Abstract
The objective of this study is to review the Healthcare Units (HU) life-cycle cost approaches with an emphasis on the project process, life-cycle cost, actors and measures to save resources. It was a systematic integrative review whose search syntax expressed the poles (phenomenon, population and context) of the question. The Virtual Health Library (VHL) portal was used, which gathers 29 databases, with the time limit from 1977 to 2017 and in Portuguese, English and Spanish. All types of manuscripts and methodologies were included. As gray literature, publications from the Ministry of Health of Brazil about the object were collected and the narrative method was used to synthesize the data. A total of 18 texts were included, all foreign, covering different approaches. Case studies predominate, especially in hospitals, with a description of more efficient systems and intervention strategies. The concept of “life-cycle cost” of the building, although explicit in a few texts (22%), guides decisions and interventions aimed at recovering investment in the operation, despite the fact that many are focused on environmental criteria. It was noticed that the economic context is the major driver of measures aimed at operational rationalization in buildings. Only three Brazilian publications are consistent with the evolution of discussions abroad. It was found that the HU life-cycle approach is still mostly restricted to recovering the initial investment in the operation phase. The discussion in the Brazilian Unified Health System (SUS) is incipient and it is necessary to face problems related to the lack of tools and information to the design and management processes of the structure of this equipment.
Highlights
Unlike the health area, in which the concept of “life-cycle” refers to living organisms and their “life courses”, in civil construction the same term is associated with the various phases related to the life of a building, allowing it to be analyzed them over time, assessing performance and quantifying impacts and costs.In turn, the Life-cycle Cost (LCC) refers to the total cost of ownership over the entire life of an asset
Considering the problem of SUS de-financing in Brazil and the need for better application of available resources in the long term through the qualification of investment in the physical structures of the units, the present study aims to raise the state of knowledge related to the theme, reviewing what the literature has produced in recent decades on approaches to the cost of Healthcare Units (HU) throughout its life cycle
Regarding the means of publication, with the exception of the Spanish text, which was published in a scientific journal, the others come from journals specialized in hospital management or in the real estate sector focused on health
Summary
In which the concept of “life-cycle” refers to living organisms and their “life courses”, in civil construction the same term is associated with the various phases related to the life of a building, allowing it to be analyzed them over time, assessing performance and quantifying impacts and costs. The life-cycle of a building has a strong interaction with the discussion of sustainability, considering the impacts produced throughout its phases, which can be quantified by the methodologies of Life Cycle Assessment (LCA) (Froehlich, 2014; Sampaio, 2005) For this reason, the costs that they mean for health systems in general should be brought to the discussion of HU, especially those that are experiencing moments of disinvestment (Mendes & Carnut, 2019), as in the case of the Unified Health System (SUS) in Brazil. Considering the problem of SUS de-financing in Brazil and the need for better application of available resources in the long term through the qualification of investment in the physical structures of the units, the present study aims to raise the state of knowledge related to the theme, reviewing what the literature has produced in recent decades on approaches to the cost of HU throughout its life cycle
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