Abstract
ABSTRACTOBJECTIVE To analyze if the adjusted hospital mortality varies according to source of payment of hospital admissions, legal nature, and financing settlement of hospitals.METHODS Cros-ssectional study with information source in administrative databases. Specific hospital admission reasons were selected considering the volume of hospital admissions and the list of quality indicators proposed by the North-American Agency for Healthcare Research and Quality (AHRQ). Were analyzed 852,864 hospital admissions of adults, occurred in 789 hospitals between 2008 and 2010, in Sao Paulo and Rio Grande do Sul, applying multilevel logistic regression.RESULTS At hospital admission level, showed higher chances of death male patients in more advanced age groups, with comorbidity, who used intensive care unit, and had the Brazilian Unified Health System as source of payment. At the level of hospitals, in those located in the mean of the distribution, the adjusted probability of death in hospital admissions financed by plan or private was 5.0%, against 9.0% when reimbursed by the Brazilian Unified Health System. This probability increased in hospital admissions financed by the Brazilian Unified Health System in hospitals to two standard deviations above the mean, reaching 29.0%.CONCLUSIONS In addition to structural characteristics of the hospitals and the profile of the patients, interventions aimed at improving care should also consider the coverage of the population by health plans, the network shared between beneficiaries of plans and users of the Brazilian Unified Health System, the standard of care to the various sources of payment by hospitals and, most importantly, how these factors influence the clinical performance.
Highlights
The Brazilian health system presents peculiarities related to the way the public-private settlement results in health care
At the level of hospitals, in those located in the mean of the distribution, the adjusted probability of death in hospital admissions financed by plan or private was 5.0%, against 9.0% when reimbursed by the Brazilian Unified Health System
This probability increased in hospital admissions financed by the Brazilian Unified Health System in hospitals to two standard deviations above the mean, reaching 29.0%
Summary
The Brazilian health system presents peculiarities related to the way the public-private settlement results in health care. Hospital care is mainly carried out by private entities, which can simultaneously attended patients funded by the Brazilian Unified Health System (SUS) and by private health plans, producing complex financing settlements and assistance networks that make the regulation of the system difficult. Hospital mortality must be adjusted for the risk of the patients, to enable more reliable comparisons of providers. The variation in hospital mortality can indicate problems in the quality of the care provided by hospitals. In this sense, to measure different explanatory factors involved is crucial in this approach, it is not trivial
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