Andrea de Oliveira Gonçalves

O olhar dos conselheiros de saúde sobre os relatórios de prestação de contas no município de Natal (Rio Grande do Norte), Brasil

Se os conselhos forem analisados como organizacao que combina recursos e procura deliberadamente realizar um conjunto de objetivos, a avaliacao de sua eficacia, e nao de sua efetividade, estara centrada na capacidade de realizacao de objetivos definidos pelos seus membros. No Brasil a partir da Lei No 8142/90, os conselhos de saude passaram a deliberar assuntos ligados a saude, tornando-se pratica constante. Este artigo analisa os resultados de pesquisa qualitativa realizada sobre o desempenho do Conselho Municipal de Saude de Natal (CMS) a partir de informacoes de natureza economico-financeira prestadas pela Secretaria Municipal de Saude (SMS). De acordo com os resultados, os conselheiros tem baixo grau de compreensao sobre as informacoes de natureza economico-financeiras, dado que ocorre uma evidenciacao incompleta por parte da SMS ao CMS, o que implica no fato de o CMS nao ter a oportunidade de estabelecer maiores inferencias sobre a eficiencia da destinacao dos recursos. Dessa forma, aumenta a dificuldade do exercicio de controle por parte dos conselheiros uma vez que a informacao de modo sintetico impossibilita dentre outras inferencias o confronto entre o que foi previsto no orcamento e o que foi efetivamente realizado.

Atenção Primária à Saúde: elementos de continuidade e mudanças na saúde do Distrito Federal

Primary Health Care (PHC) has a prominent position in the Brazilian governmental agenda. This study focuses on the health system in the Federal District and the initiatives to reorganize PHC, with the analysis of expenditure behavior in order to identify aspects of continuity and change during the period from 2005 to 2014. To achieve this purpose, documental research was carried out focusing on data from the Public Budget Information System. Drawing on historical neo-institutionalism, the results reveal contradiction between the discourse in defense of PHC and the maintenance of high level of expenditure with hospital services, thus confirming path dependence characteristic.

Model of Allocating Public Financial Resources to Brazilian Hospital Organizations that Provide Highly Complex Health Care Services

The general objective of this paper was to propose a model of allocating public financial resources to Brazilian hospital organizations that provide highly complex health care services on behalf of the Brazilian Unified Health System (SUS). The main theoretical background was built on Carr-Hill et al. (1) Focusing on the highly complex health care services provided by the hospitals, the study underscored factors such as supply (or productivity and accessibility/availability of services/beds), demand (or need for health care), use (or utilization/consumption of services/beds), and complexity segmentation of the service in Brazil. The sample comprised 251 organizations offering at least type-II adult and type-II newborn Intensive Care Units in 23 Brazilian states and classified as general and/or specialized hospitals. The Carr-Hill et al. (1) model was adapted to propose a simplified theoretical model of supply that could represent the relationship between the variables included in the final equation of the model, namely: mean inpatient cost, availability of basic health care services, bed occupancy rate, organization type, and organization nature. The results pointed out that the significant determinants empirically confirm the arguments that are rejected by sanitarians in the theoretical field - that the model of resource allocation is based on productivity.

Conselhos de saúde e controle social: um estudo comparativo dos relatórios de prestação de contas das Secretarias Estaduais de Saúde

The exercise of social control is one of the democratic practices applied to the Brazilian national healthcare system. Different mechanisms were provided to this end, among which are the accountability reports. These reports are prepared by the Healthcare Secretariats and submitted to deliberation of their respective Healthcare Councils, in order to ensure transparency in public actions. This article discusses a comparative analysis of the accountability reports from different State Healthcare Secretariats, as a mean of publicizing this type of information. A survey of qualitative nature was conducted on documents which covered the years 2008 and 2009 for the following states: Parana, Santa Catarina, Rio Grande do Sul, Espirito Santo and Rio de Janeiro. The results suggest that, although the State Secretariats disclose most of the variables evaluated, Healthcare Councils do not explicit the public management analysis on their own statements. This suggests that the evaluation process for this type of information needs to be improved with regards to the way it is interpreted and the recommendations it makes to improve public healthcare policies. Further issues to be addressed are: defining priorities when applying funds and establishing goals and objectives, since these do not yet feature in most of the accountability reports issued by the States. Future research should seek to establish if the scale of the involvement of the healthcare councils actually leads to improved results in their accountability reports.