[Study of public and private hospital care on a population basis, 1986-1996]. / Estudo da assistência hospitalar pública e privada em bases populacionais, 1986-1996.

INTRODUCTION: The last decade saw the creation and implementation of the Brazilian National Health System (NHS)--public, universal and equalitarian--with the objective of offering wide coverage to meet the population's health needs. The objective of the study was the assessment of the evolution of public and private hospital care on a populational basis during the period of the implementation of the NHS. METHODS: The 984,142 inpatients of the general hospitals of Ribeirão Preto, Brazil, during the period 1986 to 1996 were studied and those of them living in their own municipal district were selected. The inpatients are classified according to the financing system as private, pre-payment and NHS; the social situation of the patients and the profile of hospital morbidity are analysed. RESULTS: In the period studied a continuous growth in the number of hospitalizations is observed, both in absolute numbers and in coefficient per thousand inhabitants, increasing from 43,773 to 55,844 inpatients per year. Though when the categories of the hospitalizations are studied, it is seen that private inpatients present a reduction both in absolute numbers and as a coefficient from 3,181 (7.3%) to 2,215 (3.9%); the NHS inpatients decrease in absolute numbers and in a percentage by a third at the end of the period--falling from 33,254 (76.0%) to 29,373 (51.7%). On the other hand the pre-payment inpatient system triplicates in absolute numbers and duplicates by rate for inhabitant--from 7,338 (16.8%) to 25,256 (44.4%). The NHS hospital care attends mainly unskilled and semi-skilled manual workers; the professionals, technicians, non manual and skilled manual workers being assisted by the private services. The hospital morbidity of NHS inpatients is different from that of the private inpatient systems. The health policy in that period, limiting NHS financing, repressing demand and discouraging the private providers to work with NHS inpatients led to negative selectivity. The result was an increase in difference between standards of care as between the public and private services.

[Hospital assistance as an indicator of social inequality]. / Assistência hospitalar como indicador da desigualdade social.

OBJECTIVE: To test a model for the study of inequalities in hospitalizations in the city of Ribeirâo Preto (SP), understanding them to be due both to the social position of inpatients and also to health care policies in Brazil. MATERIAL AND METHOD: Using a hospital information system in existence for more than 25 years in the city of Ribeirâo Preto-SP, 56.293 hospitalizations of municipal inhabitants occurring in some of the 12 general hospitals in 1993, were studied. Using the Brazilian occupancy classification for mortality, these inpatients were grouped on 6 occupational levels, as in the British classification: professional, intermediate, qualified non manual, qualified manual, partially qualified and unqualified. RESULTS AND CONCLUSIONS: Two-thirds of the inpatients had no place in the i.e. did not belong to the economically active population--and consisted of housewives, pensioners, children and students--and one third had some economic activity and thus belonged to the economically the active population. A close association was found between social strata and the classification of the hospital financing system into private, private group clinic and public health system patients. There were differences in hospital parameters as well as in morbidity patterns between these groups. The inequalities relating to average age, average age of hospital deaths, mean lengths of stay, hospital mortality, re-internment and frequency of diseases are discussed. This model allows the social position of the inpatient to be estimated using the hospital financing system, including also those patients with no economic activity, which covers the majority of the population. Social mechanisms created to compensate for inequalities in the welfare state do not cancel out the social differences.

[Inequalities among hospitalized patients due to cardiac and cerebrovascular diseases in localities of the State of São Paulo (Brazil), 1986]. / Desigualdades entre pacientes hospitalizados por doenças cardíacas e vasculares-cerebrais em localidade do Estado de São Paulo (Brasil), 1986.

The clinical and epidemiological characteristics of hospitalizations due to cardiac and cerebral-vascular diseases (CCVD-ICD 390-438), which occurred in 1986, were studied on the basis of data from an information system relating to medical care in the City of Ribeirão Preto, State of S. Paulo, Brazil. These causes accounted for 4,673 of the annual total of 43,449 hospital admissions. Using the sources of payment of the hospitalization as an indicator of the patients' social strata, the following four study groups were defined: private, social insurance, non-paying and "others". These groups showed significant differences in relation to the following variables: hospitalization rates due to CCVD, mean and median age at admission and time of death, occupation, average length of stay in the hospital, mortality rates and relative frequencies of specific sub-group diagnosis. These differences are attributed to inequalities in the standard of living and in the working conditions of the groups, which determine diverse patterns of disease, medical care and mortality.

Avaliacao da utilizacao de exames laboratoriais multiplos num hospital universitario. / Evaluation of the multiple laboratory tests utilization in an university hospital

Os autores estudam a existencia de exames sorologicos multiplos, e seus resultados, em uma amostra casual simples de prontuarios medicos de pacientes de 3 grandes clinicas de um hospital universitario.Mais da metade dos prontuarios amostrados tinha ao menos um exame de perfil 1 e 2 realizado. O numero de resultados normais foi grande. Mais ou menos 30% dos exames tinham apenas 1 resultado alterado e 23% tinham 2 ou 3 exames anormais. Os resultados sugerem que as baterias de exames realizados nao tinham por objetivo elucidar hipoteses diagnosticas dos pacientes; por outro lado, se a utilizacao dirigia-se ao controle de saude e diagnostico precoce de doencas em populacao usuaria de servico terciario, a proporcao dos achados foi muito baixa. As queixas dos pacientes, referidas no prontuario, nao justificam, na maioria dos casos, os exames realizados. E preciso desenvolver o pensamento critico a respeito da utilizacao de recursos tecnologicos a fim de propiciar seu uso mais criterioso