Indirect management in hospital care: analysis of contractualisation by outsourcing of SUS hospitals

Abstract

The purpose of this study was to analyze contracting and rendering of accounts adopted in the publicity of  hospital services in the Unified Health System (SUS)  Bahia. Qualitative research, based on contracts,  quarterly management reports, interviews with senior management of hospital care in the state, and  hospital characteristics according to the National Register of Health Establishments. Conceptually,  accountability and performance were adopted, with  implementation of the Cycle of Public Policy. The  Social Organizations presented a budget consisting of fixed and variable parts that is conditioned to  performance, its management and assistance  indicators are pre-established and the goals plan  justifies the occurrence of budget cuts and/or  rebalancing. The low correlation between contractual  goals and health needs of the territory was striking.  Moreover on the methodology of monitoring and control of the technostructure, a remarkable fragility  was observed, given the insufficiency of indicators and the incipient critical analysis of the hospital performance presented in the reports. It is considered that the model, which has a doctrinaire basis in the  neo-managerial perspective, was implemented  without simultaneous improvement of the monitoring, Gordian knot of the contracting power of the state.