title: [The contracting of teaching hospitals in the Brazilian Unified Health System].
abstract: This study identifies the potential and limitations of contracting to improve health care management, accountability and quality, and expand the participation of teaching hospitals in the health service network in the context of the Restructuring Program of Teaching Hospitals in the Brazilian Unified Health System. It is a case study of four teaching hospitals and their contracting State Health Departments. According to the hospital managers, the association is weak between contracting and the presence of mechanisms for hospital insertion into the health service network with practices and structures for managerial and healthcare qualification in the hospital. More structured hospitals in managerial and healthcare terms were more structured between contracting and the State Health Department. There was an increase in production of medium complexity outpatient care and a decrease in primary healthcare procedures. The proposal is for ongoing managerial development of the hospital and of the State Health Department, review of the operational plan, budgeting, monitoring mechanisms and an incentive system, bonding in the teams, among others.
authors.affiliation: Departamento de Administração e Planejamento em Saúde, Fundação Oswaldo Cruz, Ministério da Saúde, Rua Leopoldo Bulhões 1480/717, Manguinhos, 21041-210 Rio de Janeiro RJ. slemos@ensp.fiocruz.br
authors.forename: Sheyla Maria Lemos
authors.initials: SM
authors.lastname: Lima
authors.forename: Francisco Javier Uribe
authors.initials: FJ
authors.lastname: Rivera
mesh_terms: D001938:Brazil; D032982:Contracts; D003695:Delivery of Health Care / Q000458:organization & administration*; D006784:Hospitals, Teaching / Q000458:organization & administration*