Outsourcing of hospitals prevents inspection, reminds Health Council – Cities

State Health Council reinforced, in yet another position, that it is against hospitals built and maintained with public money being in the hands of OSs (Social Organizations) in Mato Grosso do Sul.

A contrary decision was forwarded to the State Public Prosecutor’s Office and the Federal Public Prosecutor’s Office. Currently, active contracts with institutes total R$923.1 million, according to data from the state government’s Transparency Portal.

The first organization to manage a public health unit in the State was Instituto Gerir. The entity headed the Ponta Porã Regional Hospital between 2016 and 2019, earned around R$1 billion and was the target of an operation by the PF (Federal Police) on suspicion of misappropriation of resources.

The Acqua Institute replaced Gerir in the administration of Ponta Porã and also took over the Três Lagoas Regional Hospital. In 2022, the then manager of the institution from Três Lagoas was another in the PF’s sights.

In Dourados, the Instituto Social Mais Saúde takes care of the Hospital de Cirurgias da Grande Dourados. Another OS will take over the Regional Hospital in the same city, which is still under construction, as the state government has already signaled.

Interview – This Friday (26), the president of the council, Ricardo Bueno, spoke to the reporter about the subject. He explained that the measures taken this week serve to reinforce the position that the entity has maintained since 2015, when the law was published that regulates the hiring and activities of OSs in the State.

Bueno criticizes the government’s decision to outsource hospitals. “If the State cannot manage a hospital, it signs a certificate of incompetence”, he accuses.

The council loses the ability to monitor and evaluate services when outsourcing occurs. The government’s contract with the organizations does not provide for this monitoring, which is contrary to legislation, says Ricardo.

Losses – Ricardo Bueno and Sebastião Júnior, who is secretary at the State Health Council and represents SUS (Unified Health System) users in the entity, point out what they consider to be the biggest losses of outsourcing. According to the president, OSs take over new, already structured buildings, similar to “decorated apartments”, but do not deliver highly complex services that save lives in Mato Grosso do Sul.

“When you go to the interior, the OSs continue to be of medium complexity. The high complexity ‘ends up’ at the Hospital Regional da Capital, in Santa Casa”, he says.

Another issue is the lack of resolution in services, says Sebastião. “Absenteeism [falta de pacientes] is very high, 30%. If I miss 30 surgeries out of 100 scheduled, I haven’t been able to resolve them, provide answers, show production.”

If the patient’s situation worsens, he begins a pilgrimage. “We have patients who leave Ponta Porã, go to Três Lagoas and arrive at the Regional Hospital of Mato Grosso do Sul to solve the problem”, says the representative of people who use SUS in the State.

The lack of “career” employees, public servants with titles and training financed by the State to be a reference in a certain specialty, is another problem. “You will have a lower salary for your career when you have the OS hiring under the CLT system with a base salary for the category. And there is no differentiation from the ‘guy’ who has 20, 30 years of service”, highlights Bueno.

Thus, the savings to the public coffers from hiring an OS end up not being worth it, in the opinion of the counselors. “They like to include in the justification the cost [menor] from the hospital’s payroll, but I think this can only ‘impress’ when you see experience and training given by the State itself. A professional who has a doctorate, a master’s degree, does not have the same quality as someone who is hired for a low price, without education and training”, concludes Ricardo.

MS Regional Hospital – Regarding the possible outsourcing of the Mato Grosso do Sul Regional Hospital, in Campo Grande, the State Health Council does not see any scope for this.

“Today there is a lack of employees, so much so that there was a public tender, the structure is bad because it has become old and old and needs to be completely renovated. The social organization wants to [assumir] I find it difficult, because they like good, beautiful and new structures. And the Regional Hospital is full of problems”, says the president.

What is being discussed with the council today, he says, is the intention to outsource the administration of the hospital’s infrastructure. “But we think that the SUS has to be 100% public and 100% managed by the public authorities”, points out Ricardo.

The report questioned the SES press office about how the performance of the OSs already hired is being evaluated and what benefits these partnerships are resulting in for the population. There was no response until the publication of this article, but the space remains open for comments.

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