Proposta de faturamento hospitalar alternativo ao pagamento fee- for –service, aplicado ao serviço de parto: pela sustentabilidade do sistema.

Abstract

Objective:Propose an alternative model to currently predominant hospital billing: from payment by procedure to payment for service packages, in search of cost reduction and better service management.Method: This is an exploratory-descriptive, documental, research, with a quantitative approach, in which the objective is to set up billing packages per service, considering two factors: costs and service protocols, inspired by the service package methodology of Porter and Kaplan2. For this, the behavior of hospital costs applied to the delivery service of a public maternity hospital for children from 2014 to 2016 wasanalyzed. Posteriorly,were proposedprotocols to form packages of services, based on the indications of delivery: usual risk, high risk and extreme riskMinistry of Health and Conitec; in the QALY and in the patient safety indicators.Results: After the crossing of costs and protocols, it was possible to set up three (3) service packages, classified as packets 1, 2 and 3. From the analysis of the cost data, crossing the patient's conditions, an estimated average cost, the usual risk patient being classified as type 1 with a cost of R $ 9,652.63, the high-risk pregnant patient classified as type 2 presented a cost of R $ 18,557.99 and the patient of extreme risk, classified as type 3 had an average cost of R $ 41,386.49. Other possible outcomes also have values defined in these packages.Products: Products: Product 1: Prototype of Hospital Billing, developed through the online tool Google Forms, for the preparation of forms, which allowed to separate the service packages in 3 (three types), according to the comorbidities presented by the patient. From this prototype, a system can be developed that anticipates the value of how much it will cost the total care with the patient, within the profile presented by her. This same prototype gives conditions, according to the degree of risk presented by the patient, to organize the structure of patient care before it even needs it. Product 2: Original article entitled "Hospital Billing applied to the birthing service: alternative model to the fee-forservice.Conclusion: When entering the health unit, the parturient would be classified according to the degree of risk presented. Thus, both the patient and the health service would know the estimated cost of their care. This would reduce the number of procedures recorded by the care, allowing more time for the patient, following standardized care protocols. The case was applied to the birthing service of a public hospital, but it can be replicated in any institution, whether public or private, taking into account its costs and unit quality indicators.