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A avaliação do desempenho de hospitais
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RESUMO - Este artigo questiona o modelo tradicional de hospital
público existente até 2002 no que respeita aos atributos de
economia, eficácia, eficiência, equidade e qualidade e testa
a hipótese de saber se os modelos inovadores de gestão
poderiam melhorar o desempenho dos hospitais em alguns
ou em todos aqueles atributos.
Com esse objectivo foi comparado o desempenho de três
hospitais com diferentes modelos jurídicos: o Hospital de
S. Teotónio (HST), em Viseu, o Hospital Fernando da Fonseca
(HFF), na Amadora, e o Hospital de S. Sebastião
(HSS), em Santa Maria da Feira.
O HST integrou, até finais de 2002, um grupo numeroso de
hospitais públicos que utilizavam o modelo de instituto
público, baseado no direito público e, em particular, no
direito administrativo.
O HFF, cujo modelo jurídico foi adoptado em 1994, representa
o caso singular de abandono de uma concepção de
responsabilidade exclusiva do Estado na prestação de serviços
públicos. O hospital é dirigido, desde o início de 1996,
por uma empresa privada, por delegação do Estado, que
lhe transferiu as operações de gestão e de manutenção
desse serviço público.
O HSS, finalmente, corporizava o modelo de «empresarialização
» de hospitais iniciado em 1998, como forma mínima
de privatização, que não subtrai do Estado a responsabilidade
da prestação do serviço público, mas submete-o a
regras essencialmente privadas.
Apesar de algumas limitações metodológicas, é legítimo
afirmar que se confirmou a tese que se pretendia demonstrar:
o modelo tradicional de hospital público não satisfaz
o paradigma de serviço público no que respeita aos objectivos
de economia, eficiência, equidade e qualidade e os
modelos inovadores permitem melhorar o desempenho em
alguns daqueles atributos.
É legítimo ainda afirmar que um dos modelos inovadores
— o da gestão «empresarializada» do Hospital de S. Sebastião
— apresenta globalmente melhores resultados do que
o outro modelo inovador — o da concessão de gestão do
Hospital Fernando da Fonseca.
ABSTRACT - This article questions the traditional model of public hospital, in Portugal, until 2002, through attributes such as cost control, effectiveness, efficiency, equity and quality, to test the hypothesis of the influence of the recent innovative managerial models in hospital performance. The performance of three hospitals with different models was assessed and compared: Hospital de S. Teotónio (HST), in Viseu, Hospital Fernando da Fonseca (HFF), in Amadora, and Hospital de S. Sebastião (HSS), in Santa Maria da Feira. Until the end of 2002, HST was a part of a large number of public hospitals, following the public agency model, based on public and administrative law. The private concession model was tried in 1994 in one hospital (HFF). It represents the very single case of abandonment of state exclusive responsibility for the public provision of health services. The hospital is run, since 1996, by a private company, through a management contract, assuming all managerial and operational public service duties. Finally, HSS adopted a full «public entrepreneurial» model of hospital since 1998. A minimal form of privatization was adopted, the state still handling the responsibility for providing public services, under private rules. In spite of minor methodological setbacks, it’s reasonable to accept that the traditional model of public hospital had generated increasing public service dissatisfaction as well as dubious achievements of its key objectives: cost control, effectiveness, efficiency, equity and quality. It was shown that innovative models enable to improve hospital performance in most of these attributes. It is also reasonable to conclude that one of the two innovative models — the one of «entrepreneurial» management of Hospital de S. Sebastião — shows better results than the more privatised one — the management concession contract in Hospital Fernando da Fonseca.
ABSTRACT - This article questions the traditional model of public hospital, in Portugal, until 2002, through attributes such as cost control, effectiveness, efficiency, equity and quality, to test the hypothesis of the influence of the recent innovative managerial models in hospital performance. The performance of three hospitals with different models was assessed and compared: Hospital de S. Teotónio (HST), in Viseu, Hospital Fernando da Fonseca (HFF), in Amadora, and Hospital de S. Sebastião (HSS), in Santa Maria da Feira. Until the end of 2002, HST was a part of a large number of public hospitals, following the public agency model, based on public and administrative law. The private concession model was tried in 1994 in one hospital (HFF). It represents the very single case of abandonment of state exclusive responsibility for the public provision of health services. The hospital is run, since 1996, by a private company, through a management contract, assuming all managerial and operational public service duties. Finally, HSS adopted a full «public entrepreneurial» model of hospital since 1998. A minimal form of privatization was adopted, the state still handling the responsibility for providing public services, under private rules. In spite of minor methodological setbacks, it’s reasonable to accept that the traditional model of public hospital had generated increasing public service dissatisfaction as well as dubious achievements of its key objectives: cost control, effectiveness, efficiency, equity and quality. It was shown that innovative models enable to improve hospital performance in most of these attributes. It is also reasonable to conclude that one of the two innovative models — the one of «entrepreneurial» management of Hospital de S. Sebastião — shows better results than the more privatised one — the management concession contract in Hospital Fernando da Fonseca.
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Contexto Educativo
Citação
Simões, Jorge - A avaliação do desempenho de hospitais = Hospital performance evaluation. Revista Portuguesa de Saúde Pública. ISSN 0870-9025. Volume temático, Nº 4 (2004), p. 91-120
Editora
Universidade Nova de Lisboa, Escola Nacional de Saúde Pública