Diagnóstico da gestão de custos nos procedimentos de alta complexidade de um hospital universitário federal

Abstract

This research diagnoses the cost management of high-complexity procedures performed in the hemodynamics service at the university hospital Hospital Universitário Onofre Lopes (HUOL). The chosen methodological procedure for this research used a case study, aided by documentary analysis techniques for the initial data collection, interviews tailored to HUOL’s chief administrative and financial officers, and professionals responsible for the hemodynamics service at Specialized Diagnostics Unit (UDE), The findings were compiled in a technical report presenting the diagnosis of cost management at HOUL, carried out based on NBC TSP 34 technical regulation, corroborating the organization’s adequate maturity level in identifying, measuring, and disclosing cost information, despite the lack of integration between the various systems providing operational data. In regards to the use of this information for cost control and performance evaluation, it was found to be an incipient effort and presented feedback for improvement. Furthermore, it deepened the study of micro-costing of high-complexity procedures performed at UDE, where processes were mapped, and a model for determining the costs of hemodynamics procedures was developed, based on activity and time-oriented, applying the Time-Driven Activity Based Costing (TDABC) method. The model was put to the test in determining the costs of coronary angioplasty with the implantation of 2 stents, totaling R$ 8,726.89, which, when compared against the brazilian unified health aid (Sistema Único de Saúde) SUS reimbursement values of R$ 7,801.13, showed a negative margin of R$ 925.76. This partial SUS coverage reality was also observed at the macro level of the organization in 2023 when 83.1% of expenses are covered by the Ministry of Education, and only 16.9% are covered by SUS revenue. This research provides information on the generation and management of costs in a hospital environment, based on real data, offering a cost determination model tested and applicable to hemodynamics procedures, which can be adapted to other hospital departments, serving as a basis for other hospital cost studies.