Avaliação do custeio por absorção da diálise peritoneal e hemodiálise sob o ponto de vista do prestador de serviço (bottom up), relacionado ao repasse do Sistema Único de Saúde e da Saúde Suplementar (top down): análise de um registro por três anos

Abstract

Health issues, especially those concerning the financing of its actions and services, raise great concerns in the most diverse segments of society. The International Nephrology Society emphasizes that chronic kidney disease affects 850 million people worldwide. If not addressed, by 2040 it is projected ro be the fifth most common cause of years of life lost. The estimated annual expenditure on Renal Replacement Therapy in Brazil is R$2.2 billion. The objective of the study was to evaluate the cost of absorption of peritoneal dialysis (PD) and hemodialysis (HD) from the point of view of the service provider and compare with the transfer of the Unique Health System (SUS) and Supplementary Health (SS). A study was carried out from the perspective of the service provider from January 2013 to December 2016 in a private unit that provides HD and PD services for both health systems. The variables analyzed were: permanent assets, personnel expenses, medical supplies, tax expenses, labor charges. The data were arranged in Excel spreadsheets and an analysis was performed using the Input-Output Matrix method. 27,666 HD sessions were held in 2013, 26,601 in 2014, 27,829 in 2015 and 28,525 in 2016. There were 264 PD patients in 2013, 348 in 2014, 372 in 2015 and 300 in 2016. The theoretical average cost for the service provider was: HD session in the room for patients with hepatitis B (R$981.10), for seronegative (R$197.99), for seropositive with hepatitis C (R$238.30) and for DP (R$3260.93) monthly. Compared to the SUS transfer, it was noted that for patients with hepatitis B there was a difference of -269.7%, seronegative -2.0%, seropositive for hepatitis C +10.2% and for DP -29.8%. Compared with the transfer of SS to patients with hepatitis B it was -50.2%, seronegative +56.27%, seropositive for hepatitis C +64.54% and for DP +48.26%. It was concluded that, when evaluating the cost of dialysis therapy from the perspective of the service provider related to the transfer of SUS, it is observed that, in percentage, there is a constraint on the cost in both HD and PD.