A influência das políticas de saúde nos indicadores gerados pelo sistema de informações hospitalares do SUS

Abstract

The use of information and indicators derived from the Hospital Information System (SIH/SUS) of the National Health System in Brazil (SUS) is steadily increasing, either for health situation analysis as for performance analysis. Since its original conception, this system is strongly influenced by public policies in health assistance, as defined by legislation or by incentives and restriction to some medical and hospital practices. Changes in system operation also bring up discontinuities and biases in the information, eventually resulting in imprecision or even distortions in the indicators derived from the system data. In order to evaluate health policies, health assistance situation and population health status, a clear and objective approach is needed, Knowing which information is available, its evolution and how to use it, considering internal and external influences. This study aims to describe and analyze how the SUS health policies influence and are reflected in the information and indicators derived from the SIH/SUS. It is structured according its context. As Social Security component, we study the creation of the Social Security Medical and Hospital Assistance System (SAMHPS), its origins and structure and also its extension to the philanthropic and university hospitals, with its corresponding expansion of coverage. In the context of the National Health system, we have studied the transformation of the SAMPHS into SIH/SUS, its expansion to the public hospital and universal coverage. The influence of health policies is analyzed from the implementation of incentives and restrictions that affected hospital assistance and how if reflects in the SIH/SUS information. Due to their importance in the analysis and determination of health policies, the hospital categorization and identification are also examined. Furthermore, we analyzed how the diagnostic information is captured, considering the adoption of the 10th Revision of the International Classification of Diseases (ICD-10), the specific case of the external causes and the implementation of the Compatibility Table between Procedures and Diagnostics. We have studied the legislation concerning both SUS and SIH/SUS: laws, decrees, operational norms, directives, instructions and manuals, in order to identify SUS operational and political changes, hospital assistance and SIH/SUS regulation. The relationship between information and politics is analyzes identifying the implementation of these policies and verifying the effects in the hospital assistance indicators from the SIH/SUS. Concluding, we have seen that the series analysis must take in account the political and operational changes, either SUS as SIH/SUS, in order to produce more precise conclusions. Time series discontinuities effectively reflect the political and operational changes. The access, availability, opportunity and quick update of the SIH/SUS information are positive factors; they make possible to analyze the effects of some action just after its implementation. Analyzes of the diagnostic information shows the necessity of training in the use of the ICD-10 and also a full revision in the Compatibility Table between Diagnostics and Procedures.