Serving two masters: the management of HUCAM between teaching and care
Name: LEANDRA MARIA BORLINI DRAGO
Publication date: 04/03/2011
Advisor:
Name |
Role |
|---|---|
| MARIA LUCIA TEIXEIRA GARCIA | Advisor * |
Examining board:
| Name |
Role |
|---|---|
| MARIA LUCIA TEIXEIRA GARCIA | Advisor * |
Summary: This study analyzes the management of Cassiano Antonio Moraes University
Hospital in order to identify the conflicts between teaching and health care. As casestudy, data collection was carried out through documental research (institutional documents and relevant laws) and semi-structured interviews. The subjects of the study were managers of Cassiano Antonio Moraes University Hospital who were working between 2002 and 2010; and representatives of the union, residents, city and state health departments, hospital board of directors and Ministry of Health a total of 12 interviewees. Content analysis approach was adopted for data analysis. In a State counter-reform setting, permeated by the gradual process of public policy weakening (especially in the social area), the Cassiano Antonio Moraes University
Hospital was facing financial shortages and insufficient human resources. These were pointed out by respondents as being harmful to performing professional formation activities in health care (graduation and post-graduation programs), as well as providing high complexity health care services. The results show that aiming at simultaneously meeting the interests of professional formation and health care service, the university hospital suffers daily pressures (of several types) as a result of a relation of external and internal forces acting on it. The conflict scenario tying the management of this institution masks the implicit privatizing ideals in the neoliberal project, which point at the financial and managerial factors as the only cause of the
crisis in university hospitals. In this regard, overlapping health care service and teaching activities, even if it does not seem to be an institutional choice, is justified as a surviving financial strategy. Also, the relevant laws in this context walk towards gradually transforming university hospitals into mere service renderers, under private management. We concluded that the Cassiano Antonio Moraes University Hospital management is a fight arena in which disputes of interests between political corporate- neoliberal projects and democratic-participative projects evidence the conflicts through which several issues surrounding the hospital go: teaching intentions and needs; distance between university presidency and university hospital; federal government health politics leading university hospitals to becoming the Brazilian Company of Hospital Services, detaching their management from the universities; health care services structured according to productivity; need of modeling services in compliance with the state public health care network; demands of contracts from the State Health Department; and internal demands by employees
and students. Therefore, the expression between two masters summarizes the expansion of the neoliberal project over the university hospitals in Brazil, in which the dispute or avoidance of the "masters" (Ministry of Education and Ministry of Health) increases the weakness of public policies and justifies the privatization of services they comprise.
