As Organizações sociais na política de saúde do Estado do Rio de Janeiro: avaliação de cumprimento das metas dos contratos de gestão dos hospitais de alta complexidade

Abstract

This thesis aims to contribute to the management of health policy in the State of Rio de Janeiro, considering the need to improve and expand the literature on the topic, with a focus on the subnational level. The main objective of this research is to analyze the fulfillment of contractual goals and compare them with the budget execution of management contracts of Social Organizations of high-complexity hospitals in the State of Rio de Janeiro, between 2012 and 2023. The methodology applied in this research is based on the construction of service indicators and payment indicators to analyze the behavior of the performance of OSSs in hospital management. To this end, we reviewed official documents of the State of Rio de Janeiro; contracts signed with OSSs; the accountability reports prepared by OSSs; and an analysis of the budget execution of the health sector obtained from SEFAZ/RJ through the Access to Information Law. The discussion of OSSs in the State of Rio de Janeiro is grounded in the Theory of New Public Management, reflecting the Brazilian State Reform of the 1990s and the legislation that underpins the Unified Health System. Overall, we conclude from the research that the State of Rio de Janeiro contractually agreed with social organizations between 2012 and 2023 for a total of R$25.6 billion, through 163 contracts and 341 addenda. Furthermore, a comparative analysis of the service and payment indicators of the Getúlio Vargas, Adão Pereira Nunes, and Azevedo Lima hospitals reveals that, in most cases, the contracted monthly targets were not fully met, resulting in inefficient service delivery. Furthermore, the state government allocated resources in excess of the services provided by the OSSs, resulting in a waste of public resources.