized considering the geographical distribution of the councils. The regions with the highest rates of non-compliance with the parity criterion were identified. It has been demonstrated that the guidelines for reformulating the councils are aligned with the notion of representativeness, but they are not a guarantee for the effectiveness of the representation. Future studies may deepen the analyses on representativeness in health councils in Brazil, and identify which mechanisms are adopted by entities to ensure the effectiveness of representation, as well as whether representation is renewed. It is recommended that the rules ordering the functioning of councils be permanently updated to promote social participation in health.

Resumo O texto aborda a representatividade nos conselhos de saúde no Brasil, a partir de diretrizes propostas pelo Conselho Nacional de Saúde. O objetivo do estudo foi verificar a adequação dos conselhos aos critérios descritos na Resolução 453/2012, que demonstram a representatividade dos segmentos que compõem o coletivo. Foi realizado estudo descritivo, do tipo transversal, durante os meses de maio e junho de 2017. A população do estudo foi composta pelos conselhos de saúde cadastrados no Sistema de Acompanhamento dos Conselhos de Saúde, de acesso público e disponível na internet. Os resultados obtidos foram organizados considerando a distribuição geográfica dos conselhos. Foram identificadas as regiões com maiores índices de descumprimento do critério de paridade. Ficou demonstrado que as diretrizes para reformulação dos conselhos estão alinhadas a noção de representatividade, porém, não são garantia para a efetividade da representação. Estudos futuros poderão aprofundar as análises sobre a representatividade nos conselhos de saúde no Brasil, e identificar quais mecanismos são adotados pelas entidades para garantir efetividade da representação, bem como se ocorre renovação da representação. É recomendável que as normas que ordenam o funcionamento dos conselhos sejam permanentemente atualizadas para favorecer a participação social na saúde.

Permanent education as an inalienable responsibility of health councils: the current scenario in the Unified Health System.

OBJECTIVE: To verify whether health councils in Brazil carry out permanent education activities for municipal, state and federal district councilors. METHOD: This was a cross-sectional study with secondary data collection in the Health Council Monitoring System (Sistema de Acompanhamento dos Conselhos de Saúde - Siacs) from May to August 2017. The Siacs is publicly accessible and available on the internet. It provides data from thousands of health councils throughout Brazil. Analysis and interpretation of the data were based on the literature and the enacted legislation, particularly Resolution 453/2012 and the National Policy of Permanent Education for Social Control in the Unified Health System (Política Nacional de Educação Permanente para o Controle Social no Sistema Único de Saúde). RESULTS: Despite the fact that Resolution 453/2012 establishes the deliberation, elaboration, support and promotion of permanent education for social control as functions of the councils (in accordance with the guidelines of the National Policy of Permanent Education), approximately 40% of councils do not carry out permanent education. CONCLUSIONS: It is necessary to strengthen the role of health councils in the elaboration of educational initiatives across the national territory. This includes the allocation of financial resources to increase access to and participation in these initiatives, which would strengthen social control in the Unified Health System. This study emphasizes that the discussion of permanent education is not given sufficient attention in the agendas and routines of health councils. This compromises the effectiveness of councils' monitoring and deliberation of public health policy.

Permanent education as an inalienable responsibility of health councils: the current scenario in the Unified Health System

OBJECTIVE: To verify whether health councils in Brazil carry out permanent education activities for municipal, state and federal district councilors. METHOD: This was a cross-sectional study with secondary data collection in the Health Council Monitoring System (Sistema de Acompanhamento dos Conselhos de Saúde - Siacs) from May to August 2017. The Siacs is publicly accessible and available on the internet. It provides data from thousands of health councils throughout Brazil. Analysis and interpretation of the data were based on the literature and the enacted legislation, particularly Resolution 453/2012 and the National Policy of Permanent Education for Social Control in the Unified Health System (Política Nacional de Educação Permanente para o Controle Social no Sistema Único de Saúde). RESULTS: Despite the fact that Resolution 453/2012 establishes the deliberation, elaboration, support and promotion of permanent education for social control as functions of the councils (in accordance with the guidelines of the National Policy of Permanent Education), approximately 40% of councils do not carry out permanent education. CONCLUSIONS: It is necessary to strengthen the role of health councils in the elaboration of educational initiatives across the national territory. This includes the allocation of financial resources to increase access to and participation in these initiatives, which would strengthen social control in the Unified Health System. This study emphasizes that the discussion of permanent education is not given sufficient attention in the agendas and routines of health councils. This compromises the effectiveness of councils' monitoring and deliberation of public health policy.

Thyroid cancer burden and economic impact on the Brazilian public health system.

OBJECTIVE: Recent data indicates an increasing incidence of thyroid cancer not accompanied by a proportional increase in mortality, suggesting overdiagnosis, which may represent a big public health problem, particularly where resources are scarce. This article aims to describe and evaluate the procedures related to investigation of thyroid nodules and treatment and follow-up of thyroid cancer and the costs for the Brazilian public health system between 2008 and 2015. MATERIALS AND METHODS: Data on procedures related to investigation of thyroid nodules and treatment/follow-up of thyroid cancer between 2008 and 2015 in Brazil were collected from the Department of Informatics of the Brazilian Unified Health System (Datasus) website. RESULTS: A statistically significant increase in the use of procedures related to thyroid nodules investigation and thyroid cancer treatment and follow-up was observed in Brazil, though a reduction was noted for procedures related to the treatment of more aggressive thyroid cancer, such as total thyroidectomy with neck dissection and higher radioiodine activities such as 200 and 250 milicuries (mCi). The procedures related to thyroid nodules investigation costs increased by 91% for thyroid ultrasound (p = 0.0003) and 128% in thyroid nodule biopsy (p < 0.001). Costs related to treatment and follow-up related-procedures increased by 120%. CONCLUSION: The increase in the incidence of thyroid cancer in Brazil is directly associated with an increased use of diagnostic tools for thyroid nodules, which leads to an upsurge in thyroid cancer treatment and followup-related procedures. These data suggest that substantial resources are being used for diagnosis, treatment and follow-up of a potentially indolent condition.

Thyroid cancer burden and economic impact on the Brazilian public health system

ABSTRACT Objective: Recent data indicates an increasing incidence of thyroid cancer not accompanied by a proportional increase in mortality, suggesting overdiagnosis, which may represent a big public health problem, particularly where resources are scarce. This article aims to describe and evaluate the procedures related to investigation of thyroid nodules and treatment and follow-up of thyroid cancer and the costs for the Brazilian public health system between 2008 and 2015. Materials and methods: Data on procedures related to investigation of thyroid nodules and treatment/follow-up of thyroid cancer between 2008 and 2015 in Brazil were collected from the Department of Informatics of the Brazilian Unified Health System (Datasus) website. Results: A statistically significant increase in the use of procedures related to thyroid nodules investigation and thyroid cancer treatment and follow-up was observed in Brazil, though a reduction was noted for procedures related to the treatment of more aggressive thyroid cancer, such as total thyroidectomy with neck dissection and higher radioiodine activities such as 200 and 250 milicuries (mCi). The procedures related to thyroid nodules investigation costs increased by 91% for thyroid ultrasound (p = 0.0003) and 128% in thyroid nodule biopsy (p < 0.001). Costs related to treatment and follow-up related-procedures increased by 120%. Conclusion: The increase in the incidence of thyroid cancer in Brazil is directly associated with an increased use of diagnostic tools for thyroid nodules, which leads to an upsurge in thyroid cancer treatment and followup-related procedures. These data suggest that substantial resources are being used for diagnosis, treatment and follow-up of a potentially indolent condition.

Analysis of the indicators of the Family Health Program in the Metropolitan Region of São Paulo.

OBJECTIVE: To analyze the Family Health Program replaced by the Family Health Strategy in 2011, based on health indicators and diseases classified as primary care sensitive. METHODS: This was a descriptive, analytical and documental study carried out in the Metropolitan Region of São Paulo between 2002 and 2007. We analyzed data from Health observatory for the Metropolitan Region of São Paulo. Pearson's correlation and the Statistical Package for the Social Sciences software version 17.0 were used to calculate data associations. RESULTS: We used 30 of the 31 health indicators of 24 from the 39 studied municipalities. A total of 720 (100%) health primary care sensitive indicators were analyzed in the Metropolitan Region of São Paulo. CONCLUSION: Percentages of improvements and worsening were low. In addition, some data were not presented. The majority of indicators remained stable.

Analysis of the indicators of the Family Health Program in the Metropolitan Region of São Paulo / Análise dos indicadores do Programa Saúde da Família na Região Metropolitana de São Paulo

ABSTRACT Objective To analyze the Family Health Program replaced by the Family Health Strategy in 2011, based on health indicators and diseases classified as primary care sensitive. Methods This was a descriptive, analytical and documental study carried out in the Metropolitan Region of São Paulo between 2002 and 2007. We analyzed data from Health observatory for the Metropolitan Region of São Paulo. Pearson's correlation and the Statistical Package for the Social Sciences software version 17.0 were used to calculate data associations. Results We used 30 of the 31 health indicators of 24 from the 39 studied municipalities. A total of 720 (100%) health primary care sensitive indicators were analyzed in the Metropolitan Region of São Paulo. Conclusion Percentages of improvements and worsening were low. In addition, some data were not presented. The majority of indicators remained stable.

RESUMO Objetivo Analisar o Programa Saúde da Família, substituído pela Estratégia Saúde da Família em 2011, considerando os indicadores de saúde e as doenças classificadas como sensíveis à Atenção Primária. Métodos Trata-se de estudo descritivo, analítico e documental, realizado na Região Metropolitana de São Paulo, no período de 2002 a 2007. Foram analisados dados fornecidos pelo Observatório de Saúde da Região Metropolitana de São Paulo. Após a coleta, calcularam-se, com base na correlação de Pearson e por meio do software SPSS, versão 17.0, as associações entre os dados. Resultados Foram usados 30 dos 31 indicadores de saúde de 24 dos 39 municípios pesquisados. Foram analisados 720 (100%) indicadores de saúde sensíveis à Atenção Primária na Região Metropolitana de São Paulo. Conclusão Foram baixos os percentuais de melhoras e pioras, ou, ainda, os dados não foram apresentados. A maioria permaneceu estável.

An assessment of the quality indicators of operative and non-operative times in a public university hospital / Avaliação dos indicadores de qualidade de tempo operatório e não operatório de um hospital universitário público

ABSTRACT Objective To assess the operative time indicators in a public university hospital. Methods A descriptive cross-sectional study was conducted using data from operating room database. The sample was obtained from January 2011 to January 2012. The operations performed in sequence in the same operating room, between 7:00 am and 5:00 pm, elective or emergency, were included. The procedures with incomplete data in the system were excluded, as well as the operations performed after 5:00 pm or on weekends or holidays. Results We measured the operative and non-operative time of 8,420 operations. The operative time (mean and standard deviation) of anesthesias and operations were 177.6±110 and 129.8±97.1 minutes, respectively. The total time of the patient in operative room (mean and standard deviation) was 196.8±113.2. The non-operative time, e.g., between the arrival of the patient and the onset of anesthesia was 14.3±17.3 minutes. The time to set the next patient in operating room was 119.8±79.6 minutes. Our total non-operative time was 155 minutes. Conclusion Delays frequently occurred in our operating room and had a major effect on patient flow and resource utilization. The non-operative time was longer than the operative time. It is possible to increase the operating room capacity by management and training of the professionals involved. The indicators provided a tool to improve operating room efficiency.

RESUMO Objetivo Avaliar os indicadores de tempo do centro cirúrgico de um hospital universitário para melhoraria de sua eficiência. Métodos Foi realizado um estudo descritivo transversal a partir da base de dados da tecnologia da informação do centro cirúrgico. A amostra foi obtida a partir de janeiro de 2011 a janeiro de 2012. Foram incluídas as operações realizadas em sequência na mesma sala cirúrgica, das 7 às 17h, eletivas ou de urgências. Os procedimentos com dados incompletos no sistema foram excluídos, assim como as operações depois das 17h ou realizadas em fins de semana ou feriados. Resultados Foi medido o tempo operatório e não operatório de 8.420 operações realizadas. Os tempos operatórios (média e desvio padrão) de anestesia e de cirurgia foram 177,6±110 e 129,8±97,1 minutos, respectivamente. O tempo total do paciente em sala cirúrgica (média e desvio padrão) foi de 196,8±113,2. O tempo não operatório, por exemplo, entre a chegada do paciente e o início da anestesia, foi de 14,3±17,3 minutos. O tempo de preparo e entrada do próximo paciente na sala cirúrgica foi 119,8±79,6 minutos. O tempo não operatório total foi de 155 minutos. Conclusão Atrasos frequentes ocorreram nas salas de cirurgia e tiveram um grande efeito sobre o fluxo de pacientes e a utilização de recursos. O tempo não operatório foi maior que o operatório. Portanto, é possível aumentar a capacidade do centro cirúrgico por meio da gestão e do treinamento dos profissionais envolvidos. Os indicadores oferecem uma ferramenta para melhorar a eficiência das salas de cirurgia.

Application of preventive medicine resources in the health insurance system / Aplicação de recursos em medicina preventiva no sistema de saúde complementar

ABSTRACT Objective To identify the financial resources and investments provided for preventive medicine programs by health insurance companies of all kinds. Methods Data were collected from 30 large health insurance companies, with over 100 thousand individuals recorded, and registered at the Agência Nacional de Saúde Suplementar. Results It was possible to identify the percentage of participants of the programs in relation to the total number of beneficiaries of the health insurance companies, the prevention and promotion actions held in preventive medicine programs, the inclusion criteria for the programs, as well as the evaluation of human resources and organizational structure of the preventive medicine programs. Conclusion Most of the respondents (46.7%) invested more than US$ 50,000.00 in preventive medicine program, while 26.7% invested more than US$ 500,000.00. The remaining, about 20%, invested less than US$ 50,000.00, and 3.3% did not report the value applied.

RESUMO Objetivo Identificar os recursos financeiros e os investimentos disponibilizados para os programas de medicina preventiva em operadoras de saúde suplementar de todos os tipos. Métodos Foram levantados dados referentes a 30 operadoras de saúde registradas na Agência Nacional de Saúde Suplementar, de grande porte, com registro acima de 100 mil vidas. Resultados Foi possível identificar o porcentual de participantes dos programas em relação ao número total de beneficiários da operadora, as ações de prevenção e promoção realizadas nos programas de medicina preventiva, os critérios de inclusão nos programas, bem como a avaliação dos recursos humanos e da estrutura organizacional dos programas de medicina preventiva pesquisadas. Conclusão A maior parte dos pesquisados (46,7%) investiu mais de US$ 50,000.00 no programa de medicina preventiva, enquanto 26,7% investiram mais de US$ 500,000.00. Os restantes, cerca de 20%, investiram menos de US$ 50,000.00 e 3,3% não informaram o valor aplicado.

Expenditures in the health care system in Brazil: the participation of states and the Federal District in financing the health care system from 2002 to 2013.

OBJECTIVE: To analyze the public expenditures of states on health care and the participation of states and the Federal District in financing the Unified Health System, better known by the acronym SUS. To develop the research, two targets were used: "to rescue expenses per government source (federal, state and municipal) during the period from 2002 to 2013" and "to rescue resource transfers from the federal SUS to the states and also to municipalities". METHODS: This research is bibliographic, documentary and descriptive and used a quantitative approach. Data were extracted from the Information System Public Health Budget, and additional data were collected from the public managers of states, municipalities and the Federal District during the period from 2002 to 2013. Federal data from the Undersecretary of Planning and Budget (originally extracted from the Integrated System of Financial Administration of the Federal Government and available on the Budget Public Health System webpage) were also collected. RESULTS: The data revealed that during the same researched period, the Federal District has maintained the health care system budget, whereas states and municipalities have increased their budgets for the same spending. CONCLUSIONS: By analyzing the results, there is clearly a disparity regarding the investment expended by the entities of the Federation. Although municipalities and states have gradually increased their application of resources to health care, the federal state has maintained the same budget. These results reveal a bit of concern about public health funding.

Expenditures in the health care system in Brazil: the participation of states and the Federal District in financing the health care system from 2002 to 2013

OBJECTIVE: To analyze the public expenditures of states on health care and the participation of states and the Federal District in financing the Unified Health System, better known by the acronym SUS. To develop the research, two targets were used: “to rescue expenses per government source (federal, state and municipal) during the period from 2002 to 2013” and “to rescue resource transfers from the federal SUS to the states and also to municipalities”. METHODS: This research is bibliographic, documentary and descriptive and used a quantitative approach. Data were extracted from the Information System Public Health Budget, and additional data were collected from the public managers of states, municipalities and the Federal District during the period from 2002 to 2013. Federal data from the Undersecretary of Planning and Budget (originally extracted from the Integrated System of Financial Administration of the Federal Government and available on the Budget Public Health System webpage) were also collected. RESULTS: The data revealed that during the same researched period, the Federal District has maintained the health care system budget, whereas states and municipalities have increased their budgets for the same spending. CONCLUSIONS: By analyzing the results, there is clearly a disparity regarding the investment expended by the entities of the Federation. Although municipalities and states have gradually increased their application of resources to health care, the federal state has maintained the same budget. These results reveal a bit of concern about public health funding. .

An assessment of the quality indicators of operative and non-operative times in a public university hospital.

OBJECTIVE: To assess the operative time indicators in a public university hospital. METHODS: A descriptive cross-sectional study was conducted using data from operating room database. The sample was obtained from January 2011 to January 2012. The operations performed in sequence in the same operating room, between 7:00 am and 5:00 pm, elective or emergency, were included. The procedures with incomplete data in the system were excluded, as well as the operations performed after 5:00 pm or on weekends or holidays. RESULTS: We measured the operative and non-operative time of 8,420 operations. The operative time (mean and standard deviation) of anesthesias and operations were 177.6 ± 110 and 129.8 ± 97.1 minutes, respectively. The total time of the patient in operative room (mean and standard deviation) was 196.8 ± 113.2. The non-operative time, e.g., between the arrival of the patient and the onset of anesthesia was 14.3 ± 17.3 minutes. The time to set the next patient in operating room was 119.8 ± 79.6 minutes. Our total non-operative time was 155 minutes. CONCLUSION: Delays frequently occurred in our operating room and had a major effect on patient flow and resource utilization. The non-operative time was longer than the operative time. It is possible to increase the operating room capacity by management and training of the professionals involved. The indicators provided a tool to improve operating room efficiency.

Application of preventive medicine resources in the health insurance system.

OBJECTIVE: To identify the financial resources and investments provided for preventive medicine programs by health insurance companies of all kinds. METHODS: Data were collected from 30 large health insurance companies, with over 100 thousand individuals recorded, and registered at the Agência Nacional de Saúde Suplementar. RESULTS: It was possible to identify the percentage of participants of the programs in relation to the total number of beneficiaries of the health insurance companies, the prevention and promotion actions held in preventive medicine programs, the inclusion criteria for the programs, as well as the evaluation of human resources and organizational structure of the preventive medicine programs. CONCLUSION: Most of the respondents (46.7%) invested more than US$ 50,000.00 in preventive medicine program, while 26.7% invested more than US$ 500,000.00. The remaining, about 20%, invested less than US$ 50,000.00, and 3.3% did not report the value applied.

Cost estimate of hospital stays for premature newborns of adolescent mothers in a Brazilian public hospital.

OBJECTIVE: To estimate the direct costs of hospital stay for premature newborns of adolescent mothers, in a public hospital. METHODS: A cost estimate study conducted between 2009 and 2011, in which direct hospital costs were estimated for premature newborns of adolescent mothers, with 22 to 36 6/7 gestational weeks, and treated at the neonatal unit of the hospital. RESULTS: In 2006, there were 5,180 deliveries at this hospital, and 17.8% (922) were newborns of adolescent mothers, of which 19.63% (181) were admitted to the neonatal unit. Out of the 181 neonates, 58% (105) were premature and 80% (84) of them were included in this study. These 84 neonates had a total of 1,633 days in-patient hospital care at a total cost of US$195,609.00. Approximately 72% of this total cost (US$141,323.00) accounted for hospital services. The mean daily costs ranged from US$97.00 to US$157.00. CONCLUSION: This study demonstrated that the average cost of premature newborns from adolescent mothers was US$2,328.00 and varied according to birth weight. For those weighing <1,000g at birth, the mean direct cost was US$8,930.00 per stay as opposed to a cost of US$642.00 for those with birth weight >2,000g. The overall estimated direct cost for the 84 neonates in the study totaled US$195,609.00.

[Ombudsmen in health care: case study of a municipal health ombudsman]. / Ouvidorias públicas de saúde: estudo de caso em ouvidoria municipal de saúde.

OBJECTIVE: To analyze the role of a Municipal Health Ombudsman and its contribution to the public health management from the perspective of the public health system users and the municipal health counselors. METHODS: Qualitative research approach using the case study, descriptive and transversal methods. The unit of analysis was a Municipal Health Ombudsman, in the state of Minas Gerais, Southeastern Brazil, between May and August 2010. The study was observational in nature and data were collected through interviews with two groups of stakeholders: users and municipal health counselors. We interviewed 44 Brazilian Unified Health System users who had made direct use of the Municipal Health Ombudsman and all 20 municipal health counselors. The data obtained were analyzed based on three issues: (1) nature of the data obtained; (2) discussion of subsidies to qualify the ombudsman's functioning as a management tool; (3) proposals for actions to improve democratic management in the area of public health. RESULTS: The complaints to the ombudsman denoted difficulties in access to health care services running the risk of their being perceived as shortcuts to gaining accessibility, disregarding the principle of social justice. The role of the ombudsman has the citizens' approval. Users reported the following main functions of the ombudsman: to support the resolution of health problems, to listen and to clarify issues regarding Brazilian Unified Health System operations and procedures. Information was emphasized by health counselors as an instrument of power and access to the rights of Brazilian Unified Health System users. They highlighted that the ombudsman has the role of ensuring justice to foster an effective health policy, besides playing an important mediating role between the board of the municipal health system, its managers and citizens. Furthermore, the ombudsman was shown to have an execution role that transcends its regular functions. CONCLUSIONS: The study found that the ombudsman is a key management tool in monitoring the health care system. Therefore, the establishment of the ombudsman is an advance in the field of democratic management. Nevertheless, there are challenges to be overcome in order to improve ombudsman contribution to the execution of health policies and representing citizens in ensuring their rights to health care.

Cost estimate of hospital stays for premature newborns of adolescent mothers in a Brazilian public hospital / Estimativa de custo de permanência hospitalar para recém-nascidos prematuros de mães adolescentes em um hospital público brasileiro

Objective : To estimate the direct costs of hospital stay for premature newborns of adolescent mothers, in a public hospital. Methods : A cost estimate study conducted between 2009 and 2011, in which direct hospital costs were estimated for premature newborns of adolescent mothers, with 22 to 36 6/7 gestational weeks, and treated at the neonatal unit of the hospital. Results : In 2006, there were 5,180 deliveries at this hospital, and 17.8% (922) were newborns of adolescent mothers, of which 19.63% (181) were admitted to the neonatal unit. Out of the 181 neonates, 58% (105) were premature and 80% (84) of them were included in this study. These 84 neonates had a total of 1,633 days in-patient hospital care at a total cost of US$195,609.00. Approximately 72% of this total cost (US$141,323.00) accounted for hospital services. The mean daily costs ranged from US$97.00 to US$157.00. Conclusion : This study demonstrated that the average cost of premature newborns from adolescent mothers was US$2,328.00 and varied according to birth weight. For those weighing <1,000g at birth, the mean direct cost was US$8,930.00 per stay as opposed to a cost of US$642.00 for those with birth weight >2,000g. The overall estimated direct cost for the 84 neonates in the study totaled US$195,609.00. .

Objetivo Estimar os custos diretos de internações de recém-nascidos prematuros de mães adolescentes em um hospital público. Métodos Estudo de estimativa de custos realizado entre 2009 e 2011, no qual os custos hospitalares diretos foram estimados para recém-nascidos prematuros de mães adolescentes, com 22 a 36 6/7 semanas de gestação, e tratados na unidade neonatal do hospital. Resultados Em 2006, o hospital em estudo teve 5.180 partos; 17,8% (922) foram de mães adolescentes, e 19,63% (181) recém-nascidos foram admitidos na unidade neonatal. Dos 181 neonatos, 58% (105) eram prematuros, dos quais 80% (84) foram incluídos neste estudo. Estes 84 recém-nascidos totalizaram 1.633 dias de tratamento hospitalar, a um custo total de US$195,609.00. Aproximadamente 72% desse custo total (US$141,323.00) referiu-se a serviços hospitalares. Os custos médios diários variaram de US$97.00 a US$157.00. Conclusão Este estudo demonstrou que o custo médio de recém-nascido prematuro de mães adolescentes foi US$2,328.00 e variou de acordo com o peso ao nascimento. Para recém-nascidos com peso <1.000g ao nascer, o custo médio foi US$8,930.00, e para os que pesaram >2.000g foi de US$642.00. O custo hospitalar total estimado para os 84 neonatos no estudo foi de US$195,609.00. .

Ouvidorias públicas de saúde: estudo de caso em ouvidoria municipal de saúde / Ombudsmen in health care: case study of a municipal health ombudsman / Ombudsmen in health care: case study of a municipal health ombudsman / Defensorías públicas de la salud: estudio de caso en defensor municipal de salud

OBJETIVO : Analisar o papel da ouvidoria e sua contribuição para a gestão da saúde pública segundo usuários de sistema de Saúde e de conselheiros municipais de saúde. MÉTODOS : Pesquisa qualitativa, estudo de caso, descritivo e transversal. A unidade de análise foi uma ouvidoria de saúde, localizada em município do estado de Minas Gerais, de maio a agosto de 2010. O estudo foi de natureza observacional com dados coletados em entrevistas com dois grupos de stakeholders: usuários e conselheiros de saúde. Foram entrevistados 44 usuários do Sistema Único de Saúde que registraram manifestações presenciais na ouvidoria e todos os 20 conselheiros do município. As informações obtidas foram analisadas com base em três questões: (1) natureza das informações obtidas; (2) discussão sobre subsídios para qualificar o funcionamento da ouvidoria como ferramenta de gestão; (3) proposição de ações para o aprimoramento da gestão democrática no campo da saúde pública. RESULTADOS : As demandas reportadas à ouvidoria indicaram dificuldade de acesso às ações e serviços de saúde, correndo o risco de serem percebidas como atalhos para obtenção de acessibilidade, desconsiderando o princípio da justiça social. A atuação da ouvidoria contou com a aprovação dos cidadãos. Os usuários relataram como principais funções da ouvidoria: ajudar a solucionar problemas de saúde e ouvir e esclarecer sobre o funcionamento do Sistema Único de Saúde. A informação foi enfatizada pelos conselheiros de saúde como instrumento de poder e de acesso aos direitos dos usuários do Sistema Único de Saúde. Destacaram que a ouvidoria tem como tarefa garantir justiça ...

OBJETIVO : Analizar el papel de la defensoría y su contribución para la gestión de la salud pública según usuarios de sistema de Salud y de consejeros municipales de salud. MÉTODOS : Investigación cualitativa, estudio de caso, descriptivo y transversal. La unidad de análisis fue una defensoría de salud, localizada en municipio del estado de Minas Gerais, Brasil, de mayo a agosto de 2010. El estudio fue de naturaleza observacional con datos colectados en entrevistas con dos grupos de stakeholders: usuarios y consejeros de salud. Se entrevistaron 44 usuarios del Sistema Único de Salud que registraron manifestaciones presenciales en la defensoría y todos los 20 consejeros del municipio. Las informaciones obtenidas fueron analizadas con base en tres aspectos: (1) naturaleza de las informaciones obtenidas; (2) discusión sobre subsidios para cualificar el funcionamiento de la defensoría como herramienta de gestión; (3) proposición de acciones para el mejoramiento de la gestión democrática en el campo de la salud pública. RESULTADOS : Las demandas reportadas en la defensoría indicaron dificultad de acceso a las acciones y servicios de salud, corriendo el riesgo de ser percibidas como atajos para la obtención de accesibilidad, desconsiderando el principio de la justicia social. La actuación de la defensoría contó con la aprobación de los ciudadanos. Los usuarios relataron como principales funciones de la defensoría: ayudar a solucionar problemas de salud y oír y aclarar el funcionamiento del Sistema Único de Salud. La información fue enfatizada por los consejeros de salud como instrumento de poder y de acceso a los derechos de los usuarios del Sistema Único de Salud. Destacaron que la defensoría tiene como tarea garantizar justicia en la efectividad de la política de salud y que desempeña ...

OBJECTIVE : To analyze the role of a Municipal Health Ombudsman and its contribution to the public health management from the perspective of the public health system users and the municipal health counselors. METHODS : Qualitative research approach using the case study, descriptive and transversal methods. The unit of analysis was a Municipal Health Ombudsman, in the state of Minas Gerais, Southeastern Brazil, between May and August 2010. The study was observational in nature and data were collected through interviews with two groups of stakeholders: users and municipal health counselors. We interviewed 44 Brazilian Unified Health System users who had made direct use of the Municipal Health Ombudsman and all 20 municipal health counselors. The data obtained were analyzed based on three issues: (1) nature of the data obtained; (2) discussion of subsidies to qualify the ombudsman’s functioning as a management tool; (3) proposals for actions to improve democratic management in the area of public health. RESULTS : The complaints to the ombudsman denoted difficulties in access to health care services running the risk of their being perceived as shortcuts to gaining accessibility, disregarding the principle of social justice. The role of the ombudsman has the citizens’ approval. Users reported the following main functions of the ombudsman: to support the resolution of health problems, to listen and to clarify issues regarding Brazilian Unified Health System operations and procedures. Information was emphasized by health counselors as an instrument of power and access to the rights of Brazilian Unified Health System users. They highlighted that the ombudsman has the role of ensuring justice to foster an effective health policy, besides playing an important mediating role between the board of the municipal health system, its managers and citizens. Furthermore, the ombudsman was shown to have an execution role that transcends ...

Economic and health indicators: correlation between inflation and mortality / Indicadores econômicos e de saúde: a relação entre inflação e mortalidade / Indicadores económicos y de salud: correlación entre inflación y mortalidad

The hypothesis that economic downturn periods have contributed to increase the overall mortality rate has been discussed by several authors. There is an immeasurable literature that associates socioeconomic levels with the individual´s health status. This paper seeks to analyze the correlation between mortality and the variables inflation, unemployment and income in Brazil in the period 1980?2009, examining whether the economic instabilities affect the individuals´ health status. This is an empirical-analytic study of historical series of Health Indicators (overall, infant, maternal mortality, and external causes) and Macroeconomic Indicators (Inflation, Unemployment and Income) in the period 1980 to 2009 in Brazil. The hypothesis corroboration was developed through regression analysis. The theoretical rationale of the results is based on Philips´ theory, whereby the lower the inflation rate is, the higher the unemployment becomes, or vice versa. Regression analysis performed suggests that the IPCA decrease and unemployment increase raise the overall mortality rate. The correlation of mortality with income was positive, confirming the hypothesis of some authors that high income leads to increased mortality due to factors such as stress, traffic accidents, among others. The mortality pattern follows the general behavior of the economic variables chosen. Based on Philips´ theory, the inflation drop raises unemployment levels; moreover, worse living and health conditions increase mortality rates.

A hipótese de que períodos de recessão econômica tem contribuido com o aumento da mortalidade geral tem sido discutida por diversos autores. Existe uma vasta literatura que correlaciona os níveis socioeconômicos com o estado de saúde do indivíduo. O presente trabalho busca analisar a correlação entre a mortalidade geral com as variáveis inflação, desemprego e renda no Brasil, no período de 1980?2009, analisando-se as instabilidades econômicas interferem na saúde dos indivíduos. Trata-se de um estudo empirico-analítico de séries históricas dos Indicadores de Saúde (mortalidade geral, infantil, materna e causas externas) e dos Indicadores Macroeconômicos (Inflação, desemprego e renda) no período de 1980 a 2009 no Brasil. A prova da hipótese foi desenvolvida por meio da Análise de Regressão. A fundamentação teórica dos resultados tem como base a teoria de Philips, segundo a qual quanto menor a taxa de inflação, maior a taxa de desemprego, ou vice-versa. As análises de regressão efetuadas sugerem que a diminuição do IPCA e o aumento do desemprego elevam a mortalidade geral. A correlação da mortalidade com a renda foi positiva, comprovando a hipótese de alguns autores, em que elevada renda gera aumento da mortalidade, devido a fatores como estresse, acidente de trânsito, entre outros. O comportamento da mortalidade geral acompanha o comportamento das variáveis econômicas escolhidas. Com base na teoria de Philips, a queda da inflação, eleva os níveis de desemprego; ademais, piores condições de vida e saúde majoram as taxas de mortalidade.

La hipótesis de que las crisis económicas han contribuido al aumento de la mortalidad general ha sido discutida por varios autores. Existe una vasta literatura que correlaciona los niveles socioeconómicos con el estado de salud del individuo. Este estudio tiene como objetivo analizar la correlación entre la mortalidad global y las variables inflación, desempleo y renta en Brasil, durante el período 1980?2009, analizando si las inestabilidades económicas afectan a la salud de las personas. Este método es un estudio empírico-analítico de series históricas de los Indicadores de Salud (mortalidad general, infantil, materna y causas externas) y de los Indicadores Macroeconómicos (inflación, desempleo y renta) en el período 1980?2009 en Brasil. La prueba de la hipótesis fue desarrollada a través del Análisis de Regresión. La fundamentación teórica de los resultados se basa en la teoría de Philips, según la cual lo más baja sea la tasa de inflación, mas alta será la tasa de desempleo, o viceversa. Los análisis de regresión realizados sugieren que la reducción del IPCA y el aumento del desempleo aumentan la mortalidad general. La correlación de la mortalidad con la renta fue positiva, lo que confirma la hipótesis de algunos autores, que una renta alta genera aumento de la mortalidad debido a factores como el estrés, los accidentes de tráfico, entre otros. El comportamiento de la mortalidad general acompaña el comportamiento de las variables económicas escogidas. Basado en la teoría de Philips, la caída de la inflación eleva los niveles de desempleo; además, las peores condiciones de vida y salud aumentan las tasas de mortalidad.

Financiamento da assistência farmacêutica no sistema único de saúde / Financing of pharmaceutical services in Brazilian public health system

Objetivos. Descrever e discutir a evolução do financiamento da assistência farmacêutica no Sistema Único de Saúde - SUS. Métodos. Foram identificados os valores alocados para aquisição de medicamentos, para o Programa Farmácia Popular e para estruturação de serviços farmacêuticos públicos. Os valores referentes ao financiamento da União, por meio do Ministério da Saúde, foram obtidos do sistema Siga Brasil e, dos Estados, do Distrito Federal e dos municípios, do Sistema de Informações sobre Orçamentos Públicos em Saúde - SIOPS. Resultados. Entre 2005 e 2009 houve aumento de 65,3 por cento nos recursos financeiros da União para aquisição de medicamentos. No mesmo período, ampliou-se o volume de transferências feitas às esferas subnacionais. Verificou-se que os Estados e o Distrito Federal aumentaram em 112,4 por cento o volume de recursos próprios alocados no financiamento de medicamentos e que para os municípios este crescimento foi de 22,7 por cento. Em 2008, a participação das despesas com medicamentos em relação às despesas com saúde foi de 7,8 por cento. O gasto total com medicamentos em 2009 foi de 8,9 bilhões de reais. Observou-se aumento de 20,6 vezes no valor alocado no Programa Farmácia Popular e, no caso dos recursos destinados à estruturação de serviços, crescimento de 41,6 por cento, chegando a 10,1 milhões de reais em 2009. Conclusão: Houve ampliação do financiamento de medicamentos no SUS entre 2005 e 2009.