Social right or economic good? Reasons and implications of adopting double entry door in Brazilian teaching hospitals

• In Event: Tópicos sobre infancia y adolescencia

Abstract

The so-called double entry door in public hospitals - one for the patients of the public health care system and another one for customers of private health insurance - is a growing phenomenon in many public health care facilities, especially in the State of São Paulo, Brazil, where several teaching hospitals linked to public universities assign resources to attend private clientele. The objective of this study is to understand the reasons for the adoption (or not) of the double entry door at two public teaching hospitals, seeking to identify its implications for the hospital and other stakeholders. Methods included desk research of relevant literature and interviews conducted in 2014 with representatives of selected hospitals. The results show the existence of two divergent narratives on the subject. The favorable narrative emphasizes the additional fundraising and the possibility of keeping fully dedicated teachers working at the university. The unfavorable narrative emphasizes the discrimination arising from the segmentation between paying and non-paying patients and the use of public resources for attending private clientele. By emphasizing the solution of structural problems through the privatization of public services, we conclude that the adoption of double entry door in teaching hospitals reinforces existing inequalities in society.

Author

• Hudson P Silva, University of Montreal