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Abstract(s)
As políticas de saúde em Portugal sofreram colossais transformações ao longo dos anos, e foram cruciais na gestão e financiamento do sistema de saúde e dos hospitais; todos os dias com a escassez de recursos materiais, financeiros e humanos, lutam pela pertinência de os utilizar da melhor forma.
Nunca, como atualmente, se assistiu a um avanço tão rápido da ciência e da técnica com implicações tão profundas e preocupantes nas nossas vidas, nas mentalidades e na organização das sociedades.
O progresso que durava uma ou mais gerações, com repercussões no modo de pensar e agir, reduz-se a cada vez menos anos, o que implica novas atitudes perante a gestão e exige gestores capazes de (re)agirem, permanentemente, à mutação constante do meio em que se inserem.
Para conseguirem sucesso têm de dispor de informação relevante, fiável e atempada, de modo a que possam agir principalmente em tempo útil. A informação através da faturação é um recurso-chave para atenuar a incerteza que envolve o processo decisório, bem como temos observado a disseminação de sistemas de gestão assentes na filosofia Lean thinking, consequência da evolução de filosofias como o TPS (Toyota production system), o TQM (Total Quality Management) e o JIT (just-in-time), aos quais foram associados novos conceitos como a cadeia de valor e o serviço ao cliente, permitindo uma revolução positiva, que têm tido a sua ação comprovada na gestão de operações e na redução das ineficiências dos processos, com ganhos de eficiência e eficácia.
Este trabalho foi desenvolvido com base no tema “Otimização da Gestão do Processo de Faturação Hospitalar” e surgiu com a direção do controlo permanente dos sistemas de faturação de saúde, no desenvolvimento da atividade profissional numa Unidade Hospitalar, que utilizava diariamente o sistema de gestão de sinistros, na relação entre hospitais e fornecedores de seguros de saúde. Assim, detetaram-se lacunas e oportunidades de melhoria, no desenho do sistema e das soluções utilizadas. Este sistema, necessário para o envio, por parte do hospital, da informação relativa ao sinistrado para a entidade seguradora e para a respetiva autorização da utilização da apólice, é essencial atualmente no funcionamento regular de uma instituição hospitalar, atualmente.
Health politics, in Portugal have undergone enormous transformations over the years and were crucial in the management and financing of the health system and hospitals; Every day with the scarcity of material, financial and human resources, struggle for the pertinence of using them in the best way. Never has there been such a rapid advance in science and technology as has so profound and worrying implications in our lives, in the mentalities and in the organization of societies. Progress that lasted one or more generations, with repercussions on the way of thinking and acting, is reduced to fewer and fewer years, implying new attitudes towards management and requiring managers capable of (constant) Of the environment in which they are inserted. To be successful, they must have relevant, reliable and timely information so that they can act primarily in a timely manner. Information through billing is a key resource to mitigate the uncertainty surrounding the decision-making process, as well as the dissemination of management systems based on the Lean thinking philosophy, a consequence of the evolution of philosophies such as the Toyota production system, TQM (Total Quality Management) and JIT (just-in-time), to which new concepts such as the value chain and customer service have been associated, allowing for a positive revolution, which has had its proven action in the management of Reducing inefficiencies in processes, with efficiency and effectiveness gains. This work was developed based on the theme “Optimization of the Management of the Hospital Billing Process” and it emerged with the direction of the permanent control of the health billing systems, in the development of the professional activity in a Hospital Unit, that used daily the management system of The relationship between hospitals and health insurance providers. Thus, gaps and opportunities for improvement were detected in the design of the system and the solutions used. This system, which is necessary for the hospital to send information about the injured party to the insurer and for its authorization to use the policy, is essential in the regular operation of a hospital.
Health politics, in Portugal have undergone enormous transformations over the years and were crucial in the management and financing of the health system and hospitals; Every day with the scarcity of material, financial and human resources, struggle for the pertinence of using them in the best way. Never has there been such a rapid advance in science and technology as has so profound and worrying implications in our lives, in the mentalities and in the organization of societies. Progress that lasted one or more generations, with repercussions on the way of thinking and acting, is reduced to fewer and fewer years, implying new attitudes towards management and requiring managers capable of (constant) Of the environment in which they are inserted. To be successful, they must have relevant, reliable and timely information so that they can act primarily in a timely manner. Information through billing is a key resource to mitigate the uncertainty surrounding the decision-making process, as well as the dissemination of management systems based on the Lean thinking philosophy, a consequence of the evolution of philosophies such as the Toyota production system, TQM (Total Quality Management) and JIT (just-in-time), to which new concepts such as the value chain and customer service have been associated, allowing for a positive revolution, which has had its proven action in the management of Reducing inefficiencies in processes, with efficiency and effectiveness gains. This work was developed based on the theme “Optimization of the Management of the Hospital Billing Process” and it emerged with the direction of the permanent control of the health billing systems, in the development of the professional activity in a Hospital Unit, that used daily the management system of The relationship between hospitals and health insurance providers. Thus, gaps and opportunities for improvement were detected in the design of the system and the solutions used. This system, which is necessary for the hospital to send information about the injured party to the insurer and for its authorization to use the policy, is essential in the regular operation of a hospital.
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Keywords
Lean Thinking Hfatura Otimização Processo Saúde Acidentes Seguros Optimization Process Health Accidents Insurance