O absenteísmo como fator de desperdício em consultas e exames especializados na região de saúde metropolitana do Espírito Santo
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Data
2019-06-28
Autores
Beltrame, Sonia Maria
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Universidade Federal do Espírito Santo
Resumo
Providing comprehensive healthcare is one of the challenges for the Brazilian Unified Health System (SUS). Despite the efforts to ensure access to healthcare, absenteeism in medical consultations and specialized exams is a reality in the SUS. The aim of this study was to analyse absenteeism as a factor of waste in medical consultations and specialized exams in the Metropolitan Health Region of Espirito Santo (RSMES) from 2014 to 2016. This quantitative research analyzed secondary databases provided by the Regulatory System of Espirito Santo (SISREG-ES). Selected variables were: year, scheduled procedure, confirmed procedure, unconfirmed procedure, specialized consultation, specialized exams and executing service. Procedures were initially divided into consultations and exams, and posteriorly according to year and executing service. For consultations, the Brazilian Classification of Occupations (CBO) was used to define medical specialties and others. After that, consultations and exams were coded based on the Unified Table of Procedures (SUS Table). Exams were grouped according to their classification in the SUS Table. To achieve the objectives, procedures were split by executing service and management modality, which can be public owned (direct administration) and private services, public owned services managed by health social organizations (OSS) or philanthropists (indirect administration). Monetary values were obtained from the SUS table, a complementary table of contracts and a table of estimated costs, updated for the year of 2018, according to the type of service provider. Data were treated individually for all 38 executing health services using Microsoft Excel 2010. Rates of absenteeism were calculated by dividing the total amount of unconfirmed procedures (absenteeism) (numerator) by the total amount of scheduled procedures for each specialty, multiplied by 100. Estimates of wasted monetary values were obtained by multiplying the total amount of unconfirmed procedures (absenteeism), annually, according to specialty by the attributed values for each procedures according the the administrative nature of the executing site. A total 1,002,719 procedures were analyzed, of which 666,182 were medical consultations and 336,537 were specialized exams. Thirtyfour specialties were analyzed, with rates of absenteeism that varied from 0 to 75.9%. The mean rate for consultations was 38.6% (257,025 consultations), with a total value of R$ 3,558,837.88. The amount of specialized exams during the analyzed time period was 336,537 procedures, with an absenteeism rate of 32.1% (108,103 exams) and an estimated waste of R$ 15,007,624.15, in the total R$ 18.566.462,03. Absenteeism rates varied from 22.3 to 100%. The exams of group 02, procedures with diagnostic purpose, presented the greatest waste a total of R$ 13,774,008.92. According to management modality, the lowest rate of absenteeism for consultations was verified for philanthropist services (35.5%), with an estimated waste of R$ 341.750,00. The highest rate (42.7%) was verified for the private service, with a total waste of R$ 2,000.00. For exams, the lowest rate was verified for private services (26.1%), with a total waste of R$ 781,687.87, and the highest was verified for philanthropist services (34,9%), with a total waste of R$ 4.459.951,03. The highest wasted value (R$ 8,943,943.26) was verified for public services managed by health social organizations. Considering the verified rates and monetary values, studies on absenteeism are recommended, as well as the search for causes related to service management and user characteristics in order to propose viable reductions, considering the losses they cause to users and the public management. Monetary data by management modality are important information to aid decision-making by managers regarding investments and priorities for contracts of indirect service management.Thus, it is possible to conclude that modernizing health management and optimizing available resources, tackling waste without compromising the quality of assistance, will be a constant challenge in the agenda of SUS managers.
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Absenteísmo , Atenção secundária à saúde , Integralidade em saúde , Administração de serviços de saúde , Absenteeism , Secondary health care , Integrality in health , Administration of health services