Abstract
Since its creation in 1988, major changes have been made to Brazil's public health system in response to the epidemiological transition and the country's changing economic context and demographics. This article describes the recent healthcare reform implemented in the federal district's public hospital system. Guided by evidence-based management and a series of regulatory instruments, the reform organized hospital emergency services and secondary outpatient care, regulated health services, and remodeled the organizational structure of the Department of Health. These changes were aimed at promoting integration between health professionals across different levels of care and ensuring the provision of continuing comprehensive care. This approach guarantees efficiency gains in patient treatment, since multifocal and focal professionals work in an integrated manner. By reorganizing work processes and ensuring adequate planning, it was possible to redesign the care model to promote knowledge management and improve access to information and interactivity, thus helping to ensure the provision of quality, value-added care.
Highlights
Brazil’s public health system was inspired by Britain’s National Health Service founded in 1948 to provide a comprehensive free service available to all
According to the National Hospital Care Policy (PNHOSP, acronym in Portuguese), hospitals are care facilities equipped with specific technology that provide in-patient continuing care with a strong multidisciplinary and interdisciplinary focus[17]
Emergency care in Brazil has been historically characterized by work processes directly linked to epidemiological profiles in a society where the demand for health services has been marked by one-off events such as infectious disease and strongly focused on outpatient services
Summary
Brazil’s public health system was inspired by Britain’s National Health Service founded in 1948 to provide a comprehensive free service available to all. The evolution of Brazil’s national health system (Sistema Único de Saúde – SUS) and the country’s changing economic context and demographics has led to a shift in the use profile of the system from a state-funded and employer-sponsored model to universal health coverage[2]. It was under this aegis that the Federal District Hospital Foundation was created, triggering the fragmentation of primary healthcare centers and strengthening the hospital care system[2]. In this healthcare model, centered on focal points of delivery with little or no integration with the rest of the system and primary care services, the fee-for-service approach to payment of services gained robustness and solidity
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