Considering the gap observed in studies on health costs, this article aims to propose a cost calculation model for surgical hospitalization. A systematic literature review using PRISMA was conducted to map cost drivers adopted in similar studies and provide theoretical background. Based on the review, an integrated model considering real patient flow was developed using CHEERS guidelines. The micro-costing top-down method was adopted to develop the cost model allowing a balance between the accuracy of the information and the feasibility of the cost estimate. The proposed model fills two gaps in the literature: the standardization of a cost model and the ability to assess a vast number of different surgery costs in the same hospital. Flexibility stands out as an important advantage of the proposed model, as its application enables evaluation of elective and urgent surgeries of medium and high complexity performed in public and private hospitals. As a limitation, the hospital should have hospital information and cost systems implemented. The proposed cost model can provide important information that can result in better decision making. This becomes more relevant in public health, especially in low- and middle-income countries, which faces a lack of resources and whose positive effects can improve healthcare.
Background: Several studies have been carried out with the objective of identifying health costs and developing methods to improve this research, thus contributing to better decision making based on more reliable evidence. However, there are some gaps to be filled to provide such information. This research aims to fill one of these gaps, proposing a cost calculation model for surgical hospitalizations based on real patient flow to determine hospital institutions' costs.Methods: An empirical-theoretical study was developed. The empirical approach adopted the three-step modeling process to propose a cost model based on patient flow, considering CHEERS guidelines. For the theoretical approach, a systematic literature review using PRISMA recommendation was applied.Results: The modeling process made it possible to identify the real flow of the surgical patient. This step made it possible to identify cost sources and comprehend that costs incurred by patient occur from admission (preoperative stage) to discharge (postoperative stage). The literature review showed that most studies only address the surgical stage, neglecting the costs of the two stages mentioned. The cost model was developed with a top-down approach allowing a balance between the accuracy of the information and the feasibility of the cost estimate. The proposed model fills two gaps in the literature, the standardization of a cost model and the ability to assess a vast number of different surgery costs in the same hospital.Conclusions: Flexibility stands out as an important advantage of the proposed model, as its application is possible to encompass elective and urgent surgeries of medium and high complexity performed in public and private hospitals. As a limitation, the hospital should have a HIS and cost system implemented. The proposed cost model can provide important information that can induce better decision making. This becomes more relevant in the health sector, especially public health, which faces the lack of resources and whose positive effects can improve health care.
Introdução: A farmácia hospitalar é uma unidade dentro do hospital que, dentre seus objetivos, busca garantir o uso seguro e racional dos medicamentos prescritos e responder à demanda de medicamentos dos pacientes hospitalizados. O sistema de distribuição de medicamentos de um hospital consiste em um conjunto de procedimentos técnico-administrativos que visam abastecer as unidades de atendimento ao paciente. Objetivo: Analisar o custo referente ao consumo de medicamentos de uso coletivo em um Hospital Universitário (HU) localizado no estado de Minas Gerais considerando uma intervenção de monitoramento realizada pela equipe de farmácia junto as equipes de enfermagem. Material e Métodos: Trata-se de um estudo longitudinal, retrospectivo, realizado com dados disponibilizados pela Unidade de Farmácia Clinica de um HU sobre o custo referente ao consumo de medicamentos de uso coletivo das Unidades de Internação no período de junho de 2018 a maio de 2019. A intervenção realizada pela equipe de farmácia consistiu em disponibilizar mensalmente os dados referentes ao custo do consumo de medicamentos de uso coletivo para os coordenadores das Unidades de Internação que, por sua vez, disponibilizavam para suas respectivas equipes. Os meses de junho a novembro de 2018 são referentes ao período pré-intervenção e os meses de dezembro de 2018 a maio de 2019 são referentes ao período pós-intervenção. Resultados: Não foi encontrada diferença significativa na redução dos custos referentes ao consumo de medicamentos de uso coletivo do período pós-intervenção em relação ao pré-intervenção. O aumento no preço de alguns medicamentos no período pós-intervenção impactou consideravelmente no custo final do consumo de medicamentos de uso coletivo neste período. Conclusão: Apesar do custo do consumo de medicamentos de uso coletivo não ter sido reduzido no período pós-intervenção foi possível afirmar que a intervenção realizada contribuiu para a redução do consumo quando se considera o aumento ocorrido no preço de alguns medicamentos neste período do estudo. Intervenções de monitoramento podem auxiliar na minimização de desperdícios, e consequentemente ter impacto direto sobre o consumo de medicamentos, promovendo influências positivas e benéficas para os hospitais.
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