Tendências e obstáculos na gestão e organização da rede hospitalar do SUS no contexto da experiência internacional

Abstract

This work proposes the adoption of new criteria in the organization and management of SUS hospital care, which, given the heterogeneity of both quantitative and qualitative provision, has not allowed the necessary integration with primary care and other levels on a national level. of care, thus violating the principles of universality, equity, and comprehensiveness provided for in our National Health Policy. These problems are systematically addressed in the light of national and international experiences, considering important aspects of the management of modern hospitals, such as financing based on care goals, administrative autonomy within well-established standards in management contracts, remuneration of professionals consistent with their responsibilities and performance, technological incorporation in compliance with the need for services based on population criteria, quality, and patient safety programs, among others, which the public administration must lead, as they are inalienable roles of the State. It is an exploratory, narrative review research, which aims to describe the development of the subject in a concise and non-systematic way, providing a quick update on the topic. It aims to analyze institutionalization and forms of public-private collaboration that, combined with regionalization, help consolidate sustainable SUS hospital care, considering national and international experience. The main assumptions of this study are that a set of State actions – which include the institutionalization of public hospitals, the establishment of public-private partnerships, the implementation of hospital care networks, and integration with other levels of care, taken concomitantly – could contribute to consolidating the SUS as a universal health system. After a long process of political and social discussion marked by ideological divergences over 34 years of consecration of the SUS, there seem to be objective conditions for this to occur, although with some effort, due to the paths taken, marked by political-ideological discussions and financial difficulties meaning that the critical conditions for achieving this result were postponed.