The creation of the autonomous social service Instituto Hospital de Base as a new model for public hospital management in the Federal District, Brazil.

Humberto Lucena Pereira Da Fonseca,Luiz Arnaldo Pereira Da Cunha Júnior

doi:10.1590/1413-81232018246.08502019

Abstract

The public health network of the Federal District, as in the rest of the Brazilian Unified Health System, suffers from inefficiencies related to the difficulty in hiring and managing professionals, as well as the implementation of supply and maintenance contracts. In Brasilia, a new management model was implemented in 2018 in its largest hospital. With the creation of the autonomous social service "Instituto Hospital de Base", a health unit in operation since 1960, the possibility of providing agility to these contracts was opened, in addition to establishing a management based on goals and outcome indicators, with expressive efficiency gains. This article reports the steps for the implementation of this decentralized model of hospital management, the alternatives considered, the difficulties faced and some of the first results of this new model. One can already verify and affirm the success of the legal-administrative model of "Instituto Hospital de Base", which can serve as a paradigm for other health units in the Federal District and in Brazil.

Highlights

In the current underfunding scenario of the Brazilian Unified Health System (Sistema Único de Saúde - SUS) and bureaucratic obstacles arising from an outdated and anachronistic legislation, the State Health Secretariat of the Federal District (SHS-DF), as well as the public health management throughout Brazil and at all federative levels, has been facing many difficulties over time regarding the provision of health care services
Management model alternatives for the implementation of public health care policies Given the wide-ranging and different types of difficulties, the SHS-DF started looking for legal-administrative models and arrangements capable of providing greater autonomy and flexibility to the HBDF, which would have a positive impact on results, quality and productivity
The population’s aging, the change in the epidemiological profile, the increase in chronic-degenerative diseases, and economic recession - leading people to lose their jobs, corporate health plans or the ability to pay for private public health – result in the increased demand for public health care, while the health system is receiving fewer and fewer resources to cover its expenditures

Summary

Introduction

In the current underfunding scenario of the Brazilian Unified Health System (Sistema Único de Saúde - SUS) and bureaucratic obstacles arising from an outdated and anachronistic legislation, the State Health Secretariat of the Federal District (SHS-DF), as well as the public health management throughout Brazil and at all federative levels, has been facing many difficulties over time regarding the provision of health care services This difficulty is mainly based on the supply and management of resources, that is, on the supply of medical and hospital materials, on the provision of support services, including maintenance of medical and hospital equipment, and, on the supply, motivation and management of people, a picture that is greatly aggravated by the economic-fiscal-budgetary situation that the country has experienced since 2015. In addition to health care activities, the HBDF, in the area of education and research, in April

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Findings

Conclusion