Cost estimate of hospital stays for premature newborns in a public tertiary hospital in Brazil

OBJECTIVES: To estimate the direct costs of hospital stays for premature newborns in the Interlagos Hospital and Maternity Center in São Paulo, Brazil and to assess the difference between the amount reimbursed to the hospital by the Unified Health System and the real cost of care for each premature newborn. METHODS: A cost-estimate study in which hospital and professional costs were estimated for premature infants born at 22 to 36 weeks gestation during the calendar year of 2004 and surviving beyond one hour of age. Direct costs included hospital services, professional care, diagnoses and therapy, orthotics, prosthetics, special materials, and blood products. Costs were estimated using tables published by the Unified Health System and the Brasindice as well as the list of medical procedures provided by the Brazilian Classification of Medical Procedures. RESULTS: The average direct cost of care for initial hospitalization of a premature newborn in 2004 was $2,386 USD. Total hospital expenses and professional services for all premature infants in this hospital were $227,000 and $69,500 USD, respectively. The costs for diagnostic testing and blood products for all premature infants totaled $22,440 and $1,833 USD. The daily average cost of a premature newborn weighing less than 1,000 g was $115 USD, and the daily average cost of a premature newborn weighing more than 2,500 g was $89 USD. Amounts reimbursed to the hospital by the Unified Health System corresponded to only 27.42 percent of the real cost of care. CONCLUSIONS: The cost of hospital stays for premature newborns was much greater than the amount reimbursed to the hospital by the Unified Health System. The highest costs corresponded to newborns with lower birth weight. Hospital costs progressively and discretely decreased as the newborns' weight increased.

Utilização e resolubilidade de sistema de atendimento pré-hospitalar / Use and resolution capability of a pre-hospital care system

Objetivo: este trabalho tem por objetivo descrever o atendimento realizado por uma empresa privada de serviços médicos pré-hospitalares da região da Grande São Paulo, por meio de estudo de caso, no período compreendido entre junho de 2000 e agosto de 2001. Métodos: foram estudados os registros do banco de dados informatizado da empresa, avaliando-se a utilização de acordo com idade, gravidade do quadro e capacidade de resolução por faixa etária. Resultados: a população beneficiária de atendimento médico pré-hospitalar era de 1.115.803 pessoas, mas somente 5 por cento dos beneficiários utilizaram efetivamente esse serviço. Observou-se que em 87,15 por cento das vezes foi possível a resolução dos problemas de saúde por telefone ou consulta médica domiciliar e que a gravidade, assim como a capacidade de resolução dos casos em domicílio, estava diretamente relacionada à idade do usuário do serviço. Conclusão: concluiu-se que o sistema permite conhecer as necessidades de saúde da população coberta por planos de saúde, evita ida desnecessária a prontos-socorros e auxilia o gerenciamento de sistemas de saúde.