9º Congreso Mundial de Información en Salud y Bibliotecas

Salvador, Bahia - Brasil, 20 a 23 de septiembre de 2005


4a. Reunión de Coordinación Regional de la BVS

19 y 20 de septiembre de 2005

P148 - Application of the Hospital Information System data to the study of public/private relationship in Brazilian National Health System

Brazilian information systems data have often been used to evaluate services supplied by the Brazilian National Health System (SUS). Among several aspects of this evaluation, the relationship between the public and private health services suppliers is studied focusing the structure of the health system, using the Hospital Information System (SIH/SUS) to analyse health services production according to regional differentials, contractual situation, kind of procedures realised, costs, causes of hospitalisation etc.
However, some discontinuities and information biases, which are not always explicit, may lead to errors of interpretation and to false conclusions. These discontinuities are associated to changes in health policies or changes in administrative or operational concepts of the health system.
In this work, we aim to show the main points of inflection on the data from the Hospital Information System (SIH/SUS), according to contractual situation during the last 2 decades, since its implementa tion in 1982 in the Social Security scope.
We analyse its expansion to university hospitals, the separation of the philanthropic hospital services from other hired services, the generalization of health attention to the whole population, the adoption of the Hospital Information System by the Brazilian National Health System (SUS) that included the public health services (federal, state and municipal net). Other developments considered are the new categories of public hospitals (payment by production of health services or by annual budget) and reclassification of private hospitals according to tax regulations. In addition, we show how the implementation of a National Register of Health Establishments (CNES) affected the information retrieved from the SIH/SUS.
We have constructed time series with indicators based on the number and mean cost of hospital admissions according to its classification by contractual situation of the hospital. We have also analysed the impact of changes in administrative or operational concepts of the health system on the profile and participation of each category of hospital, like the higher mean cost in university hospital and an initial increasing of admissions when philanthropic hospital services entered in the system. The incorporation of public hospitals to the system has increased in 20% the number of hospital admissions registered by the information system but the reclassification made in 1997 has not changed the profile of hospital services. During the nineties, the participation on the public net steadily increased, while the non-philanthropic decreased.  Implementation of the CNES introduced a serious discontinuity in time series, since classification criteria was incompatible with the previous one.