Interesses públicos e privados na rede SUS de Petrópolis / Public and private interests in the SUS network at Petrópolis

Essa dissertação tem como objetivo analisar a rede SUS de Petrópolis e a proposta de sua reorganização, sugerida pelo Diagnóstico executado pela equipe CEPESC/IMS/UERJ no ano de 2019. considerando os interesses em jogo que interferem nas chances de efetivação da proposta no Plano Municipal de Saúde para o período 2022-2025. O estudo consistiu principalmente em uma abordagem qualitativa por meio de entrevistas com atores-chave envolvidos no processo de tomada de decisão, além, de procedimentos quantitativos utilizando cálculos estatísticos simples. Os resultados demonstraram que as principais propostas sugeridas e aprovadas na 1ª Conferência Extraordinária de Saúde no ano de 2019 e no Fórum de Saúde em 2021, foram colocadas de forma secundária e tangencial no Plano Municipal de Saúde. Foi ponderada ainda, a dinâmica da relação público/privado e os meios de incentivo que facilitam a proliferação do setor privado a partir da falta de planejamento e organização da rede pública de saúde, de modo a discutir a quem interessa? Ou cui bono ?

The aim of this dissertation aims is the analysis of the SUS network at Petrópolis and the proposal for reorganization, suggested in the Diagnosis executed by the CEPESC/IMS/UERJ team in the year 2019, considering the interests at stake that interferes in the chances of implementation of the proposal in the Municipal Health Plan for the period 2022-2025. The study consisted mainly of qualitative approach through interviews with key actors involved in the decision-making process, in addition to quantitative procedures using simple statistical calculations. The results showed that the main proposals suggested and approved at the 1st Extraordinary Health Conference in 2019 and at the Health Forum in 2021 were placed in a secondary and tangential way in the Municipal Health Plan. It also considered the dynamics of the public/private relation and the means of incentive that facilitate the proliferation of the private sector from the lack of planning and organization of the public health network, in order to discuss who is interested? Or cui bono?.

Costos directos asumidos por pacientes y gastos de bolsillo en ACV isquémico durante el primer año / Direct cost assumed by patients and out-of-pocket expenses of acute ischemic stroke

RESUMEN Objetivo Describir los CD y GB en pacientes con ACV isquémico en Colombia. Materiales y Métodos Se recolectó información de 67 pacientes con diagnóstico de ACV isquémico agudo que ingresaron por el servicio de urgencias o fueron remitidos a dos instituciones de tercer nivel de complejidad durante el año 2017. Se realizaron entrevistas donde se evaluaron CD y GB durante la hospitalización y un año posterior. Resultados 74 % realizaron algún gasto durante la hospitalización, con un costo promedio de 1 619 USD en los pacientes con Rankin-m de 2 o menos. Por otra parte, 56,7% efectuó un gasto posterior al alta, con un costo entre 444 y 5 909 USD por paciente. Conclusión El ACV es una enfermedad de gran impacto tanto en los pacientes, debido a la discapacidad residual, como en las familias, por su alto costo. Los CD y GB en ACV son elevados, lo que podría significar un gasto catastrófico, potencialmente empobrecedor, y representan una barrera para acceder a los servicios. Es importante investigar el gasto catastrófico en pacientes con ACV y abrir el debate sobre financiación de servicios no incluidos en el PBS en poblaciones de escasos recursos.

ABSTRACT Objectives To describe the direct cost and out-of-pocket expenses that stroke survivors face in Colombia. Materials and Methods We collected data from 67 stroke patients, who came to the emergency department or were referred to two institutions during 2017. We applied a questionnaire on which we asked about direct cost and out-of-pocket expenses at the moment of hospitalization and one year after the stroke. Results 74% of patients made payments during hospitalization, the average cost for Ran-kin score 0 to 2 or less was $1,619. On the other hand, 56,7% of patients made payments after hospital discharge, the average cost for patients was between $444 and $5,909. Conclusion Stroke is a disease with a great impact on patients because of their disability and families because of its high cost. Direct cost and out-of-pocket expenses in stroke are high which can mean a catastrophic expenditure even leading to an impoverishing expenditure and a barrier to patients and families. We consider necessary to investigate the catastrophic costs in this population and open up the debate to finance goods excluded from health insurance plans in low-income families.