Análise do Processo de Formalização da Contratualização no SUS em um Município do Triângulo Mineiro

Abstract

The aim of this study was to analyze the formalization of the process, the sectors involved and the formal contractualization instruments of the Unified Health System signed between the hospitals and the municipality of Uberaba, in line with the applicable legal regulations. This study is the result of qualitative research, with an active search for the terms of the formal hospital contractualization instruments, as well as information available on the National Register of Health Establishments - CNES, the Uberaba City Hall website and other relevant records related to contractualization within the SUS, from July to November 2024. The case study methodology based on the social scientist Robert K. Yin was used, in which a protocol was devised for conducting the analysis of the SUS hospital contractualizations in force in the municipality of Uberaba. The numerical results were organized in tables and descriptive graphs, according to the content analyzed, and the names of the hospitals were identified by alphanumeric codes (H1, H2). The research also included the analysis of municipal ordinances and decrees, as well as consultation with committees related to the hospital contractualization process. The project was approved by the Research Ethics Committee of the Federal University of the Triângulo Mineiro (CEP/UFTM). From the results obtained, it was possible to verify the contractualizations of the Unified Health System in force with seven hospitals in the municipality. It was found that the Uberaba Municipal Health Department (SMS) acts as an intermediary in formalizing SUS contracts between the municipality and the hospitals, through the Regulation Department. In this study, it was possible to see that most of the network of contracted hospitals in the municipality are made up of private, non-profit entities through formal terms (contracts/agreements). There was greater caution about the validity of formal terms than of descriptive documents. In hospital financing, there is a predominance of partial budgeting, mostly made up of pre-fixed funds, 70% of which are subsidized by the Federal Government. It was also observed that the hospital contractualization instrument that fully complied with all the items set out in the applicable regulations was the most recent instrument signed by the Municipality of Uberaba. In this sense, it is necessary to improve contractualization management practices, reducing the risk of hospital services being interrupted and ensuring that the population is not left without assistance. However, the municipality has seen a continuous improvement in the formal contractualization instruments, indicating a development in the planning of these instruments.