Integrative Review about Life-Cycle Cost Approaches in Healthcare Units: Evolution, Limits and Reflections for Public Health in Brazil

Abstract

The objective of this study is to review the Healthcare Units (HU) life-cycle cost approaches with an emphasis on the project process, life-cycle cost, actors and measures to save resources. It was a systematic integrative review whose search syntax expressed the poles (phenomenon, population and context) of the question. The Virtual Health Library (VHL) portal was used, which gathers 29 databases, with the time limit from 1977 to 2017 and in Portuguese, English and Spanish. All types of manuscripts and methodologies were included. As gray literature, publications from the Ministry of Health of Brazil about the object were collected and the narrative method was used to synthesize the data. A total of 18 texts were included, all foreign, covering different approaches. Case studies predominate, especially in hospitals, with a description of more efficient systems and intervention strategies. The concept of “life-cycle cost” of the building, although explicit in a few texts (22%), guides decisions and interventions aimed at recovering investment in the operation, despite the fact that many are focused on environmental criteria. It was noticed that the economic context is the major driver of measures aimed at operational rationalization in buildings. Only three Brazilian publications are consistent with the evolution of discussions abroad. It was found that the HU life-cycle approach is still mostly restricted to recovering the initial investment in the operation phase. The discussion in the Brazilian Unified Health System (SUS) is incipient and it is necessary to face problems related to the lack of tools and information to the design and management processes of the structure of this equipment.