Sustentabilidade econômica de um serviço de atendimento móvel de urgência

Abstract

The Mobile Emergency Care Service (Serviço de Atendimento Móvel de Urgência/ SAMU) program is the reference of mobile pre-hospital emergency care of the Brazilian Ministry of Health for the entire country. There is a financial stimulus from the federal government in the form of a monthly transfer that works as an incentive for the program; however, there is no regularity of adjustments that follows the market economy. This program is the gateway to the Unified Health System, but the sustainability of the service requires financing and funding. OBJECTIVE: To assess the financial incentives for costing of the Mobile Emergency Care Service provided by the federative entities in relation to the cost of the service carried out in the municipalities, in order, to check the economic sustainability of the program. METHODS: Cross-sectional research with descriptive design, with quantitative approach of analytical type, with correlation between descriptive variables, in the period from April 2017 to December 2020 in a Mobile Emergency Care Service that covers 31 municipalities in northwestern of São Paulo state . Secondary data from the Municipal Health Secretary of the main municipality of this program and from the Public Health Budget System of the Ministry of Health were used. The population comprised the medical records of the Mobile Emergency Care Service; the call regulation services; services provided and professional training. For the costing calculation; the absorption costing method was used. The project was approved by the Research Ethics Committee, opinion number 5103688. The descriptive and inferential statistical analyses of data were performed using SPSS Statistics (IBM®) software. RESULTS: The average cost of each service provided was consolidated as follows: R$ 41.18 per regulated call; R$ 2,383.35 per care performed by the Advanced Supporting Unit and R$ 89.45 per trained participant. The total cost of the components was R$ 42,254,621.96, with an average of 73.68% being covered by the municipalities; 26.32% by the union and 0.00% by the state of São Paulo. In relation to the costing percentages recommended by the federated entities, the municipalities with agreements covered 48.68% more than what was recommended; the union covered 23.68% less and the state did not cover the entire 25%. In relation to the municipalities with convening agreements; 90.32% were in default at some point and at by the end of this research period; 74.19% of them remained in default (73.91% of these, for more than seven months). A statistical association was found that the smaller the municipality, the greater the intensity of the covenant's financial default. There is also some scientific evidence that the greater the degree of dependence of municipalities on transfers from other government spheres, the longer the period of default condition and its intensity. No association was found between financial default and the percentage of own revenue applied in health. The use of indicators to evaluate the economic sustainability of the Mobile Emergency Care Service is proposed. CONCLUSION: Among the federative entities, the municipalities are being overburdened, accounting for 48.68% more than the costs of this program. The condition of financial default of the municipalities suggests the weakening of the economic sustainability of this service, which can result in its interruption to the population.