12,216 research outputs found
Antenatal care within Brazil’s Unified Health System
Objetivo
Analisar o atendimento ao pré-natal em unidades de saúde, com o intuito de obter uma
linha de base que subsidie futuros estudos avaliativos.
Métodos
Realizou-se estudo exploratório para avaliação da atenção do Sistema Único de Saúde
à saúde de mulheres grávidas, por meio de inquérito auto-aplicado em gestores
municipais de saúde sobre amostra probabilística do tipo aleatória estratificada de 627
municípios que, submetida à técnica de expansão, permitiu análises para 5.507
municípios. O período de coleta de dados foi de outubro de 2003 a abril de 2004. O
questionário captou informações sobre a prioridade às distintas modalidades de atenção,
além de dados sobre a oferta de atenção e estimativa declarada de atendimento de
demanda. Foram realizados os testes de qui-quadrado e t de Student para verificação
de independência entre variáveis qualitativas e a igualdade entre médias,
respectivamente.
Resultados
Dos municípios analisados, 43,8% (n=2.317) não atendiam ao risco gestacional; 81%
(n=4.277) e 30,1% (n=1.592) referiram atender acima de 75% da demanda do prénatal
de baixo e alto risco, respectivamente; 30,1% (n=1.592) atendiam acima de 75%
da demanda de alto risco. Atenção ao baixo risco (χ2=282,080; P<0,001 n=4.277) e
ao alto risco (χ2=267,924; P<0,001 n=5.280) estiveram associadas à região geográfica,
tamanho do município e modalidade de gestão no Sistema Único de Saúde. A garantia
de vaga para o parto também esteve associada à modalidade de gestão.
Conclusões
Houve lacunas relacionadas à oferta e qualidade da atenção ao pré-natal no Sistema
Único de Saúde. A municipalização amplia a oferta de pré-natal, mas há desigualdades
entre regiões e entre municípios de diferentes dimensões populacionais.Objective
To assess antenatal care in health care units, so as to obtain a baseline for future
evaluation studies.
Methods
A self-applied inquiry was conducted among municipal health managers within a probabilistic stratified random sample of 627 municipalities which, through expansion
technique, extended the analysis to 5,507 municipalities. Data was collected from
October 2003 to April 2004. The survey appraised information about the priority
granted by the managers to each modality of care, as well as data concerning
characteristics of the assistance provided and the declared estimate of the demand
being covered. The Chi-square test and Student’s t-test were performed in order to
verify independence among the qualitative variables and mean differences, respectively.
Results
Almost half (43.8%; n=2,317) of the municipalities did not attend gestational risk;
81% (n=4,277) and 30.1% (n=1,592) reported that they attend over 75% of the
demand for low and high risk antenatal respectively; 30.1% (n=1,592) attend over
75% of the demand for high risk care. Care for low risk (c2=282,080; P<0.001
n=4,277) and for high risk pregnancies (c2=267.924; P<0.001 n=5,280) were
associated to geographic region, municipality’s size and management modality within
the Unified Health System. The guarantee of vacancy for labour and birth was also
associated to management modality.
Conclusions
There were gaps related to the provision and the quality of antenatal care within the
Unified Health System. Municipal based health care extends the provision of antenatal
care, but there are inequalities among regions and among municipalities according
to demographic size
Cost of heart failure in the Unified Health System
OBJECTIVE: To describe the direct and indirect costs of ambulatory and in-patient treatments of heart failure during 2002, in the University Hospital Antônio Pedro, Niterói. METHODS: A cross-sectional and retrospective study on utilization and valuation of resources in 70 patients, consecutively selected, under ambulatory and in-patient treatment. Questionnaires and records of the patients were used for data collection. The resources used were valuated in Brazilian Reais (2002). The study's point of view was the perspective from society. The data were analyzed in the EPINFO program, 2002 version. RESULTS: The studied population consisted of 70 patients (39 women), with average age of 60.3 years old. 465 in-patients days (28.5% of the patients) took place. There were 386 ward hospitalizations and 79 in ICUs. The cost with ambulatory appointments was R 83,430.00 (R 4,033.62. The cost with complementary examinations totaled R 557.28/patient/year). Twenty patients retired due to heart failure, which represented a loss in productivity of R 444,445.20. Hospitalization represented 39.7% and the use of medications 38.3% from direct costs. CONCLUSION: The hospitalization cost and the expenses with medications represented the main components of direct costs. Indirect costs represented economic impacts similar to direct costs.OBJETIVO: Descrever custo direto e indireto do tratamento ambulatorial e hospitalar da insuficiência cardíaca, durante 2002, no Hospital Universitário Antônio Pedro, Niterói. MÉTODOS: Estudo transversal, retrospectivo sobre utilização e valoração de recursos em 70 pacientes, selecionados de forma consecutiva, em tratamento ambulatorial e hospitalar. Foram utilizados questionários e prontuários dos pacientes para coleta dos dados. Os recursos utilizados foram valorados em reais (ano 2002). O ponto de vista do estudo foi a perspectiva da sociedade. Os dados foram analisados no programa EPINFO, versão 2002. RESULTADOS: A população estudada constou de 70 pacientes (39 mulheres), idade média de 60,3 anos. Ocorreram 465 diárias hospitalares (28,5% dos pacientes). Houve 386 internações em enfermaria e 79 em unidade de tratamento intensivo. O custo com consulta ambulatorial foi de R 83.430,00 (custo por paciente/ano de R 4.033,62. O custo com exames complementares totalizou R 557,28). Foram aposentados pela insuficiência cardíaca 20 pacientes, representando perda de produtividade de R 444.445,20. Hospitalização representou 39,7% e a utilização de medicamentos 38,3% do custo direto. CONCLUSÃO: O custo com hospitalização e os gastos com medicamentos representaram os principais componentes do custo direto. Os custos indiretos representaram impactos econômicos semelhantes aos custos diretos.Escola Paulista de MedicinaUniversidade Federal FluminenseUNIFESP, EPMSciEL
The challenge of managing medical equipment in the Unified Health System
O estudo analisou as políticas de gestão de equipamentos médico-hospitalares ado¬tadas pelo Ministério da Saúde para o Sistema Único de Saúde. Realizou-se uma análise docu¬mental das publicações do Ministério da Saúde e uma análise de dados do Cadastro Nacional de Estabelecimentos de Saúde, no período de 2005 a 2013. O País instituiu uma Política de Gestão de Tecnologias em Saúde e uma área para a gestão dos equipamentos da Hemorrede. A oferta de equipamentos na rede privada é superior à pública, reforçando a necessidade da gestão e monitoramento de tecnologias para garantir o acesso aos usuários da rede pública e diminuir a dependência do Sistema Único de Saúde.The study analyzed the medical equipment management policies adopted by the Ministry of Health for the Unified Health System. We conducted a document analysis of the publications of the Ministry of Health and a data analysis of the National Registry of Health Facilities, in period from 2005 to 2013. The country established a Technology Management Policy on Health and an area for the management of Hemorrede equipment. The supply of equipment to the private network is superior to the public one, highlighting the need for management and monitoring technologies to ensure access to users in the public area and reduce the dependence of the Unified Health System
Health and Democracy in Brazil: Public Value and Institutional Capital in the Unified Health System
Objectives: This paper looks at the Unified Health System in Brazil, evaluating the progress and contradictions that arise in the differential dynamics of each of the processes that compose it
The Brazilian Unified Health System: Thirty Years of Advances and Resistance
In 1988, in the context of the re-democratization of Brazil after an authoritarian period, a new Federal Constitution promoted an institutional rupture in the hitherto valid frameworks of health policy, whose origin and expansion until then had been prioritized by the means of insurance restricted to workers inserted in the formal labor market. The constitution has defined principles and guidelines for a reform informed by a publicist perspective and by a conception of health as the right of everyone and the duty of the state, with the corollary of universalization and equality. For this, the unique health system was created. The chapter aims to describe the construction and evolution of the universal health system of Brazil and its results and perspectives. The construction of the universal system from a segmentation legacy, considering the argument that the previous policies defined constraints for the subsequent institutional development, is portrayed. After that, the evolution of the health system and its results and political, financial, and institutional difficulties, also considering the institutional characteristics derived from Brazilian federative institutions, has been discussed. Finally, the country’s current political scenario is presented, which points to a new cycle of social policies, including health policy, in the sense of restricting spending and rights
Cost estimate of hospital stays for premature newborns in a public tertiary hospital in Brazil
OBJECTIVES: To estimate the direct costs of hospital stays for premature newborns in the Interlagos Hospital and Maternity Center in São Paulo, Brazil and to assess the difference between the amount reimbursed to the hospital by the Unified Health System and the real cost of care for each premature newborn. METHODS: A cost-estimate study in which hospital and professional costs were estimated for premature infants born at 22 to 36 weeks gestation during the calendar year of 2004 and surviving beyond one hour of age. Direct costs included hospital services, professional care, diagnoses and therapy, orthotics, prosthetics, special materials, and blood products. Costs were estimated using tables published by the Unified Health System and the Brasindice as well as the list of medical procedures provided by the Brazilian Classification of Medical Procedures. RESULTS: The average direct cost of care for initial hospitalization of a premature newborn in 2004 was 227,000 and 22,440 and 115 USD, and the daily average cost of a premature newborn weighing more than 2,500 g was $89 USD. Amounts reimbursed to the hospital by the Unified Health System corresponded to only 27.42% of the real cost of care. CONCLUSIONS: The cost of hospital stays for premature newborns was much greater than the amount reimbursed to the hospital by the Unified Health System. The highest costs corresponded to newborns with lower birth weight. Hospital costs progressively and discretely decreased as the newborns' weight increased.Universidade Federal de São Paulo (UNIFESP) Centro Paulista de Economia da SaúdeUniversidade Federal de São Paulo (UNIFESP) Brazilian Cochrane CenterUNIFESP, Centro Paulista de Economia da SaúdeUNIFESP, Brazilian Cochrane CenterSciEL
Impact analysis of drug-eluting stent in the unified health system budget
BACKGROUND: Drug-eluting stents represent an additional option to treat coronary artery disease. This technology represents a major breakthrough that may require additional funding in the short-term to enable its inclusion in procedures of the Unified Health System. OBJECTIVE: To estimate the impact on the Unified Health System budget in the first year of use of drug-eluting stents. METHODS: A Budget Impact Model was designed to predict the economic impact of the inclusion of drug-eluting stents in the Unified Health System budget. Data about costs and local procedures were collected in multiple sources, specifically procedure volume data, hospital costs, cost of stents, drug costs and number of stents used in single and multi-vessel procedures. RESULTS: The results in the first year indicate that the impact on the Unified Health System is of 12.8% in the best scenario and 24.4% in the worst scenario, representing an increase by R 24 milhões a R$ 44 milhões no orçamento total projetado. CONCLUSÃO: O uso de stent farmacológico tem custo adicional comparativamente ao uso de stent convencional, no primeiro ano de utilização, no Sistema Único de Saúde.Universidade Federal de São Paulo (UNIFESP) EPMUNIFESP, EPMSciEL
Health self-assessment by hemodialysis patients in the Brazilian Unified Health System
Unified health system 30th birthday : health surveillance
Este artigo apresenta uma visão geral sobre a natureza, as funções e a trajetória da vigilância sanitária na conformação do SUS. Recorreu-se a fontes bibliográficas e a documentos oficiais, cuja discussão foi enriquecida com referências oriundas da trajetória dos autores, bastante vinculada a esta área. Verdadeiras tragédias ocorridas nos anos 1990 evidenciaram a fragilidade da vigilância sanitária e trouxeram graves problemas ao SUS. A criação da Anvisa e do SNVS e o apoio aos órgãos estaduais e municipais proporcionaram melhoria na estrutura e funcionamento do sistema e também para o reconhecimento da área enquanto tema emergente na pesquisa e no ensino em Saúde Coletiva. Diversos problemas ainda dificultam a efetiva estruturação do SNVS. Postula-se mudança da concepção de promoção da saúde, com responsabilização social das grandes corporações, cujas atividades têm fortes conexões com fatores de risco relacionados à atual epidemia de doenças crônicas, e refere-se um elenco de desafios para melhor estruturação da vigilância sanitária no SUS.This article presents an overview of the nature, functions and history of health surveillance in the structure of the Brazilian Unified Health System (SUS). Bibliographical sources and official documents were used, with references from the careers of the authors, who have worked in health surveillance. Extremely serious adverse events in the mid-1990s gave political visibility to the fragility of Brazilian health surveillance, and were reflected in serious problems for the SUS. The creation of Anvisa and the SNVS surveillance system, and the support for bodies in individual states and municipalities, resulted in improvement in the structure and functioning of health surveillance, and improved recognition of the area as an emerging theme in research and education in public health. Several problems hamper the effective structuring of the SNVS. A change in the conception/design of health promotion is postulated, in which the large corporations, whose activities have strong connections with risk factors related to the current epidemic of chronic diseases, would be given a social responsibility. A set of challenges for better structuring of health surveillance in the SUS is also put forward
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