The mayor’s office of Joinville, north of Santa Catarina, began to explore the possibility of transferring the administration of the UPA (emergency squad) south to the OS (social organization), the same type of administration that operates today in Infantile. and Bethesda Hospitals. According to the Ministry of Health, the main justification for the changes is the optimization of procurement and bidding processes.

UPA Sul is located in the Juan Costa area. Photo: Joinville City Hall/Duivulgação

Health Minister Andrej Colaqueke explains that the mayor’s office is still studying the possibility of changing the leadership of the UPA Sul and that this analysis was mainly motivated by the bureaucracy that the state administration imposes.

“Today at UPA we have seasonal visits, demand that you cannot predict, and sometimes there is not enough time to buy things at UPA. NEED something urgent [OS] I could make purchases faster, ”Andrey justifies himself.

For the secretary, this would be the main benefit of private OS administration. Because it is not a public body, management has more freedom to make quick choices without relying, for example, on lengthy procurement, bidding, or contracting processes.

Maristel Kasper is a Nurse Doctor with a double degree from USP (University of São Paulo) and CY Cergy Paris Université (France), studied hospital management, mainly in relation to OS. She was even called to the Joinville Health Board to talk about the differences between public and private government.

An expert on the subject, she explains that public administration has certain principles, such as impersonality and legitimacy, designed in accordance with the morality and culture of the moment, publicity and efficiency. The researcher agrees that bureaucracy eventually leads to delays in some processes, especially in the healthcare sector, where in many cases emergency care is required.

“OS is a more drastic alternative, but you have to be a little careful with it. Each management model has strengths and limitations. There is no miracle. Whether it is direct administration or private administration, such as OS, it will also have limitations,” he comments.

This is because, as Maristel mentions, while public administration is focused on the public good, the private network is aimed at making a profit. Different criteria need to be created for the researcher to approve or disapprove OS administration.

“There are organizations that seek to benefit society, but there are others that have a purely commercial look, they are, in my opinion, the most dangerous,” he comments. In her research, Maristel shows that several SOs have already been implicated in healthcare corruption scandals, which is why she expresses this concern.

For her, the fact that Joinville is an economically wealthy city attracts many stakeholders with the goal of getting rich in the municipality. “OS is very interested in taking a place in the city, because it is beneficial from an economic point of view. This is a very big game of financial power. It’s very delicate to manage it,” he says.

According to Andrey, this is also a concern of the Joinville City Hall, so one of the determined criteria was that the organization was not profitable and invested what it “profits” into the division itself.

Currently, the Department of Health is even evaluating organizations interested in managing UPA Sul. Ten have already received a positive rating, and three more have been rejected for not meeting the established criteria.

Another evaluation parameter is experience, – Andrei quotes. “In the Children’s Hospital, for example, excellent service is undeniable, but there are other bad examples as well. We have a filter for the adequacy of subjects, one of them is their experience,” says Andrey.

In addition to evaluating legal entities, the Department of Health is also examining whether a change in administration is economically viable. Thus, it is not yet determined whether UPA Sul will be controlled by the OS. “We intend to do this, but we are studying the pros and cons,” the secretary comments.

If the OS is defined, what happens next?

If it is concluded that it is worth changing the state administration of VAP Sul to OU, the Department of Health will determine what services should be provided, how many visits should be made within the agreed amount, how much will be paid if it exceeds the previously set amount, in addition to other criteria. The contract also defines the time during which the OS must visit patients.

In addition, it is at this moment that the members of the audit commission are selected. It is aimed at ensuring that the OS complies with the contract, guarantees the labor rights of its specialists and provides adequate and high-quality care.

What changes for workers and visitors

Shinsei (Union of Joinville and Regional Civil Servants), who opposed OS management, points out that one of the downsides of this type of management is making a profit. According to Jane Becker, president of Sinsej, organizations that prioritize money over services may decide to close sectors and services that do not bring financial returns, which will harm the public.

Shinsei is concerned about, for example, labor rights. “Salaries are falling, there are fewer working conditions for outsourcers. SO sometimes have labor disputes, salary arrears. For the population, this means non-standard work, the closure of sectors, the exclusion of certain services, ”Jane is quoted as saying.

“When we transfer public administration to a private person, there is a risk that the population will be left overnight without supervision,” agrees Maristel. This is because it is the OS that decides which sectors should or should not work.

Through her research, Maristel also found that OS staff turnover is high, as salaries are generally lower than those of civil servants. “Professionals are changed because they are looking for better wages or even work in more than one place to earn more,” comments Maristel.

In the case of the UPA, Sul Andrey explains that the professionals will be heard and that, based on this, they can be transferred from the unit or replaced by the OS. “We will understand your professional aspirations and try to achieve the least possible impact on everyone.” Other hires, if management is determined by the OS, will be the responsibility of the organization.

Future prospects

For Maristel, the change in the case of UPA Sul may turn out to be good, but she argues that this will depend on the criteria for evaluation and subsequent scrutiny by government authorities and society.

“But [OS] will present problems. Each model has limitations, the OS may lack professionals, and services close hour by hour. The public is not 100% bad, and depending on the private, it is not 100% bad either,” he reasons.

Andrei says that in the near future it is not predicted that the management of any other medical institution will be transferred to the OS. At the moment, the mayor’s office is studying only the UPA Sul case.