Publications IPH Magazine IPH Magazine 13th: Annals The Future of Hospital System - The Sustainability Challenge of Small Hospitals

From an epidemiological point of view, it is increasingly evident that chronic diseases are in the leading causes of death. In the mid-60s of the twentieth century there was an inversion in the curve of the proportion of deaths due to specific causes, with cardiovascular disease taking the lead in place of infectious and parasitic diseases. In the 80s, cancer, respiratory diseases and external causes also exceed the proportion of deaths corresponding to infectious and parasitic diseases. Since then, this scenario is accentuated because, currently, diseases of the circulatory, respiratory, digestive and tumors, added to external causes account for more than 60% of deaths volume nearly 15 times greater than that posed by infectious and parasitic diseases. There has also been a sharp decline in the volume of admissions in the last 16 years, with a decrease of about 17% in the proportion of admissions, being 5.57% of the amount in 2012. This information deserves a deepening in its analysis as that numerous factors contribute to this decline, with yet another set of circumstances that determine the existence of waiting lists for surgery or other clinical requirements, setting up paradoxical frame.

On the other hand, when analyzing the hospitals built in the country, their occupation has a significant idle capacity that reaches almost half the hospital beds in the country. In some states the occupancy rate does not reach 45% of beds. This fact undoubtedly also forces to deepen the reasons underlying this scenario, but we can, with some confidence, discuss some aspects that have contributed and still contribute to this scenario. The fall in the birth rate, as well as improving nutritional conditions and technology for coping childhood diseases influenced the decrease in demand for admissions both in the field of obstetrics, pediatrics. Similarly, technical advances in surgery allowed a sharp contraction in the average time spent in a huge number of procedures in the area. Nevertheless, Brazilian hospitals in general still have the same traditional pattern of supplying services and their correspondence on beds in the basic specialties, which implies underutilization presented in the table mentioned in this article.

Hospital indicators by hospital size

Source: SIH-SUS

After analyzing this idleness from another angle, classifying hospitals by size, it is observed that the smaller hospitals, which make up most of the country units, have the lowest rates of occupation, as shown in Table 4. The occupancy rates increase to the extent that the hospital size also grows in size.

Also adds to this picture the financing condition for the services that are provided by the network, how they occur, the corresponding efficiency and quality.

This context necessarily requires a reflection on the role of hospitals in national set, defining new doctrinal basis for the provision of hospital services and the provision of health services in inpatient settings, and even resetting the vocation of hospitals for services to that better meet the health needs of the population.

Paulo Carrara de Castro

GRADUATION: Faculty of Medicine, University of Mogi das Cruzes, graduated in 1979. GRADUATE: Medical Residence in Public Health by the Public Health Department, Faculty of Medical Sciences of Santa Casa de São Paulo, completed in 1981.