Public-private relationship in surgical hospitalizations through the Unified Health System

Abstract

Objective: to characterize surgical hospitalizations, length of stay, cost and mortality, according to the legal nature (public and private) of the hospital institution linked to the Unified Health System (Sistema Único de Saúde, SUS). Method: a descriptive study, of the survey type, with retrospective data collection (2008 to 2017) and a quantitative approach. The dependent variables surgical hospitalizations in Brazil, costs, length of stay and mortality and the independent variables regime/legal nature (public and private) were obtained from the Informatics Department of the Unified Health System. The Mann-Whitney test was used for analysis. Results: the average number of hospitalizations through the Unified Health System was 4,214,083 hospitalizations/year, 53.5% occurred in private hired hospitals and 46.5% in public hospitals (p=0.001). The financial transfer was greater for the private sector (60.6%) against 39.4% for the public (p=0.001). The average stay was 4.5 days in the public hospital and 3.1 days in its private counterpart (p<0.001). Mortality was higher in the public (1.8%) than in the private hospital (1.4%) (p<0.001). Conclusion: there was predominance of surgical hospitalizations through the Unified Health System in private hospitals with greater financial transfer to this sector, to the detriment of the public. The diverse evidence produced contributes to the debate and actions to avoid budgetary asphyxiation in the public sector in favor of the private sector.

Comparison of the market share of public and private hospitals under different Medical Alliances: an interrupted time-series analysis in rural China

“…Specifically, the proportion of outpatients in member public hospitals decreased after the reform, whereas in member private hospitals, it was mainly the proportion of inpatients that declined. Previous studies have also shown that the proportion of hospitalizations in public hospitals is generally higher than that of private hospitals, and most of them were complex cases or operations required to treat patients with multiple injuries [ 17 – 19 ]. On the one hand, due to the different functional positioning of inpatient services and outpatient services, it is more difficult to treat diseases that require hospitalization and the level of medical services varies greatly among different medical institutions.…”

Cesarean childbirth: an institutional socio-clinical study of the professional practices and discourses

“…The aforementioned seals, in many services, the decisive factor for changes in the care process and in the degree of interventions performed ( 13 ) . This means that the service management method leads to the quality of care offered to people ( 22 ) . Thus, existence of a risk in this process, which can be, for example, signaled by the logic of the New Public Management, cannot be denied.…”

Implementation of consensus-based perioperative care pathways to reduce clinical variation for elective surgery in an Australian private hospital: a mixed-methods pre–post study protocol

“…8 Data from Australia and the USA demonstrate a high degree of variation in length of stay (LOS), rates of transfer to inpatient rehabilitation following hip and knee arthroplasty, 9 and specific to private hospitals, higher unplanned stay (>2 hours) in recovery after surgery. 8 Considering the increasing number of elective surgeries and associated hospitalisations undertaken in private hospitals in Australia 10 and elsewhere, [11][12][13] reducing unwarranted clinical variation in these settings is critical to generating higher value care, improving patient outcomes, and reducing healthcare expenditure.…”