Modelagem de custeio para mensuração de custos na graduação médica com base em um projeto político-pedagógico de uma instituição pública: estudo metodológico / Cost modeling for cost measurement in medical graduation based on a political-pedagogical project of a public institution: a methodological study

A Constituição da República Federativa do Brasil, de 1988, tem entre seus direitos fundamentais a educação e a saúde, temas sociais que são assegurados às pessoas que se encontram dentro do território nacional. Os tópicos são inseridos no ordenamento jurídico brasileiro através das leis infraconstitucionais, ao longo da sua história. A educação está amparada pelas Diretrizes e Bases da Educação Nacional, que legalizaram o tema em três níveis, entre os quais o nível superior, que se baseia nas Diretrizes Curriculares Nacionais direcionadas às instituições de ensino superior. A promulgação da Lei nº 8.080/1990 criou o Sistema Único de Saúde brasileiro, assegurando a todos o acesso universal e igualitário. A importância dos enunciados requer recursos públicos humanos, materiais, físicos e financeiros na prestação do serviço, alinhados aos elementos básicos necessários ao estudo de custo, o qual se volta para eficiência, eficácia e economicidade, ancorados pelas prerrogativas legais de cunho econômico, financeiro e fiscal. Assim, com a perspectiva de unir os temas educação, saúde e custo, este trabalho teve como questionamento central mensurar o custo da formação em medicina, com base no projeto político-pedagógico de uma instituição de ensino superior. Para responder a essa indagação, a pesquisa objetivou criar uma modelagem de custeio para mensurar o custo da formação acadêmica, através da lógica acadêmica. O trabalho teve características descritivas; qualitativa; de estudo de caso; empírica e dedutiva. A metodologia empregada levantou os instrumentos pedagógicos das escolas públicas federais e algumas estaduais das capitais brasileiras, visando identificar elementos mensuráveis pelo método de custo. Entre os projetos que apresentaram elementos necessários, os dados encontrados no projeto pedagógico da Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro foram utilizados no estudo proposto. A modelagem sugerida quantificou o custo da formação médica de forma lógica segundo as características acadêmicas, dentro do Plano de Periodização da instituição. Concluiu-se que é possível mensurar os custos da formação médica com base nos projetos pedagógicos, aglutinando os recursos disponíveis institucionais consumidos na carga horária das disciplinas.

The 1988 Constitution of the Federative Republic of Brazil has among its fundamental rights education and health, social issues that are guaranteed to people within the national territory. The topics are inserted in the Brazilian legal system by infra-constitutional laws throughout its history. Education is supported by the National Education Guidelines and Bases, which legalized the topic at three levels, including the higher level, is based on the National Curriculum Guidelines aimed at higher education institutions. The enactment of Law no. 8.080/1990 created the Brazilian Unified Health System, ensuring universal and equal access to all. The importance of the statements requires public human, material, physical and financial resources in the provision of the service, which are aligned with the basic elements necessary for the cost study, focusing on efficiency, effectiveness, and economy, anchored by legal prerogatives of an economic, financial, and fiscal nature. Thus, with the perspective of uniting the themes of education, health and cost, the central issue of this work is measuring the cost of training in medicine, based on the political-pedagogical project of a higher education institution. To answer this question, the research aimed to create a costing model to measure the cost of academic training, through academic logic. The work had descriptive; qualitative; case study; empirical and deductive characteristics. The methodology used surveyed the pedagogical instruments of federal public schools and some state schools in Brazilian capitals, aiming to identify measurable elements using the cost method. Among the projects that presented necessary elements, the data found in the pedagogical project of the School of Medical Sciences of Rio de Janeiro State University were used in this study. The suggested modeling quantified the cost of medical training in a logical way according to academic characteristics, following the institution's Periodization Plan. It was concluded that it is possible to measure the costs of medical training based on pedagogical projects, bringing together the available institutional resources consumed in the course load.

Cost of producing a medical doctor at Chulalongkorn University.

To illustrate the cost of producing a medical doctor through a 6-year curriculum and the analysis of the cost components of the Faculty of Medicine, could be used as key data for future planning, budgeting and preparation for the autonomous university. The cost centers were categorized to be executive, education support and education unit. The simultaneous equation method was employed to allocate all costs from other associated cost centers to the education unit. The unit cost per enrolled student was 2,161,124 baht and 8,217 Baht/Student Credit Hour (SCH), while the unit cost per graduate was 2,174,091 baht and 8,267 Baht/SCH. The labor cost accounted for 69.46 per cent, capital cost, 26.42 per cent and material cost, 4.12 per cent of the total medical doctor production cost. The three most costly departments were,: Department of Medicine (13.24%), Department of Obstetrics and Gynecology (11.73%) and Department of Paediatrics (9.87%). The cost-fee ratio (cost/fee) was 95:5 which suggested that medical students obtain 95 per cent subsidy from the government budget or the society. If the University becomes autonomous and less dependent on public budget, the fee may have to be adjusted higher to cover the cost. The percentage of drop out and repeat students was 0.00-0.88 per cent with a delay duration of about 6 months to one year only. The opportunity cost of six years' study for a student attending the medical school was 544,956 baht which raised the total cost per graduate to 2,719,047 baht from student/societal perspective.