Gestão pública de custos hospitalares: estudo sobre o resultado econômico em um hospital do Exército Brasileiro

Abstract

This study aimed to identify factors that relate cost management to economic results in medical activities in Brazilian Army Public Hospital in 2014. Economic result is the difference between production cost in a public organization and the lowest corresponding market price. Costs were calculated by direct costing method combined with ABC and TDABC, and the market price followed two premises: the services must have quality equivalent to those produced domestically and must be sized to meet the annual demand in 2014 at the military hospital . The sample (52 medical services) was selected from the interviews focused on find the services that consume more resources in the organization. The results find that HMAPA is efficient in 45 medical services and the cause is a successful aquisition planning to materials such orthotics & prosthetics and chemotherapy drugs, followed by an efficient labor hiring, especially doctors, and MRI equipment rental. The causes for negative economic results in seven medical services were, in the case of four surgeries, the high purchase price of orthotics & prosthetics; and, in case of laboratory tests, the manual bases productive structure prevents a competitive cost per exam (mainly overheads costs), especially arising from the depreciation of hospital equipments. The positive economic result of R$4.4 million in all the 52 medical services researched was distributed in R$ 2.1 million in 10 tests selected in the Diagnostic Imaging sector, R$ 1.6 million in 15 chemotherapy protocols studied in the oncology sector, R$ 349,000 in 14 clinical laboratory exams and R$ 335,000 in 13 surgery.