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Advisor(s)
Abstract(s)
o Sistema Nacional de Saúde encontra-se em remodelações quanto à sua estrutura organizacional,
reestruturando os Cuidados de Saúde Primários. Estes centros estão vocacionados para proporcionar
um primeiro contacto com a comunidade, contudo observamos um aumento das listas de espera nos
hospitais para os utentes beneficiarem de Terapia da Fala, devido à falta de contratação destes
técnicos nos centros de saúde. A análise de custo-benefício é um instrumento útil para a tomada de
decisões de uma instituição. Assim, consegue··se apurar os custos e os benefícios de determinado
projecto para uma escolha mais acertada.
Este estudo de caso, exploratório e descritivo, pretende identificar: as necessidades reais dos
utentes que necessitem de tratamento em Terapia da Fala nos Cuidados de Saúde Primários da área
da grande Lisboa; verificar a capacidade de resposta do Sistema Nacional de Saúde a estes serviços;
quais os locais de encaminhamento; identificar os custos e os benefícios na contratação de
Terapeutas da Fala para os centros de saúde; alnalisar a relação custo-benefício desta contratação e
comparar os custos para o utente destes tratamentos nos cuidados de saúde primários e no privado_
A amostra recolhida através da aplicação de um questionário foi de 77 utentes nos Agrupamentos de
Centros de Saúde de Loures, Odivelas e Vila Franca de Xira.
Após análise dos dados e de ser efectuada uma estimativa de cálculos, observou-se, que não se
conseguiu verificar a significância estatística ,da amostra e que o Sistema Nacional de Saúde não
consegue dar uma resposta adequada nos Cuidados de Saúde Primários, uma vez que encaminhou os
utentes para clínicas convencionadas, sendo estas, Fundação CEBI, Centro de Fisioterapia da Póvoa
de Santo Adrião, Fundação Carlos Larroudé, Segurança Social, Clínica Novas Luzes, Instituto de
Surdos Mudos Imaculada Conceição e Hospital ,do Mar; contudo alguns doentes foram encaminhados
para os próprios Centro de Saúde de Nampula - Saúde Escolar e Unidade de Cuidados na Comunidade
do Centro de Saúde da Pontinha. No que respe·ita aos custos identificados para a contratação de um
Terapeuta da Fala para os Centros de Saúde, observaram-se custos directos com o pessoal -
remuneração base, contribuições para a segurança social, subsídio de alimentação, de férias e
natal, seguro de acidentes de trabalho - prestação de serviços ao utente, transporte de ambulância
e material de desgaste. Como custos indirectos apurou-se a electricidade e a água. No que respeita
aos benefícios apurados, verificou-se que est.es existem apenas através do pagamento de taxas
moderadoras. No que respeita à relação de custo-benefício da contratação destes técnicos para os
Cuidados de Saúde Primários, observou-se que esta os custos sào mais elevados que os benefícios,
na medida em que o rácio desta análise é de aproximadamente 0,04. Relativamente à comparação
da estimativa de custos suportados pelos utentes nos tratamentos nos centros de saúde esta é de
aproximadamente entre 94% e 97% mais barat.o no Sistema Nacional de Saúde do que no privado,
dependendo do número semanal de tratamentos.
Este estudo permitiu perceber que, devido ao financiamento do Sistema Nacional de Saúde ser
efectuado através do orçamento do estado, o retorno de benefícios não é tão visível se o valor da
prestação de cuidados de saúde fosse suportado pelo utente, ou por uma outra entidade cofinanciadora.
Permitiu ainda conhecer, a realidade da pouca oferta relativamente a clínicas convencionadas com o Sistema Nacional de Saúde. Observou-se, também, que os utentes
beneficiariam muito, relativamente a custos suportados, em ter Terapia da Fala nos Cuidados de
Saúde Primários, pois são muito mais elevados se fo rem efectuados particularmente.
The National Health System is under renovation as to its organizational structure, restructuring the Primary Health (are. These centers are geared to provide a first contact with the community, yet we observe an increase in waiting lists in hospitais for the users benefit from Speech Therapy for lack af hiring these technicians in health centers. The cost-benefit analysis is a useful tool for making decisions af an institution. Thus it is possible to determine the costs and benefits af particular project for a most suitable choice. This case study, exploratory and descriptive, aims to identify the real needs af users who require treatment in Speech Therapy in Primary Health (are in the Greater Lisbon area, check the responsiveness of the National Health System to these services, which the local referral, identify the costs and benefits in hiring Speech Therapists for the health centers, analyze the cost-benefit of hiring and compare the costs to the user of these treatments into primary care and in private. The sample collected by applying a questionnai re was 77 users on Clusters of Health Centers Loures, Odivelas and Vila Franca de Xira. After analyzing the data and to make an estimate of calculations showed that it was not possible to verify the statistical significance of the sampl.e and the National Health System cannot provide an adequate response in Primary Health Care, as referred users clinics agreed to these being Fundação CESI, Centro de Fisioterapia da Póvoa de Santo Adrião, Fundação Carlos Larroudé, Segurança Social, Clínica Novas Luzes, Instituto de Surdos Mudos Imaculada Conceição and Hospital do Mar. However, some patients were referred to the very center Nampula Health . School Health and Community Care Unit in the Centro de Saúde da Pontinha. With regard to the identified costs to hire a speech therapist for health centers, there were direct costs with staff . basic remuneration , contribLltions to social security, food allowance, holiday and Christmas, accident insurance work . services to the patient, ambulance transport and material wear. Found as indirect costs to electricity and water. With regard to benefits calculated it was found that these are only through the paymenlt of fees. Regarding the cost-benefit of hiring these technicians for Primary Health Care observed that the costs are higher than the benefits, to the extent that this analysis is the ratio of approximately 0.04. For the comparison of the estimated costs incurred by users in treatment in health centers that is approximately between 94% and 97% cheaper in the National Health Service than in private, depending on the number of weekly treatments. This study allowed us to realize that due to flJnding the National Health Service be made through the state budget, the return of benefits is ne,t as visible as if the value of health care would be supported by the user or by another party co·financing . Also allowed to know the reality of short supply for clinical agreed with the National Health System was also observed that users would greatly benefit, in respect of costs ineurred in having Speech Therapy in Primary Health Care, they are much higher particularly if carried privately.
The National Health System is under renovation as to its organizational structure, restructuring the Primary Health (are. These centers are geared to provide a first contact with the community, yet we observe an increase in waiting lists in hospitais for the users benefit from Speech Therapy for lack af hiring these technicians in health centers. The cost-benefit analysis is a useful tool for making decisions af an institution. Thus it is possible to determine the costs and benefits af particular project for a most suitable choice. This case study, exploratory and descriptive, aims to identify the real needs af users who require treatment in Speech Therapy in Primary Health (are in the Greater Lisbon area, check the responsiveness of the National Health System to these services, which the local referral, identify the costs and benefits in hiring Speech Therapists for the health centers, analyze the cost-benefit of hiring and compare the costs to the user of these treatments into primary care and in private. The sample collected by applying a questionnai re was 77 users on Clusters of Health Centers Loures, Odivelas and Vila Franca de Xira. After analyzing the data and to make an estimate of calculations showed that it was not possible to verify the statistical significance of the sampl.e and the National Health System cannot provide an adequate response in Primary Health Care, as referred users clinics agreed to these being Fundação CESI, Centro de Fisioterapia da Póvoa de Santo Adrião, Fundação Carlos Larroudé, Segurança Social, Clínica Novas Luzes, Instituto de Surdos Mudos Imaculada Conceição and Hospital do Mar. However, some patients were referred to the very center Nampula Health . School Health and Community Care Unit in the Centro de Saúde da Pontinha. With regard to the identified costs to hire a speech therapist for health centers, there were direct costs with staff . basic remuneration , contribLltions to social security, food allowance, holiday and Christmas, accident insurance work . services to the patient, ambulance transport and material wear. Found as indirect costs to electricity and water. With regard to benefits calculated it was found that these are only through the paymenlt of fees. Regarding the cost-benefit of hiring these technicians for Primary Health Care observed that the costs are higher than the benefits, to the extent that this analysis is the ratio of approximately 0.04. For the comparison of the estimated costs incurred by users in treatment in health centers that is approximately between 94% and 97% cheaper in the National Health Service than in private, depending on the number of weekly treatments. This study allowed us to realize that due to flJnding the National Health Service be made through the state budget, the return of benefits is ne,t as visible as if the value of health care would be supported by the user or by another party co·financing . Also allowed to know the reality of short supply for clinical agreed with the National Health System was also observed that users would greatly benefit, in respect of costs ineurred in having Speech Therapy in Primary Health Care, they are much higher particularly if carried privately.
Description
Keywords
Cuidados de saúde primários - Terapia da fala Terapia da fala - Análise custo-benefício