Odontologia hospitalar: custos ou receitas?
Autor: Jayro Guimaraes Junior | Publicado: 2014-09-06T21:30:00-03:00


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<![endif]-->Artigo original&nbsp; do cirurgião dentista, estomatologista,&nbsp; MBA em Gestão
de Saúde e Controle de Infecção e assessor em Biossegurança, Presidente da 
Câmara Técnica de Estomatologia e membro da Comissão de Odontologia Hospitalar do 
CROSP
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Na literatura internacional existem inúmeros trabalhos de pesquisa
comprovando que a presença do cirurgião dentista (CD) em hospitais representa
economia ou receita para estas instituições, sejam privadas ou
particulares.&nbsp; O que se relata aqui são
exemplos com finalidades sintéticas e está aquém do que se pode argumentar numa
abordagem mais completa.



&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; É necessário
esclarecer que nem todas investigações que citam custos falam expressamente em
receitas ou cobranças feitas pelos hospitais, isto é, lucros. Entretanto,
intui-se, logicamente, que os custos em hospitais públicos são ressarcidos
pelas receitas provenientes dos contribuintes através de seus impostos e os
custeios em hospitais privados são pagos pelas receitas oriundas dos planos de
saúde complementar ou dos pacientes particulares. 

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Segundo o Banco Mundial, o correto diagnóstico de neoplasias malignas (cânceres) primárias ou
secundárias e cuidados bucais preventivos e terapêuticos baseados em evidências
pode melhorar significativamente a qualidade de vida do paciente e reduzir os custos de morbidade e de
saúde. Conforme um relatório dessa instituição, em países em desenvolvimento,
os custos do tratamento precoce (prevenção secundária)
de cânceres de boca&nbsp; e de outros locais
varia de US$1.300 a US$6.200 por ano de vida salva. Mais econômico é fazer
prevenção primária, isto é, antes da doença se manifestar. 

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Em pacientes
que receberam tratamento para câncer
primário de cabeça e pescoço ou sob quimioterapia prévia a transplantes de
medula óssea, a mucosite oral, efeito secundário destes tratamentos que se
manifesta por feridas na boca, foi associada a um aumento de custos significativos,
dependendo de sua gravidade. Um CD presente em hospitais pode prevenir ou
minimizar os efeitos e os custos da mucosite oral, pois sua ação contribui para
diminuir o tempo de internação dos pacientes acometidos. 

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; No estado norte-americano de &nbsp;Massachusetts, por menos de US$1.000, as necessidades odontológicas dos pacientes
podem ser satisfeitas em mais de 88%
deles, sejam eles segurados por um programa governamental ou privado, e tal
tratamento pode resultar em menor ocorrência de septicemias (infecções
sanguíneas). 

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Se as infecções orais não são tratadas prontamente, a
disseminação em alguns casos para o pescoço e até regiões abaixo dele&nbsp; pode levar à necessidade de internações
hospitalares, inclusive em unidades de tratamento intensivo, com o decorrente
aumento de despesas. Uma extrapolação regional &nbsp;para o custo
total nacional dessas internações se aproxima US$200 milhões/ano. 

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Um outro dado, levantado durante oito anos,&nbsp; nos informa que infecções de origem dental
(odontogênicas) que levaram às hospitalizações num nosocômio chegaram, em
média, a mais de quatrocentos mil doláres de custo e permitiram auferir mais de
um milhão e duzentos mil doláres de receita. Outros pequisadores lembram-nos o
evidente: tais atendimentos seriam mais bem atendidos e custariam muito
menos em consultórios
odontológicos do que em pronto socorros hospitalares.&nbsp; 

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; A falta
de avaliação clínica do estado dental por um CD e dos critérios para intubação durante a
anestesia pode envolver a responsabilidade
profissional e o pagamento de indenização aos pacientes devido a lesões orais e
avulsões dentais acidentais que poderiam ser prevenidas e informadas aos pacientes.
Em algumas circunstâncias o CD poderia confeccionar placas protetoras que,
seguramente teriam custos menores que os ressarcimentos legais. 

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Uma indagação
encomendada por uma grande empresa de saúde complementar a investigadores
universitários americanos demostrou que as grávidas ou os que têm doenças crônicas (diabetes, coronariopatia, acidentes
vásculo-encefálico e artrite reumatoide) que receberam e mantiveram o tratamento periodontal e de infecções orais tiveram
quedas dramáticas em hospitalizações e consultas médicas, salvando milhares de dólares por ano em
despesas médicas. 

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Para terminar algumas reflexões. 

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; O currículo de graduação da Odontologia e de outras
profissões de saúde ainda não acordou inteiramente para a necessidade de aliar a
saúde sistêmica com a estomatológica, diante do que ocorrem defeitos de
transdisciplinaridade, relacionamento e entendimento e más práticas.&nbsp; 

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Muito se fala de interdisplinaridade e holismo, mas
nem sempre isto é praticado. Na verdade, alguns profissionais de saúde
desconhecem o que outros fazem e como eles podem ajudar os enfermos minimizando
ou eliminando as complicações e os efeitos nocivos indesejáveis da prática
hospitalar. 

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Podemos facilmente inferir que, quanto
maiores as complicações, maiores os custos e maiores as cobranças, mais grave
ainda, pior para o paciente e para quem custeia seu tratamento. 

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Como dizer que estamos realizando
as melhores práticas se não atendemos integralmente ou não temos cobertura
financeira ao que se deve amparar de maneira preventiva ou terapêutica as
doenças que acometem os seres humanos. 
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   Name="Grid Table 7 Colorful Accent 5"/>
  <w:LsdException Locked="false" Priority="46"
   Name="Grid Table 1 Light Accent 6"/>
  
  
  
  
  <w:LsdException Locked="false" Priority="51"
   Name="Grid Table 6 Colorful Accent 6"/>
  <w:LsdException Locked="false" Priority="52"
   Name="Grid Table 7 Colorful Accent 6"/>
  
  
  
  
  
  
  
  <w:LsdException Locked="false" Priority="46"
   Name="List Table 1 Light Accent 1"/>
  
  
  
  
  <w:LsdException Locked="false" Priority="51"
   Name="List Table 6 Colorful Accent 1"/>
  <w:LsdException Locked="false" Priority="52"
   Name="List Table 7 Colorful Accent 1"/>
  <w:LsdException Locked="false" Priority="46"
   Name="List Table 1 Light Accent 2"/>
  
  
  
  
  <w:LsdException Locked="false" Priority="51"
   Name="List Table 6 Colorful Accent 2"/>
  <w:LsdException Locked="false" Priority="52"
   Name="List Table 7 Colorful Accent 2"/>
  <w:LsdException Locked="false" Priority="46"
   Name="List Table 1 Light Accent 3"/>
  
  
  
  
  <w:LsdException Locked="false" Priority="51"
   Name="List Table 6 Colorful Accent 3"/>
  <w:LsdException Locked="false" Priority="52"
   Name="List Table 7 Colorful Accent 3"/>
  <w:LsdException Locked="false" Priority="46"
   Name="List Table 1 Light Accent 4"/>
  
  
  
  
  <w:LsdException Locked="false" Priority="51"
   Name="List Table 6 Colorful Accent 4"/>
  <w:LsdException Locked="false" Priority="52"
   Name="List Table 7 Colorful Accent 4"/>
  <w:LsdException Locked="false" Priority="46"
   Name="List Table 1 Light Accent 5"/>
  
  
  
  
  <w:LsdException Locked="false" Priority="51"
   Name="List Table 6 Colorful Accent 5"/>
  <w:LsdException Locked="false" Priority="52"
   Name="List Table 7 Colorful Accent 5"/>
  <w:LsdException Locked="false" Priority="46"
   Name="List Table 1 Light Accent 6"/>
  
  
  
  
  <w:LsdException Locked="false" Priority="51"
   Name="List Table 6 Colorful Accent 6"/>
  <w:LsdException Locked="false" Priority="52"
   Name="List Table 7 Colorful Accent 6"/>
 
<![endif]--><!--[if gte mso 10]>

 /* Style Definitions */
 table.MsoNormalTable
 {mso-style-name:"Tabela normal";
 mso-tstyle-rowband-size:0;
 mso-tstyle-colband-size:0;
 mso-style-noshow:yes;
 mso-style-priority:99;
 mso-style-parent:"";
 mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
 mso-para-margin-top:0cm;
 mso-para-margin-right:0cm;
 mso-para-margin-bottom:8.0pt;
 mso-para-margin-left:0cm;
 line-height:107%;
 mso-pagination:widow-orphan;
 font-size:11.0pt;
 font-family:"Calibri","sans-serif";
 mso-ascii-font-family:Calibri;
 mso-ascii-theme-font:minor-latin;
 mso-hansi-font-family:Calibri;
 mso-hansi-theme-font:minor-latin;
 mso-fareast-language:EN-US;}

<![endif]-->