Quality of the public health system: a systemic comprehension in Brazilian southern region

Marciano, Marcelo Antunes; Vaccaro, Guilherme; Scavarda, Anníbal

Marcelo Antunes Marciano

Hospital Moinhos de Vento, Rua Ramiro Barcelo, 910, CEP 90035-004, Porto Alegre, RS, Brasil, e-mail: marcelo.marciano2000@gmail.com

Programa de Pós-graduação em Engenharia de Produção e Sistemas – PPGEPS, Universidade do Vale do Rio dos Sinos – UNISINOS, Av. Unisinos, 950, Cristo Rei, CEP 93020-190, São Leopoldo, RS, Brasil, e-mail: guilherme.vaccaro@gmail.com

https://orcid.org/0000-0002-5226-1216

Guilherme Vaccaro

Programa de Pós-graduação em Engenharia de Produção e Sistemas – PPGEPS, Universidade do Vale do Rio dos Sinos – UNISINOS, Av. Unisinos, 950, Cristo Rei, CEP 93020-190, São Leopoldo, RS, Brasil, e-mail: guilherme.vaccaro@gmail.com

Anníbal Scavarda

Pontifícia Universidade Católica do Rio de Janeiro – PUC-Rio, Rua Marquês de São Vicente, 225, Gávea, CEP 22451-900, Rio de Janeiro, RJ, Brasil, e-mail: annibal@esp.puc-rio.br

Academic Education	Quantity of Professionals by Education	Experience in health care sector (in years)	Role in health care sector	Area
Administration	1	More than 20	Consultant	Health consultory business
Economy	2	More than 15	Superintendent	Private non-profit organization
Economy	2	More than 5	Superintendent	Private non-profit organization
Engineering	2	More than 20	Manager	Private non-profit organization
Engineering	2	More than 20	Director	Technology supply business
Medicine	3	More than 15	Director	Public Health Care Service
		More than 15	Superintendent	Private non-profit organization
		More than 20	Medical Manager of Quality	Private for-profit organization

Events	Variables	Criteria and/or practice related to:
Onset of vaccination against childhood paralysis	Children vaccinated against childhood paralysis	Prevention; immunization of the infant community;
Creation of SUS (Health Unic System)	Atendances made by SUS	Regulamentation; public health care system
Creation of the Family Health Program/PSF	Families attended by PSF	Pro-active health attendance; primary attendance
Creation and End of the Provisional Contribution on Financial Transactions/CPMF	Collected amount and left by CPMF	Investment-sum to public health care
Laws that regulate health insurance policies	Number of patients attended by health insurance	Legislation/regulamentation of private health care systems

Federal government	“There is a need for improvement, although the budget’s resources are not enough to fix it. There is also other priorities that are more important than health care”; “The problems already exist since its creation and for this fact it is difficult to fix immediately”; “We do not have the budget to provide the expenses by ourselves”; “The tax reform is vital in the country”; “I don’t know exactly the cost of health care”.
State Government	“It’s not possible to do more for public health without the support of the federal government and the cities”; “it could be better if we had transfer of funds more frequently”; “The investments done by the federal government in health are not enough to attend all the demand of the state”; “There is a lack of professionals of the health sector”; “The cost of the state public machine prevents that more resources for health exist”; “State debt (decreased the resources for investment and maintenance)”; “The centralization of resources in the federal government makes the quality improvement difficult”.
Health care sector workers	“SUS is very bad, we work a lot and earn a little”; “The salaries and emotional distress verified in the public health service makes the service unattractive for the carrier”; “As soon as I get more private clients, I’ll de-accredit from SUS”; “We could have more resources to work. Better salaries and gratifications”; “The amount of procedures paid to the professionals are impediments to do a good job”; “There are a lot of infrastructure problems”.
Health Insurance Administrators	“The access to a quality health care system is only possible through private companies”; “And the worse the quality of public health is, the bigger our consumer market will be”; “Providing access to a quality health system and in counterpart the weak service of public health care”; “The federal and state governments do not invest enough to provide a good public health system”; “The norms of ANS (National Health Agency) makes it less lucrative to the Insurance Company”.
Press/Media	“Public health is chaos, it does not improve because the enters government and leaves government and the do not give proper attention to this issue”; “State government does not apply the fixed budget in public health”; “The quality of public health is concerning because people die in waiting line for transplants, medications, treatments”; “Leave society informed”; “Lack of effort from governors in putting ideas in practice”; “The focus of the government is not public health”; “Diversion of funds that should be destined to health and the lack of population’s awareness concerning their rights and responsibilities”.
Health Training Organization	“We need to guarantee the quality training to improve the quality of the public system”; “we train capable professionals, but we are not responsible for the bad infrastructure offered by government”; “Training professionals capable of attending the population”; “Government does not present long term projects, that would involve the training organizations too, but focus on visible actions that can be seen in the 4 years of government”.
Civil Society	“The situation is very concerning, since there is a lack of financial resources to improve the infrastructure, like hospitals, health care units, equipment to do exams”; “The doctors take too long to attend, and when they attend, do it in a few minutes”; “There is lack of medication, for free distribution”; “Government does not invest properly with the taxes we pay”; “My responsibility is to charge public power to improve public health”; “I have to elect candidates that worry about the quality on the public health system”; “There is misappropriation of budget that should be destined to public health”; “There is a lack of specialty doctors”; “It is difficult to access routine exams and more sophisticated ones in a reasonable amount of time”.
Pharmaceutical Companies	“There is a lack of medication, which causes the delay/suspension on treatment by lack of investment in public health”; “To do more deals with the government to distribute medication”; “To look for innovation in the development of pharmaceutical industry in order to reduce the price of medication and equipment”; “Too much bureaucracy of the health system”; “Why does the government do not exempt the pharmaceutical industry of taxes like it happens with the automotive industry?”
Hospital Administrators	“Government does not invest appropriately in infrastructure and training professionals”; “We do what is possible with the available resources, do not ask us more than that”; “Giving conditions for the professionals to save the biggest number of lives, using available resources”; “Federal and state government do not pass along all the budget destined to health care by law”; “I need to work the least of necessary resources”; “The values on the SUS table are very below the cost”.

Suggested actions focusing in Short Term

Suggested actions focusing in Medium/Long Term

• Mapping the main incidental illnesses
• Analyzing effectiveness/closing of diagnosis/medical treatments
• Contention plan definition/chronicle illnesses control
• Integration between public and private organizations
• Stratification of the actions in health area by social class, region, age and epidemiological profile
• Analysis of the necessities of investment in the areas of health/sanitation

• Incentive to the training of new professionals with subside to the courses
• Integration of the school with social problems, mainly in courses of the education, health and engineering fields
• political reform aiming to avoid radical alterations in investment plans in each govern
• Investment actions to amplify the sanitation system

[1] Source: Author.

Brasil

Brasil

Quality of the public health system: a systemic comprehension in Brazilian southern region

Abstract