According to paper “The prospects for dehospitalization in Brazil and humanized care as an adjunct to this process: a literature review” from the Senac Technical Bulletin, the concept of dehospitalization refers to “the patient leaving the hospital environment to continue receiving necessary health care in another environment in a safe manner, through structured and efficient care processes, directly reducing the length of hospitalization”.
A ANS indicates that dehospitalization can be applied to adults with chronic non-communicable diseases, adolescents, children, and palliative care users. For this dehospitalization to take place, it is necessary for the user to demonstrate a certain clinical stability and not require intensive medical care. One of the great benefits surrounding this strategy, according to the article, is the reduction of the risk of hospital infection. In addition, according to 2020 report from the Ministry of Health, investing in planned dehospitalization helps reduce hospital readmissions and the burden of emergency services, which leads to a reduction in costs. In England, for example, around 35% of hospitalizations are assessed as emergency admissions, costing 11 billion pounds annually.
In addition, Brazil has been undergoing a demographic transition in recent decades marked by the reduction of the fertility rate and the aging of the population. In this sense, according to Dant's Plan (Chronic Diseases and Non-Communicable Diseases in Brazil, 2021-2030) from ANS, published in 2022, the country is undergoing an epidemiological transition characterized by an increase in chronic diseases, which ranked first as a cause of death from 30 to 69 years and registered an expenditure of 8.8 billion on hospitalizations. The article in the Senac Technical Bulletin indicates that, given this scenario of chronic diseases and also the increase in life expectancy, dehospitalization has proven to be an outlet for health services, including transitional hospitals and home care.
Transition hospitals
As already mentioned in Interview with Alexandre Santini, they are highly recommended in cases of physical or cognitive rehabilitation after acute conditions, chronic illnesses, the elderly, or at the end of life. It is understood that, often, when a patient is discharged from the hospital after a serious condition, they still need to undergo a recovery plan before returning home. This reduces the risk of readmissions and possible complications.
According to Brazilian Association of Transitional Hospitals and Clinics (ABRAHCT), this model of transition hospitals has gained space in Brazil, with a ratio of 13 transition beds for every 1,000 acute care beds in the private setting. However, there is still nothing similar to this in the SUS.
ABRAHCT emphasizes that the pandemic helped to demonstrate the relevance of this model. These hospitals provide the necessary support for post-COVID patients who have sequelae, need rehabilitation and are not so ready to return home. Still, general hospitals are focused on the acute patient, and not on those in need of rehabilitation, and this space has to be filled for transition hospitals.
In addition, the association points out that this hospital model helps to relieve the health system, since patients who need continuous care remain occupying beds in highly complex hospitals. In several countries, the development of this model was designed to reduce the length of hospitalization for acute care, leading to a reduction in medical expenses. Thus, these transition hospitals fill the gap of lack of beds and promote efficiency in the health process, reducing the costs of prolonged hospitalization. According to ABRAHCT, the average cost of a patient in a transition hospital is around 15% to 40% of a general hospital.
Home care or home care
Regarding home care, the article in the Senac Technical Bulletin pointed out that this model replaces hospital care for clinically stable patients. Home care involves several positive factors, including the reduction of the risk of hospital infection, the humanization of care through the proximity of the patient to their families, an increase in the therapeutic response linked to an improvement in the quality of life, among other points.
However, home care has several challenges, as indicated throughout the article: there is often resistance from the family in relation to home care, as family members are frustrated with being discharged from the hospital before all symptoms disappear; the role of the one who cares for the patient is seen as exhausting, with a strong need for psychological support from the health team; and families feel insecure about taking care at home, among other things.
In Brazil, family doctors were pioneers in the provision of services and home health, but the expansion of this form of care began with the expansion of programs inherent to the SUS. According to the National Center of Home Care Services Companies (Nead), the pandemic boosted this care model because of the risk of infection in hospitals, with a 15% increase in revenue in the sector in 2020. However, Nead points out that more than 95% of home care services are aimed at health plan clients.
International context of dehospitalization
Dehospitalization is already more consolidated in more developed countries, both in relation to transitional hospitals and home care. The report of Grand View Research pointed out that the global market for services aimed at transitional care was valued at US$ 175.6 billion in 2021 and estimated expansion at a compound annual growth rate of 17.4% from 2022 to 2030.
Grand View Research also attributes this growth perspective to the demand caused by the increase in chronic diseases in the world, which is closely linked to population aging. The elderly population was highlighted in countries such as the United States, Italy, China, Japan, and India. Other factors driving the expansion of this market are the reduction of readmissions to health units and the cost-effectiveness of these services.
The report indicates that in 2021 North America prevailed in this market with a share of more than 45%, and it is very competitive, since the main players in this market are in that region. Still, the compound annual growth rate in the Asia-Pacific region is expected to be 18.3% between 2022 and 2030 (i.e., higher than the 17.4% average). This is mainly due to the growth of the elderly population, in addition to the increase in surgeries, illnesses, and the establishment of health facilities in this region.
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