Custos hospitalares da meningite causada por Streptococcus pneumoniae na cidade de São José dos Campos, SP

Abstract

À minha orientadora, Profa. Dra. Ana Maria de Ulhôa Escobar, com todo o meu respeito, admiração e gratidão por toda a confiança em mim depositada, fundamentais para a conclusão desta tese, e também por todo incentivo.

Hospitalization costs for congenital syphilis in the state of Ceará

“…A gap is perceived due to the lack of updating of these values, a situation also demonstrated in a study on the costs of hospital treatment for pneumococcal meningitis in São José dos Campos, state of São Paulo, which showed that costs were ten to twenty times higher than the average paid by SUS. 18 It is noteworthy the fact that, in this study, some items are not accounted for and that indirect costs were not included. The IHA values paid by SUS do not reflect the actual costs of treating CS and do not follow inflationary indices such as the Broad National Consumer Price Index (IPCA, Índice Nacional de Preços ao Consumidor Amplo) and the National Consumer Price Index (INPC, Índice Nacional de Preços ao Consumidor).…”

“…In 2008, the Table of Procedures, Medicines, Orthotics, Prosthetics and Special Materials (SIGTAP -Portuguese acronym) was established to create the SUS and Ambulatory (SIA) and Hospital (SIH) Information System databases; however, even after these values were readjusted, resources from SUS are still scarce and limited. 18 When the child needs a neonatal ICU bed, it is possible to increase the values, as well as the costs of more complex tests. Nonetheless, it is still likely that these costs are underestimated, not characterizing the costs adequately, consisting of reimbursed amounts and not the actual values of the health resources that were used, as it may have been necessary to perform additional procedures that were not foreseen in the list of those covered by the IHA and,therefore,they were not computed.…”

“…17 To analyze the underfunding of these values, a bottomup cost study would be necessary, using tables that are more up-to-date than those provided by SUS. 16,18 Hospital admission costs are usually classified into: a) direct medical-hospital costs, which refer to expenses directly related to health care, such as the payment of health professionals, medications, complementary exams and hospital charges; nonmedical and hospital costs,which include expenses with patient transportation, home and vehicle adaptations due to a disease, as well as the necessary care with food and clothing, among others; b) indirect costs, which basically include losses and gains in productivity related to an intervention, for instance, days off work; and c) intangible costs, which are those that cannot be commercialized, such as the cost of pain and suffering associated with the disease that is being treated. 16,19 For the IHA selection, the variables main diagnosis and secondary diagnosis were used, of which codes, according to the Tenth Review of the International Statistical Classification of Diseases and Related Health Problems (ICD-10), 20 referred to the diseases in Chapter I: Some infectious and parasitic diseases that incorporate the list of morbidity: ICD from A50 to A50.9 (congenital syphilis).…”