Remuneração dos hospitais da Rede de Urgência e Emergência em Minas Gerais: repasses de recursos públicos e reflexos nos atendimentos para o SUS entre 2008 e 2018

Abstract

The way a health care system pays its service providers directly interferes with its care costs and results. Through manipulation of payment formats, managers can induce the behavior of establishments and professionals in order to change their productivity, quality and service offer. Currently, different remuneration models coexist in health systems without a consensus on the most appropriate or advantageous. In the first years of its effectiveness, the Unified Health System (SUS) reimbursed its providers essentially for the consideration of services. Among other disadvantages, this modality is criticized for encouraging unnecessary assistance, inducing fraudulent production records and increasing system expenses. From the mid-2000s, SUS gradually incorporated new costing modalities for its providers, looking for alternatives that would provide greater qualification and effectiveness in the assistance provided. As the new forms of transfer were superimposed on the existing ones, there are establishments financed in different payment systems. This particularity is more common among hospitals, which are responsible for most of the care provided in medium and high complexity, and which concentrate a significant part of the federal, state and municipal resources that finance SUS. Understanding and improving hospital financing is essential for the balance of the system. Nowadays, about 40% of federal resources transferred to the state of Minas Gerais are intended to fund Health Care Networks (Redes de Atenção à Saúde – RAS), established in 2010 by the Ministry of Health (Ministério da Saúde – MS) as the main strategy for reorganizing assistance and overcoming the logic of payment by production. Aiming to contribute to this discussion, this study aims to evaluate the composition of public resources transferred between 2008 and 2018 to hospitals participating in the Urgency and Emergency Network (Rede de Urgência e Emergência – RUE) of SUS/MG. It is also expected to verify the evolution of the SUS production volume of these establishments considering the inclusion of network incentives in their remuneration. An observational analytical-descriptive study with a quantitative approach will be carried out with hospitals in the RUE, with emphasis on the 20 establishments under management by the Minas Gerais State Department of Health.