Descomparticipação de cuidados

Uma medida a juntar às propostas da Comissão responsável pelo estudo de sustentabilidade do SNS, para aplicação prioritária aos HHs do SNS de gestão privada link

(...) In reality, payments under this system have never been completely prospective, being influenced to some degree by what happens to an individual patient during a hospitalization. For example, higher payments are made on behalf of patients in whom clinically significant complications develop after admission than for those with the same diagnosis who have no such complications. There are also so-called outlier payments that partially compensate hospitals for the additional expenses incurred for very-high-cost cases. With regard to preventable complications, these retrospective features of the DRG payment system have harbored a perverse incentive: hospitals that improved patient safety and ameliorated problems such as nosocomial infections saw their Medicare revenues — and sometimes their profits — reduced.

After issuing a proposed set of measures and considering comments from stakeholders and experts, CMS decided to disallow incremental payments associated with eight secondary conditions that it sees as preventable complications of medical care .These conditions, if not present at the time of admission, will no longer be taken into account in calculating payments to hospitals after October 1, 2008.
Meredith B. Rosenthal, NEJM, 18.10.07