Hospital utilization and reimbursement method in Brazil

How to bridge the gap in human resources for health

Human resources are the crucial core of a health system, but they have been a neglected component of health-system development. The demands on health systems have escalated in low income countries, in the form of the Millennium Development Goals and new targets for more access to HIV/AIDS treatment. Human resources are in very short supply in health systems in low and middle income countries compared with high income countries or with the skill requirements of a minimum package of health interventions. Equally serious concerns exist about the quality and productivity of the health workforce in low income countries. Among available strategies to address the problems, expansion of the numbers of doctors and nurses through training is highly constrained. This is a difficult issue involving the interplay of multiple factors and forces.

Incentives and provider payment methods

The mode of payment creates powerful incentives affecting provider behavior and the efficiency, equity and quality outcomes of health finance reforms. This article examines provider incentives as well as administrative costs, and institutional conditions for successful implementation associated with provider payment alternatives. The alternatives considered are budget reforms, capitation, fee-for-service, and case-based reimbursement. We conclude that competition, whether through a regulated private sector or within a public system, has the potential to improve the performance of any payment method. All methods generate both adverse and beneficial incentives. Systems with mixed forms of provider payment can provide tradeoffs to offset the disadvantages of individual modes. Low-income countries should avoid complex payment systems requiring higher levels of institutional development.

SISTEMA DE CLASSIFICAÇÃO DE PACIENTES - PARTE I: DIMENSIONAMENTO DE PESSOAL DE ENFERMAGEM

Um sistema de classificação de pacientes pode ser considerado como um instrumento essencial da prática administrativa na área de enfermagem. Estes sistemas proporcionam aos gerentes de enfermagem informações para o processo de tomada de decisão em áreas referentes à alocação de recursos humanos, monitoramento da produtividade e custos de enfermagem. O propósito deste trabalho é o de demonstrar a importância de um sistema de classificação de pacientes, depois de uma revisão da literatura, com a esperança de que este tópico venha afazer parte de uma agenda de pesquisa no Brasil.