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

“…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 cases or operations required to treat patients with multiple injuries [17][18][19] .On the one hand, due to the different functional positioning of inpatient services and outpatient services, it is more di cult to treat the diseases that need to be hospitalized and the level of medical services varies greatly among different medical institutions. On the other hand, the level of hospitalization expenses in the private sector is higher than that in public hospitals [17] .Therefore, residents generally choose public medical institutions with more advanced medical technology for hospitalization [53,54] , thereby contributing to the observed decline in inpatient proportions within member private hospitals. For outpatient services with relatively low technical complexity, residents will be more inclined to go to private hospitals when there is not much difference in the level of outpatient expenses between public and private hospitals.…”

“…However, at present, the healthcare landscape in the majority of developing nations is characterized by the predominance of public hospitals, with a minimal market share held by private hospitals. Notably, hospitalization services and surgical treatment of complex cases are mainly provided by public hospitals [16][17][18][19] . In the case of unbalanced resource allocation and the system dominated by public hospitals, the participation of private hospitals in MAs has defects in resources, capabilities and reputation, and also faces obstacles in concepts, interests and systems.…”

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.…”