Custo da atenção domiciliar de uma equipe pediátrica: estudo de caso no município de Contagem, Minas Gerais.

Abstract

FARIA, C. O. C. Cost of a Pediatric Home Care Service: a case study in Contagem, Minas Gerais. 2021. 93f. Dissertation (Master's in Nursing) - School of Nursing, University of Minas Gerais, Belo Horizonte, 2022. Introduction: Home Care (HC) is defined by actions of health promotion, prevention, treatment, rehabilitation and palliation, which are carried out at home, with safety and guarantee of continuity of care and articulated with other points of the health care network. The deployment of an HC service requires a thorough analysis of the costs involved in this assistance. Objective: To calculate the cost related to the health care processes of the Multi-professional Team of the Pediatric Home Care Service (MTPHC) in Contagem/MG. Methods: An adaptation Time-Driven Activity-Based Costing´s (TDABC) steps methodology was used, as microcosting estimates are the gold standard for cost valuation. The care provided to 75 children at home was observed to map the processes linked to monitoring children with low birth weight for weight gain; home antibiotic therapy, care for children with chronic conditions and care for newborns for home phototherapy. Service expenses related to human resources, supplies, medicines, equipment and transport for each of the processes were obtained. The unit cost rate (UCR), the total cost of the process and the overall cost of the patient were calculated considering the time spent on activities at home and the use of resources made available by the service. Results: The unit cost rates (UCR´s) found were R$0.73/min, R$0.88/min, R$0.67/min and R$0.91/min, respectively, for antibiotic therapy home care, care for children with chronic conditions, weight gain and home phototherapy, which generated a cost of the process of R$ 93.58, R$ 94.93, R$ 71.60 and R$ 111.69, respectively. In the 4 groups, the highest cost component is the amounts with human resources, followed by transportation costs. The global value of each patient in HC was approximately R$ 748.64 (with 8 doses of antibiotic), R$ 2,942.83 (monitoring for chronic/palliative care), R$ 286.4 (4 visits for weight gain) and R$ R$ 111.69 (one cycle of phototherapy). Considering all children assisted in 2019, only for the processes analyzed in this study, a total amount of R$181,375.72 was identified, covered by Public Health System (SUS) financing through the transfer of Consolidation Ordinance No. 6/GM/MS. Conclusion: Home care costs are complex because they involve direct and indirect expenses and an important component of resources applied to families. These costs are essential to ensure continuity of care at home. Thus, despite the cost that this represents, it is still less than the patient's hospital stay. The bottom-up microcosting methodology, with an approximation to the TDABC method, proved to be efficient for application in HC, as it takes into account not only the consumed inputs, but also, and mainly, the cost of the labor of the health professional involved. in care practices and care provided at home.