Audit in health and health economics: analysis of a case study

• Autor(a) principal: Quevedo, André Luis Alves de
• Data de Publicação: 2019
• Outros Autores: Leal, Rodrigo Mendes
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Cadernos Ibero-Americanos de Direito Sanitário (Online)
• Texto Completo: https://www.cadernos.prodisa.fiocruz.br/index.php/cadernos/article/view/503
• topic: Auditoria médica. Economia da saúde. Gestão em saúde. Judicialização da saúde. Sistema único de saúde.; Medical audit. Health economics. Health management. Health's Judicialization. Unified Health System.; Auditoría Médica. Economía de la Salud. Gestión en Salud. Judicialización de la Salud. Sistema Único de Salud.

Objective: To analyze the results of the health audit in the area of orthoses, prostheses and special materials (OPM), multiple and sequential surgeries (CMS), performed by the State Health Department of Rio Grande do Sul, Brazil (SES/RS). Methodology: Descriptive quantitative study, based on secondary data from SES/RS, in the area of OPM and CMS, referring to the period of post-payment audit practice, from March 2013 to January 2017, using the case study approach. Results: 1,004 completed observations were analyzed for the period; the number of administrative processes requiring a return of financial resources did not have a tendency in the analyzed historical series, a result influenced by the presence of administrative processes that were not conclusive, especially from 2014, on the execution of the audit or even the judicialisation of the subject audited institutions. As for the financial value requested for the return of the analyzed processes, it was higher in 2014, decreasing in 2015 and decreasing considerably in the years 2016 and 2017. Considering the 30 health regions of the state of Rio Grande do Sul, Brasil, three hospitals were highlighted, the first with 43 administrative processes requesting the return of financial resources; the second with 30; and the third with 28. Conclusion: health actions in this area can be qualified through special attention to the regions of health and hospital institutions that repeat more and have large financial volumes glossed.