Machado Juliana Pires, Martins Mônica, Leite Iuri da Costa
Agência Nacional de Saúde Suplementar, Rio de Janeiro, Brasil.
Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
Cad Saude Publica. 2016 Jul 21;32(7). doi: 10.1590/0102-311X00114615.
In Brazil, the combined presence of public and private interests in financing and provision of healthcare services stands out clearly in hospital care. Financing arrangements adopted by hospitals (the public Brazilian Unified National Health System - SUS and/or health plans and/or out-of-pocket payment) can affect quality of care. Studies have analyzed the hospital standardized mortality ratio (HSMR) in relation to quality improvements. The objective was to analyze HSMR according to source of payment for the hospitalization and the hospital's financing arrangement. The study analyzed secondary data and causes that accounted for 80% of hospital deaths. HSMR was calculated for each hospital and payment source. Hospitals with worse-than-expected performance (HSMR > 1) were mostly large public hospitals. HSMR was higher in the SUS, including between admissions in the hospital. Despite the study's limitations, the findings point to inequalities in results of care. Efforts are needed to improve the quality of hospital services, regardless of the payment sources.
在巴西，公共和私人利益在医疗服务融资和提供方面的共同存在在医院护理中表现得尤为明显。医院采用的融资安排（巴西公共统一国家卫生系统 - SUS和/或健康计划和/或自付费用）会影响护理质量。已有研究分析了与质量改进相关的医院标准化死亡率（HSMR）。目的是根据住院费用支付来源和医院的融资安排分析HSMR。该研究分析了占医院死亡原因80%的二手数据。计算了每家医院和每种支付来源的HSMR。表现比预期差（HSMR>1）的医院大多是大型公立医院。SUS中的HSMR更高，包括在医院内的入院之间。尽管该研究存在局限性，但研究结果表明护理结果存在不平等。无论支付来源如何，都需要努力提高医院服务质量。
