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RESUMO - A democratização dos cuidados de saúde, aliada às mudanças demográficas, tem contribuído para o aumento das despesas no setor. Em Portugal, o SNS garante o transporte de doentes, promovendo o acesso equitativo aos serviços de saúde e diminuindo desigualdades. Contudo, a centralização dos serviços de saúde nos grandes centros urbanos, tem incrementado o volume de transportes, os custos e das emissões de gases de efeito de estufa, com impacto na saúde pública e no ambiente.
Este estudo tem como objetivo avaliar os custos diretos e a pegada carbónica associada ao transporte de doentes não urgentes, propondo um modelo de gestão regional interinstitucional que promova a sustentabilidade financeira e ambiental. A metodologia aplicada combina uma abordagem observacional, descritiva e retrospetiva, com a recolha de dados, realizada através do Sistema de Gestão de Transportes de Doentes (SGTD) e da legislação pertinente. A análise quantitativa das variáveis foi facilitada pela abordagem descritiva, enquanto a metodologia retrospetiva permitiu a avaliação dos dados de 2023 no contexto do transporte de utentes para ambulatório hospitalar.
Em 2023, foram realizados 127.228 transportes de doentes não urgentes. A maior parte foi efetuada pela instituição “B” (63.073 transportes), seguida das instituições “C” (49.007) e a instituição “A” (15.148). A ambulância múltipla foi o meio de transporte mais utilizado (67,7%), seguido pelas viaturas destinadas ao transporte de doentes (17,6%) e pelas ambulâncias individuais (14,7%). Os transportes em viatura múltipla e veículo destinado ao transporte de doentes (VDTD) geraram um custo total de 13.468.305,7 euros e uma pegada carbónica direta de 6.950.363 Kg CO2. Foi analisada a eficiência dos transportes agrupados, considerando a ocupação máxima de 5 utentes por viatura para distâncias inferiores e iguais ou superiores a 100 Km. Verificou-se um total de 108.528 utentes transportados, resultando num custo global de 13.468.012 euros e um potencial de poupança de 8.326.058 euros. A maior eficiência foi observada com a ocupação total dos veículos, tendo um desperdício nulo (0%). O transporte de doentes não urgentes é crucial para assegurar o acesso equitativo aos cuidados de saúde, embora apresenta anualmente custos elevados. A plataforma SGTD, apesar das suas limitações, otimiza a gestão dos transportes. A integração de tecnologias avançadas, como a Inteligência Artificial, pode potenciar a eficiência na alocação de recursos. Propõe-se um modelo de gestão regional partilhada, iniciando-se por um projeto piloto na Grande Lisboa, com uma revisão regulamentar e promoção na saúde preventiva.
ABSTRACT - The democratization of healthcare, combined with demographic changes, has contributed to the increase in expenses in the sector. In Portugal, the NHS ensures patient transportation, promoting equitable access to health services and reducing inequalities. However, the centralization of healthcare services in major urban centers has increased the volume of transportation, costs, and greenhouse gas emissions, impacting public health and the environment. This study aims to assess the direct costs and carbon footprint associated with non-emergency patient transportation, proposing a regional inter-institutional management model that promotes financial and environmental sustainability. The applied methodology combines an observational, descriptive, and retrospective approach, with data collection carried out through the Patient Transportation Management System (SGTD) and relevant legislation. The quantitative analysis of variables was facilitated by the descriptive approach, while the retrospective methodology allowed for the evaluation of 2023 data in the context of patient transportation for hospital outpatient services. In 2023, 127,228 non-emergency patient transports were conducted. Most were carried out by institution 'B' (63,073 transports), followed by institution 'C' (49,007) and institution 'A' (15,148). The multiple-patient ambulance was the most used mode of transportation (67.7%), followed by vehicles designated for patient transportation (17.6%) and individual ambulances (14.7%). Transports in multiple-patient vehicles and vehicles designated for patient transportation (VDTD) generated a total cost of 13,468,305.7 euros and a direct carbon footprint of 6,950,363 Kg CO2. The efficiency of grouped transports was analyzed, considering the maximum occupancy of 5 patients per vehicle for distances less than or equal to and greater than 100 Km. A total of 108,528 patients were transported, resulting in an overall cost of 13,468,012 euros and a potential savings of 8,326,058 euros. The greatest efficiency was observed with full vehicle occupancy, with zero waste (0%). Non-emergency patient transportation is crucial to ensuring equitable access to healthcare, although it presents high annual costs. The SGTD platform, despite its limitations, optimizes transport management. The integration of advanced technologies, such as Artificial Intelligence, could enhance resource allocation efficiency. A shared regional management model is proposed, starting with a pilot project in Greater Lisbon, along with regulatory review and promotion of preventive health.
ABSTRACT - The democratization of healthcare, combined with demographic changes, has contributed to the increase in expenses in the sector. In Portugal, the NHS ensures patient transportation, promoting equitable access to health services and reducing inequalities. However, the centralization of healthcare services in major urban centers has increased the volume of transportation, costs, and greenhouse gas emissions, impacting public health and the environment. This study aims to assess the direct costs and carbon footprint associated with non-emergency patient transportation, proposing a regional inter-institutional management model that promotes financial and environmental sustainability. The applied methodology combines an observational, descriptive, and retrospective approach, with data collection carried out through the Patient Transportation Management System (SGTD) and relevant legislation. The quantitative analysis of variables was facilitated by the descriptive approach, while the retrospective methodology allowed for the evaluation of 2023 data in the context of patient transportation for hospital outpatient services. In 2023, 127,228 non-emergency patient transports were conducted. Most were carried out by institution 'B' (63,073 transports), followed by institution 'C' (49,007) and institution 'A' (15,148). The multiple-patient ambulance was the most used mode of transportation (67.7%), followed by vehicles designated for patient transportation (17.6%) and individual ambulances (14.7%). Transports in multiple-patient vehicles and vehicles designated for patient transportation (VDTD) generated a total cost of 13,468,305.7 euros and a direct carbon footprint of 6,950,363 Kg CO2. The efficiency of grouped transports was analyzed, considering the maximum occupancy of 5 patients per vehicle for distances less than or equal to and greater than 100 Km. A total of 108,528 patients were transported, resulting in an overall cost of 13,468,012 euros and a potential savings of 8,326,058 euros. The greatest efficiency was observed with full vehicle occupancy, with zero waste (0%). Non-emergency patient transportation is crucial to ensuring equitable access to healthcare, although it presents high annual costs. The SGTD platform, despite its limitations, optimizes transport management. The integration of advanced technologies, such as Artificial Intelligence, could enhance resource allocation efficiency. A shared regional management model is proposed, starting with a pilot project in Greater Lisbon, along with regulatory review and promotion of preventive health.
Descrição
Trabalho Final do Curso de Especialização em Administração Hospitalar
Palavras-chave
Transportes de doentes não urgentes acesso eficiência pegada carbónica sustentabilidade Non-emergency patient transportation access efficiency carbon foot sustainability
Contexto Educativo
Citação
Editora
Universidade Nova de Lisboa. Escola Nacional de Saúde Pública