Propostas à implantação da Gestão de Custos na saúde: a experiência dos Hospitais e Institutos Federais do Rio de Janeiro

Abstract

This study deals with the importance of cost management in the health area, given a scenario of large public health expenditures, budget constraints, questions about the efficiency of resource allocation and the need to improve the quality of services provided to citizens. In response to these issues, the Ministry of Health (MS) created the National Program for Cost Management (PNGC) and the ApuraSUS information system. However, none of the hospitals and federal institutes of RJ, directly subordinate to the MS, effectively joined the PNGC. In this sense, this work aims to propose actions that contribute to the transposition of the difficulties and barriers faced by these institutions in the implementation of the PNCG. In order to reach the objectives, a methodology with a qualitative approach was used, using as an instrument of data collection an exploratory questionnaire applied in the nine institutions, aiming to identify the status of the cost management in each one of them, this, identified the institutions that initiated attempted deployment, but were unsuccessful. In-depth interviews were conducted with a semi-structured script with the institutions that tried to implement the PNGC, in order to identify the practical barriers, based on the literature and concepts raised in the theoretical framework. Subsequently, an open interview was conducted with the NES of Bahia, considered a success case in the implementation of PNGC, in order to understand the experience of this state. Finally, an interview was conducted with DGH / RJ servers, aiming to construct proposals to transpose the identified barriers. As results, barriers related to human resources, management systems, organizational culture, PNGC, organizational structure, high management, political factors and communication plan were identified. For each of the identified barriers, propositions were built for their transposition and progress in the implementation of cost management in federal units.