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. The contractual additives were essential for expansion of hospital beds, but did not meet the need for more human resources and determined an important challenge for the capacity of budgetary rebalancing. 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.