Quem vai bancar o Hospital de Base?

Para receber o novo curso de medicina da USP, a prefeitura tem que assumir as contas do Hospital de Base; essa mudança ainda é incerta

Reportagem publicada em 5 de janeiro de 2018

Há cinco anos sob gestão da Famesp, o Hospital de Base de Bauru completa 67 anos de existência no próximo dia 21 (Foto: Lucas Mendes/JORNAL DOIS)

 

Por Lucas Mendes

Bauru ganha um novo curso de medicina e, em troca, se compromete a assumir as contas do Hospital de Base. Em resumo, esse é o acordo feito entre a Prefeitura Municipal e o Governo do Estado.

Isso porque com a nova faculdade de medicina da Universidade de São Paulo (USP), o Estado vai tirar uma parte do dinheiro que bancava o Base e direcioná-lo para o novo hospital da USP. Em contrapartida, a Prefeitura assumiu o compromisso de completar a quantia para manter o Hospital de Base funcionando.

A nova configuração na saúde municipal vem num momento de crise financeira. No último mês de julho o prefeito Clodoaldo Gazzetta (PSD) disse, em entrevista à TV Tem, que a Prefeitura estava tirando dinheiro de outras secretarias para colocar na saúde, e que seriam necessárias medidas de cortes de gastos para manter o equilíbrio nas contas da cidade.

O custeio mensal do Hospital de Base, segundo o próprio Gazzetta declarou ao Jornal da Cidade (JC), é de R$ 8,5 milhões. Atualmente a Secretaria de Estado da Saúde repassa para a administração do Base R$ 6 milhões. Os outros R$ 2,5 milhões vêm do Fundo Nacional de Saúde. A partir de 2018 (ainda sem data precisa para isso acontecer) o Estado vai diminuir sua participação no custeio, e a prefeitura se comprometeu a assumir o pagamento de R$ 2 milhões por mês para fechar a conta.

De onde vem o dinheiro?

Hoje quem administra o Hospital de Base é a Famesp — Fundação para o Desenvolvimento Médico Hospitalar, por meio de um contrato de gestão com o Estado de São Paulo. A Famesp é uma Organização Social de Saúde (OSS), e também comanda o Hospital Estadual e o Hospital Manuel de Abreu, ambos em Bauru.

Em 2018 o Base vai deixar de ser administrado pela Famesp e passará para a responsabilidade do município. No momento existem propostas para a Prefeitura de Bauru arcar com essa despesa extra, mas nem todas estão definidas de forma oficial. São elas:

(Ícones desenvolvidos pelo Freepik: Ana Carolina Moraes/JORNAL DOIS)

 

Também como fonte financeira virá o repasse da Uninove, que inaugurou um curso privado de medicina no segundo semestre de 2017. A instituição vai repassar para a Prefeitura 10% do lucro bruto obtido com o novo curso, pois vai usar o Hospital de Base para o ensino prático dos seus alunos.

Já o dinheiro da nova lei do Imposto Sobre Serviços será possível graças à lei aprovada pela Câmara Municipal em novembro. O mecanismo aprovado regulariza o pagamento do ISS de cartões de crédito e débito para o município.

Isso prevê que o recolhimento desse imposto fique para os cofres do município de origem da prestação do serviço. Não se trata de uma contribuição fixa de dinheiro, pois depende da movimentação das compras efetuadas com cartões na cidade.

As outras medidas ainda são incertas. A certificação do Base como Hospital Escola depende do aval do Governo Federal, e já foi motivo de preocupação dos vereadores da cidade. Em sessões da Câmara Municipal e na audiência pública que discutiu o projeto das OSs, alguns vereadores apontaram para a possibilidade dessa certificação demorar mais tempo que o esperado pela Prefeitura.

Projeto de OS

A mais polêmica das medidas para custear o Hospital de Base é a do projeto de passar sua gestão para uma Organização Social (OS). Se isso for concretizado, a Prefeitura repassará o dinheiro para a OS, que se encarrega de administrar o hospital e pagar os salários dos funcionários.

Audiência pública discutiu o projeto das OSs no final de outubro. Vereadores da cidade, população e o secretário de saúde estiveram presentes (Foto: Reprodução Pedro Romualdo/Câmara Municipal de Bauru)

Dessa forma, a despesa com salários não vai impactar a folha de pagamento do município, uma vez que a cidade não pode ultrapassar a marca de 51,3% de sua Receita Corrente Líquida (RCL) com remuneração de servidores, segundo entendimento do Tribunal de Contas do Estado (TCE).

A ideia do prefeito Gazzetta é que a Fundação Estatal Regional de Saúde seja qualificada como OS, e passe a gerir o Base. Na cidade, a Fundação Regional já é responsável pela contratação de médicos nas Unidades de Pronto Atendimento (UPAs) da Bela Vista, Ipiranga e Geisel/Redentor, através de convênios com o município.

A Famesp, que já administra o Base, teria sua participação readequada, servindo como prestadora dos serviços no hospital e mantendo seus funcionários.

Segundo afirmou o secretário Fogolin, em audiência pública na Câmara Municipal para discutir o projeto das OSs, essa seria a “única possibilidade” do município dar conta de assumir o Hospital de Base.

 

 

De autoria do prefeito Gazzetta, o Projeto de Lei (PL) 213/2017 concede à administração pública o poder de qualificar entidades como Organizações Sociais.

No início o PL contemplava diversas áreas: ensino, pesquisa científica, desenvolvimento tecnológico, proteção e preservação do meio ambiente, cultura e saúde. Depois da audiência pública, a Prefeitura encaminhou um projeto substitutivo, em que só consta a saúde como possibilidade de atuação das OSs.

Para valer, o projeto ainda precisa ser votado pelo vereadores na Câmara Municipal.

Hospitais geridos por OSs

Organização Social é um título que a administração pública concede a entidades privadas — sem fins lucrativos — para que recebam benefícios do poder público e desempenhem determinados serviços. Elas são regidas por uma lei federal que define as suas possibilidades de aplicação.

De acordo com estudo do TCE, as atividades transferidas para as OSs devem ter o controle da sociedade, por meio de um conselho de administração, e do governo, mediante um contrato de gestão. Esse contrato regula o repasse de recursos, estipula resultados a serem obtidos e metas de desempenho.

O instrumento das Organizações Sociais surgiu com a ideia de conseguir maior autonomia e agilidade administrativa. O TCE aponta que no momento do Contrato de Gestão, a entidade classificada como OS deve apresentar “um plano operacional detalhado de implantação e os custos estimativos do mesmo”.

A Lei das OSs, segundo o TCE, trouxe mais autonomia e flexibilidade para as entidades que passam a gerir os equipamentos públicos, permitindo a “contratação sem concurso público, adquirir bens e serviços sem processo licitatório, e estipular um plano próprio de cargos, salários e benefícios dos empregados”. Apesar da flexibilidade, as OSs devem continuar respeitando os princípios do Sistema Único de Saúde (SUS), e o controle pela Administração Pública e pelo Tribunal de Contas.

Comparando os hospitais geridos pela Administração Direta (os governos) com os geridos pelas Organizações Sociais de Saúde (OSS), o TCE apontou uma série de comparativos. Alguns deles são os seguintes:

Participação da sociedade

Umas das formas de atuação direta da sociedade nos assuntos da administração pública em Bauru é através dos Conselhos Municipais. Nesses espaços, representantes das sociedade civil, de entidades e da Prefeitura reúnem-se para discutir e deliberar sobre assuntos do interesse de todos.

Com a missão de supervisionar, aprovar, fiscalizar, examinar e controlar as ações na área da saúde, principalmente da Secretaria Municipal de Saúde, o Conselho Municipal de Saúde não teve nenhuma participação nas decisões que vão mudar a organização da saúde em Bauru no próximo ano.

Pelo menos é o que se conclui ao analisar as atas (registros das reuniões) do conselho.

Com reuniões mensais, o conselho é presidido por Luiz Aurélio de Jesus Salles. Em nenhuma reunião do conselho desde o início do ano foi discutida a passagem do Hospital de Base para a Prefeitura, nem sobre o arranjo necessário para garantir a vinda do novo curso de medicina da USP, e nem sobre o Projeto de Lei para as OSs atuarem no campo da saúde em Bauru.

Procurados pelo Jornal Dois, até o fechamento desta matéria Luiz Salles, presidente do Conselho Municipal de Saúde e José Eduardo Fogolin, Secretário Municipal de Saúde, não responderam às perguntas da reportagem.

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