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INTRODUCTION
The Brazilian health system is undergoing an important financial crisis that threatens the survival of hospital organizations, especially philanthropic ones, that play an essential role in serving the poorest class of the population.
These philanthropic institutions benefit from tax immunity, but must allocate 60% of their capacity to the Unified Public Health System (SUS) or 20% of their total services as free services to the population[1-3]. In this way, they face serious financial problems that may compromise their survival[4] and impact on meeting the population's demand, considering the various health care procedures that are performed by SUS throughout Brazil. Therefore, cost management has been pointed out as an essential tool for controlling and evaluating these organizations, both public and private[4,5].
Among the several cardiac surgeries performed by SUS in Brazil, the most frequent is coronary artery bypass graft (CABG), performed in both public and private hospitals throughout the country[4]. However, few Brazilian studies have analyzed the cost of this complex procedure and the specific transfer of funds from SUS regarding this surgery.
Cost is defined as an expense relating to a good or service used in the production of other goods or services, and may be classified into direct, indirect, fixed or variable cost, and the sum of all these cost forms is defined as total cost[6]. The most widely used costing system by hospitals to gauge total costs is known as the Absorption Costing System. The main characteristics of this costing system are the need for apportionment in the case of appropriation of indirect costs, and that the results are directly influenced by the production volume[6].
On the other hand, the transfer of funds from SUS consists of the amount of money paid by the Ministry of Health (MOH) to health institutions for their performed procedures, pursuant to Administrative Rule no. 204 of January 29, 2007, which regulates the financing and transfer of federal resources to health actions and services, with appropriate monitoring and control[7].
SUS spent more than R$209 million to perform isolated CABGs and/or those associated with other procedures in...