Publications IPH Magazine IPH Magazine 13th: Annals The Future of Hospital System - The Sustainability Challenge of Small Hospitals
- Editorial - 13th
- HEALTH MANAGEMENT: Efficiency, Innovation and Sustainability
- Health Management Focused on Efficiency, Innovation and Sustainability!
- CONGRESS FOR COST AND FINANCIAL MANAGEMENT
- Hospitals, networks and sustainability
- Cost Reduction through Process Review
- Integrating Business Management to the Assistance Management
- International experience on the compensation models
- The Future of Hospital System - The Sustainability Challenge of Small Hospitals
- Advances in Patient Safety: Indicators and Impact on Cost Assistance
- Prospects for Public Private Partnerships and the Partnership Arrangements with Health Social - Critical Analysis of the PPP Brazilian Experiences in Health
- ENGINEERING, ARCHITECTURE AND LOGISTICS CONGRESS
- Hospital Logistics: Intelligence at Service for the Health Manager
- PEOPLE MANAGEMENT AND LEADERSHIP CONGRESS
- Illusionist Performance: Transformation and Innovation in Tough Times
- Implementation Careers & Salaries: New Paradigms and Opportunities
- The Art of Leading Generations X, Y and Z - How to retain talent?
- Giving Back Over the Organizational Climate - Talent Retention Strategies
- Creative Practices to Innovate in HR
- HEALTH MANAGMENT CONGRESS
- Efficiency
- Efficiency (2)
- The Process of Change in Bolivia "Hospital Arco Iris" from Solid Hospital to Liquid Hospital
- PATIENT'S QUALITY AND SAFETY CONGRESS
- Impact of External Assessment in Brazil
- Impact of External Assessment in Brazil (2)
- Quality and impact of patient safety in the hospital financial result - Santa Casa de Misericordia de Maceió
- Quality and Safety Integration on Education Process
- Management
- The Apthapi as Innovation Strategy in the Humanization of Healthcare Hospitality
- The experience of the State Hospital Sumaré / Unicamp in management by care
- HOSPITAL HOTEL CONGRESS
- Hospitality in Patient Perspective
- Hospitality at the Service of Humanization
- Hospitality and Humanization
- Hospitals Infrastructure Trends aimed at Physical and Mental Comfort for Patients and Families
- The Multidisciplinary Integration of Beds Management as a Way to Seek Effectiveness
- Spirituality in Hospitals Focusing on Healthcare Hospitality
The Future of Hospital System - The Sustainability Challenge of Small Hospitals
Paulo Carrara de Castro
In recent years, studies published in several journals deal with issues that, at present, may be strategic for the future of Brazilian public system: the demographic process in progress, the current epidemiological situation, the health care network built and the services it offers.
About the first, the 2010 census showed some results that indicate significant changes in demographic trends in Brazil. The crude birth rate has been falling sharply, reaching in 2013 an estimated 13.82 / 1000 inhabitants, a level deemed to European standard. An indicator very sensitive and important aspect of this is the fertility rate from 2000 to 2013 decreased by 31.4%, which now means 1.64 children per woman in reproductive age. Other key information in this chapter refers to life expectancy at birth, which had 70.43 years in 2000 and in 2013, 74.23 years, an increase of 5.4%.
From an epidemiological point of view, it is increasingly evident that chronic diseases are in the leading causes of death. In the mid-60s of the twentieth century there was an inversion in the curve of the proportion of deaths due to specific causes, with cardiovascular disease taking the lead in place of infectious and parasitic diseases. In the 80s, cancer, respiratory diseases and external causes also exceed the proportion of deaths corresponding to infectious and parasitic diseases. Since then, this scenario is accentuated because, currently, diseases of the circulatory, respiratory, digestive and tumors, added to external causes account for more than 60% of deaths volume nearly 15 times greater than that posed by infectious and parasitic diseases. There has also been a sharp decline in the volume of admissions in the last 16 years, with a decrease of about 17% in the proportion of admissions, being 5.57% of the amount in 2012. This information deserves a deepening in its analysis as that numerous factors contribute to this decline, with yet another set of circumstances that determine the existence of waiting lists for surgery or other clinical requirements, setting up paradoxical frame.
On the other hand, when analyzing the hospitals built in the country, their occupation has a significant idle capacity that reaches almost half the hospital beds in the country. In some states the occupancy rate does not reach 45% of beds. This fact undoubtedly also forces to deepen the reasons underlying this scenario, but we can, with some confidence, discuss some aspects that have contributed and still contribute to this scenario. The fall in the birth rate, as well as improving nutritional conditions and technology for coping childhood diseases influenced the decrease in demand for admissions both in the field of obstetrics, pediatrics. Similarly, technical advances in surgery allowed a sharp contraction in the average time spent in a huge number of procedures in the area. Nevertheless, Brazilian hospitals in general still have the same traditional pattern of supplying services and their correspondence on beds in the basic specialties, which implies underutilization presented in the table mentioned in this article.
Hospital indicators by hospital size
Source: SIH-SUS
After analyzing this idleness from another angle, classifying hospitals by size, it is observed that the smaller hospitals, which make up most of the country units, have the lowest rates of occupation, as shown in Table 4. The occupancy rates increase to the extent that the hospital size also grows in size.
Also adds to this picture the financing condition for the services that are provided by the network, how they occur, the corresponding efficiency and quality.
This context necessarily requires a reflection on the role of hospitals in national set, defining new doctrinal basis for the provision of hospital services and the provision of health services in inpatient settings, and even resetting the vocation of hospitals for services to that better meet the health needs of the population.
Paulo Carrara de Castro
GRADUATION: Faculty of Medicine, University of Mogi das Cruzes, graduated in 1979. GRADUATE: Medical Residence in Public Health by the Public Health Department, Faculty of Medical Sciences of Santa Casa de São Paulo, completed in 1981.
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