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Contratualização em contexto hospitalar
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Resumo(s)
RESUMO - Acompanhando a tendência europeia para atribuir maior
autonomia e responsabilização aos hospitais, incentivando
uma gestão empresarial e a inovação na prestação de cuidados,
o governo português transformou, em finais de
2002, 34 hospitais do Serviço Nacional de Saúde (SNS) em
31 Hospitais Sociedades Anónimas (SA).
Pretende-se, neste artigo, apresentar uma síntese do
modelo de afectação de recursos aos hospitais do SNS, a
partir de 2003.
Em 2003, o modelo apenas foi aplicado na contratação com
os Hospitais SA. Em 2004, a sua implementação estendeu-
-se aos Hospitais do Sector Público Administrativo (SPA),
aquando da elaboração dos respectivos orçamentos financeiros.
Em 2005, os Hospitais SPA foram incluídos no processo
de contratação, sofrendo o contrato as adaptações
impostas pelo seu estatuto legal.
A presente análise baseia-se, fundamentalmente, no trabalho
desenvolvido no Ministério da Saúde (MS), aquando da
criação dos Hospitais SA, cujo estudo foi, para este efeito,
disponibilizado pela Administração Central do Sistema de
Saúde (ACSS).
O modelo descrito terá o enquadramento teórico do estudo
efectuado na altura, completado com a evidência retratada
na literatura existente sobre estas matérias, especialmente
no que respeita ao processo de contratação e às modalidades
de pagamento.
Serão identificados os principais constrangimentos à implementação
do actual modelo de financiamento hospitalar,
que não são específicos do nosso país, dando destaque aos
que se considera que deverão ser objecto de maior investimento,
para se garantir uma distribuição de recursos mais
equitativa, melhorar a acessibilidade, a qualidade na prestação
de cuidados e a eficiência dos prestadores de cuidados.
ABSTRACT - Following the European’s trend to attribute more autonomy and responsibility to hospitals, incentivizing the increase of enterprise management and innovation, at the end of 2002 the Portuguese government transformed 33 National Health Service (NHS) hospitals into public enterprises. With the present paper we intend to carry out a synthesis of the new financing resource allocation model, implemented in 2003 and applied only to the hospitals transformed into public enterprises. In 2004 this model was enlarged to the Public Administrative Sector’s (SPA) hospitals, to calculate the financial budgets for the next year. In 2005 the purchasing mechanism was applied also to the SPA hospitals, with the consequent contract adjustment. The present analysis is based, mainly, on the work developed by the Portuguese Health Ministry, when enterprise hospitals were created, work that was made available for this purpose by the Administração Central do Sistema de Saúde (ACSS – Health System Central Administration). The description of the resource allocation model will comprise the theoretical framework developed in the study that has preceded its implementation, supported by the evidence found in the existing bibliography on this matters, namely as far as the purchasing mechanism and the payment modalities are concerned. The main and internationally recognized constraints to a resource allocation model implementation will be identified emphasizing the ones that should be object of further debate and analysis in order to guaranty a more equitable resource allocation, enhance accessibility, improve the quality of healthcare delivered as well as hospitals efficiency.
ABSTRACT - Following the European’s trend to attribute more autonomy and responsibility to hospitals, incentivizing the increase of enterprise management and innovation, at the end of 2002 the Portuguese government transformed 33 National Health Service (NHS) hospitals into public enterprises. With the present paper we intend to carry out a synthesis of the new financing resource allocation model, implemented in 2003 and applied only to the hospitals transformed into public enterprises. In 2004 this model was enlarged to the Public Administrative Sector’s (SPA) hospitals, to calculate the financial budgets for the next year. In 2005 the purchasing mechanism was applied also to the SPA hospitals, with the consequent contract adjustment. The present analysis is based, mainly, on the work developed by the Portuguese Health Ministry, when enterprise hospitals were created, work that was made available for this purpose by the Administração Central do Sistema de Saúde (ACSS – Health System Central Administration). The description of the resource allocation model will comprise the theoretical framework developed in the study that has preceded its implementation, supported by the evidence found in the existing bibliography on this matters, namely as far as the purchasing mechanism and the payment modalities are concerned. The main and internationally recognized constraints to a resource allocation model implementation will be identified emphasizing the ones that should be object of further debate and analysis in order to guaranty a more equitable resource allocation, enhance accessibility, improve the quality of healthcare delivered as well as hospitals efficiency.
Descrição
Palavras-chave
contrato contratualização convergência custos eficiência empreendedorismo financiamento incentivos objectivos outputs pagador prestadores produção planeamento e qualidade contract purchasing convergence costs efficiency entrepreneurship financing incentives objectives outputs payer provider production planning and quality
Contexto Educativo
Citação
Valente, Maria do Céu - Contratualização em contexto hospitalar = The Portuguese hospitals purchaser-provider model. Revista Portuguesa de Saúde Pública. ISSN 0870-9025. Volume temático, Nº 9 (2010), p. 25-39
Editora
Universidade Nova de Lisboa, Escola Nacional de Saúde Pública