The accessibility paradox in health services: global and individual costs

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The Accessibility Paradox in Health Services: Global and Individual Costs

Prof. Luiz Antonio Titton, Universidade de São Paulo, Brasil Prof. Julio Araujo Carneiro da Cunha, Universidade de São Paulo, Brasil Prof. Dr. Marilson Alves Gonçalves, Universidade de São Paulo, Brasil Prof. Dr. Hamilton Luiz Correa, Universidade de São Paulo, Brasil

The health organizations management has threeimportant cornerstones that are fundamental for organizational performance: quality; accessibility and costs (AL-ASSAF, 1997). They are, hence, fundamental for its evaluation, resulting in a perspective for healthcare organizations more incisive based in performance (SHORTELL; KALUZNY, 2000). These issues related to healthcare organizations management are shown necessary before the perception thatgreat part of healthcare professionals point out that management where they work is inefficient (VLASTARAKOS; NIKOLOPOULOS, 2007).


The intense control over little resources on hospital-physician context demands an adequate medical service that involves decision makings based on planning and resources management (HARPER, 2002), Hospital financing limitations bring along the need to findefficient ways to manage (utilize and allocate) lack of resources (AKTAS et al., 2007). This consideration has direct effects on hospital management, since studies from several different countries (developed nations and not-developed ones) have already denoted the challenge in managing costs from lack of resources and contentions, e.g. United Kingdom (FITZGERALD, 1994; FITZGERALD; DUFOUR, 1998),Sweden (QUAYE, 1997), Canada (LOO, 1997; FITZGERALD; DUFOUR, 1998), Netherlands (SCHOLTEN; VAN DER GRINTEN, 1998), United States (GOSS; VOZIKIS, 2002; SLOAN, 2007), Oman (ABRI et al., 2006), Spain (SÁNCHEZ-MARTÍNEZ et al., 2006), France (BELLANGER; TARDIF,

2006), Poland (KOZIERKIEWICZ et al., 2006), Turkey ( KTAS et al., 2007), Tanzand A (GILSON, 1995). This worries with researches based oncosts related to health also interferes on Brazil, what is reflected when it’s perceived that 69% of researches from Economic Healthcare done in the country involves in some way the analysis of costs from hospital management (ANDRADE et al., 2007). In Brazil, according with Cherchiglia and Dallari (2006), these pressures for higher efficient and effectiveness in organizational activities about lackof resources happened in 1990 decade, mainly when treating about public hospitals. The authors allege that these lasts suffered with a State crisis that reduced the financial maintenance power of the State with public organizations. This decade was marked by an increasing fiscal crisis, protectionism exhaustion to national organizations and a bureaucratic and inefficient public management. Thus,it’s evidenced that one of the greatest issues of Brazilian hospitals relates to lack of resources. In absolute aspects, in the year of 2004, the public spending with health had a mean value of 99,89 euro per habitant (DATASUS, 2006). Adding to this, in the year of 2003, 5,32% of familiar earnings in Brazil was spent with health assistance (IBGE, 2004). So, it’s justified why management costs isthe greatest issue on national discussion in Healthcare Management. In general aspects, managing lack of resources is still a challenge for Healthcare Management. It means that for some time, healthcare organizations from different countries are facing similar problems (HUNTER, 1996), what brings the fact that no matter what culture the nation has, similar issues are found in different healthcareorganizations. In many countries, the hospital costs make pressure over healthcare management, bringing along reflections about how the resources are better destined and allocated in hospital management (KEEN et al., 1993). According to Hunter (1996), these issues related to costs contention seek for better services performance, in an effort to make hat services more sensitiveness to user...