Strategic circumvention of regulations: the judicialization of the Brazilian private health system

Detalhes bibliográficos
Autor(a) principal: Ryngelblum, Arnaldo L.
Data de Publicação: 2019
Outros Autores: Oliveira, Paulo C. Duarte de, Telles, Renato, Costa, Mayla C.
Tipo de documento: Artigo
Idioma: por
eng
Título da fonte: Cadernos EBAPE.BR
Texto Completo: https://periodicos.fgv.br/cadernosebape/article/view/75094
Resumo: The article aims to advance the understanding of the successive circumvention of regulations by organizations, to determine whether it is possible to characterize them as purposeful actions, while the institutional literature analyzes decoupling and circumvention as sporadic activities. It analyzes the responses adopted by health plan companies to favor their interests, responses that often fail to comply with the rules of the institutional context, and which boosted the phenomenon known as ‘judicialization’. The study analyzed 158 lawsuits collected from the electronic archives of the Court of Justice of São Paulo, where beneficiaries sue health plan companies because of treatment coverage denial. Using correspondence and thematic analysis, some associations between denials and allegations showed to be significant, suggesting companies’ strategic patterns. It was possible to identify different strategic practices adopted by companies to avoid complying with institutional guidelines, and to observe that certain regulatory features can contribute to non-compliance strategies. The article contributes to the institutional literature by identifying organizational practices meant to successively circumvent and confront institutional prescriptions, indicating that health plan companies apparently design specific strategies to respond to beneficiaries’ demands.
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spelling Strategic circumvention of regulations: the judicialization of the Brazilian private health systemLa evasión estratégica de las regulaciones: la judicialización del sistema de salud privado brasileñoEvasão estratégica das regulações: a judicialização do sistema privado de saúde brasileiroInstitutional theory. Health care. Regulation. Justice. Strategy.Teoría institucional. Salud. Regulación. Justicia. Estrategia.Teoria Institucional. Saúde. Regulação. Justiça. Estratégia.The article aims to advance the understanding of the successive circumvention of regulations by organizations, to determine whether it is possible to characterize them as purposeful actions, while the institutional literature analyzes decoupling and circumvention as sporadic activities. It analyzes the responses adopted by health plan companies to favor their interests, responses that often fail to comply with the rules of the institutional context, and which boosted the phenomenon known as ‘judicialization’. The study analyzed 158 lawsuits collected from the electronic archives of the Court of Justice of São Paulo, where beneficiaries sue health plan companies because of treatment coverage denial. Using correspondence and thematic analysis, some associations between denials and allegations showed to be significant, suggesting companies’ strategic patterns. It was possible to identify different strategic practices adopted by companies to avoid complying with institutional guidelines, and to observe that certain regulatory features can contribute to non-compliance strategies. The article contributes to the institutional literature by identifying organizational practices meant to successively circumvent and confront institutional prescriptions, indicating that health plan companies apparently design specific strategies to respond to beneficiaries’ demands.El artículo tiene como objetivo avanzar en la comprensión de la evasión sucesiva de las regulaciones por parte de las organizaciones, para determinar si es posible caracterizarlas como acciones intencionales, mientras que la literatura institucional analiza el desacoplamiento y la evasión como actividades esporádicas. De esta forma, analiza las respuestas adoptadas por las compañías privadas de seguros de salud para favorecer sus intereses que a menudo no cumplen con las reglas del contexto institucional y que impulsaron el fenómeno conocido como ‘judicialización’. Los datos analizados se recopilaron en los archivos electrónicos del Tribunal de Justicia de São Paulo y el análisis es el resultado de 158 demandas presentadas por beneficiarios individuales contra los operadores del seguro de salud debido a la negativa de cobertura de tratamientos. Usando la correspondencia y el análisis temático, algunas asociaciones entre las negaciones y las alegaciones se mostraron significativas, lo que sugiere patrones estratégicos de los operadores. El trabajo identificó diferentes prácticas estratégicas que los operadores adoptan para evitar cumplir las directrices institucionales, y argumenta que ciertas características regulatorias pueden contribuir a las estrategias de incumplimiento. La contribución a la literatura institucional reside en la identificación de prácticas organizacionales destinadas a evadir y enfrentar sucesivamente las prescripciones institucionales, lo que indica que los operadores de seguros de salud aparentemente diseñan estrategias específicas para responder a las demandas de los beneficiarios.O artigo busca aprofundar a compreensão sobre as evasões sucessivas às regulações pelas organizações, de modo a estabelecer se é possível caracterizá-las como ações intencionais, enquanto a literatura institucional analisa o descolamento e a evasão como atividades esporádicas. Nesse sentido, o artigo analisa as respostas adotadas pelas companhias de planos de saúde para favorecer seus interesses, que frequentemente deixam de cumprir as regras do contexto institucional, e que acabou por provocar o fenômeno da ‘judicialização’. Os dados analisados foram levantados nos arquivos eletrônicos do Tribunal de Justiça de São Paulo e a análise é o resultado de 158 ações impetradas por beneficiários contra os planos de saúde devido a negativas de cobertura de tratamentos. Ao fazer uso de análise de correspondência e análise temática, algumas associações entre negativas e alegações mostraram-se significativas, sugerindo padrões estratégicos das operadoras. O trabalho identificou diferentes práticas estratégicas adotadas para evitar cumprir com diretrizes institucionais e argumenta que determinadas características regulatórias podem contribuir para as estratégias de descumprimento. A contribuição para a literatura institucional reside na identificação de práticas organizacionais voltadas para sucessivamente evadir e confrontar as prescrições institucionais, indicando que as operadoras de planos de saúde aparentemente elaboram estratégias específicas para responder às demandas dos beneficiários.Escola Brasileira de Administração Pública e de Empresas da Fundação Getulio Vargas2019-03-26info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttps://periodicos.fgv.br/cadernosebape/article/view/75094Cadernos EBAPE.BR; Vol. 17 No. 3 (2019); 623-638Cadernos EBAPE.BR; Vol. 17 Núm. 3 (2019); 623-638Cadernos EBAPE.BR; v. 17 n. 3 (2019); 623-6381679-3951reponame:Cadernos EBAPE.BRinstname:Fundação Getulio Vargas (FGV)instacron:FGVporenghttps://periodicos.fgv.br/cadernosebape/article/view/75094/75282https://periodicos.fgv.br/cadernosebape/article/view/75094/75297Copyright (c) 2019 Cadernos EBAPE.BRinfo:eu-repo/semantics/openAccessRyngelblum, Arnaldo L.Oliveira, Paulo C. Duarte deTelles, RenatoCosta, Mayla C.2019-08-08T13:22:20Zoai:ojs.periodicos.fgv.br:article/75094Revistahttps://periodicos.fgv.br/cadernosebapehttps://periodicos.fgv.br/cadernosebape/oaicadernosebape@fgv.br||cadernosebape@fgv.br1679-39511679-3951opendoar:2024-05-13T10:00:10.426933Cadernos EBAPE.BR - Fundação Getulio Vargas (FGV)true
dc.title.none.fl_str_mv Strategic circumvention of regulations: the judicialization of the Brazilian private health system
La evasión estratégica de las regulaciones: la judicialización del sistema de salud privado brasileño
Evasão estratégica das regulações: a judicialização do sistema privado de saúde brasileiro
title Strategic circumvention of regulations: the judicialization of the Brazilian private health system
spellingShingle Strategic circumvention of regulations: the judicialization of the Brazilian private health system
Ryngelblum, Arnaldo L.
Institutional theory. Health care. Regulation. Justice. Strategy.
Teoría institucional. Salud. Regulación. Justicia. Estrategia.
Teoria Institucional. Saúde. Regulação. Justiça. Estratégia.
title_short Strategic circumvention of regulations: the judicialization of the Brazilian private health system
title_full Strategic circumvention of regulations: the judicialization of the Brazilian private health system
title_fullStr Strategic circumvention of regulations: the judicialization of the Brazilian private health system
title_full_unstemmed Strategic circumvention of regulations: the judicialization of the Brazilian private health system
title_sort Strategic circumvention of regulations: the judicialization of the Brazilian private health system
author Ryngelblum, Arnaldo L.
author_facet Ryngelblum, Arnaldo L.
Oliveira, Paulo C. Duarte de
Telles, Renato
Costa, Mayla C.
author_role author
author2 Oliveira, Paulo C. Duarte de
Telles, Renato
Costa, Mayla C.
author2_role author
author
author
dc.contributor.author.fl_str_mv Ryngelblum, Arnaldo L.
Oliveira, Paulo C. Duarte de
Telles, Renato
Costa, Mayla C.
dc.subject.por.fl_str_mv Institutional theory. Health care. Regulation. Justice. Strategy.
Teoría institucional. Salud. Regulación. Justicia. Estrategia.
Teoria Institucional. Saúde. Regulação. Justiça. Estratégia.
topic Institutional theory. Health care. Regulation. Justice. Strategy.
Teoría institucional. Salud. Regulación. Justicia. Estrategia.
Teoria Institucional. Saúde. Regulação. Justiça. Estratégia.
description The article aims to advance the understanding of the successive circumvention of regulations by organizations, to determine whether it is possible to characterize them as purposeful actions, while the institutional literature analyzes decoupling and circumvention as sporadic activities. It analyzes the responses adopted by health plan companies to favor their interests, responses that often fail to comply with the rules of the institutional context, and which boosted the phenomenon known as ‘judicialization’. The study analyzed 158 lawsuits collected from the electronic archives of the Court of Justice of São Paulo, where beneficiaries sue health plan companies because of treatment coverage denial. Using correspondence and thematic analysis, some associations between denials and allegations showed to be significant, suggesting companies’ strategic patterns. It was possible to identify different strategic practices adopted by companies to avoid complying with institutional guidelines, and to observe that certain regulatory features can contribute to non-compliance strategies. The article contributes to the institutional literature by identifying organizational practices meant to successively circumvent and confront institutional prescriptions, indicating that health plan companies apparently design specific strategies to respond to beneficiaries’ demands.
publishDate 2019
dc.date.none.fl_str_mv 2019-03-26
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv https://periodicos.fgv.br/cadernosebape/article/view/75094
url https://periodicos.fgv.br/cadernosebape/article/view/75094
dc.language.iso.fl_str_mv por
eng
language por
eng
dc.relation.none.fl_str_mv https://periodicos.fgv.br/cadernosebape/article/view/75094/75282
https://periodicos.fgv.br/cadernosebape/article/view/75094/75297
dc.rights.driver.fl_str_mv Copyright (c) 2019 Cadernos EBAPE.BR
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Copyright (c) 2019 Cadernos EBAPE.BR
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Escola Brasileira de Administração Pública e de Empresas da Fundação Getulio Vargas
publisher.none.fl_str_mv Escola Brasileira de Administração Pública e de Empresas da Fundação Getulio Vargas
dc.source.none.fl_str_mv Cadernos EBAPE.BR; Vol. 17 No. 3 (2019); 623-638
Cadernos EBAPE.BR; Vol. 17 Núm. 3 (2019); 623-638
Cadernos EBAPE.BR; v. 17 n. 3 (2019); 623-638
1679-3951
reponame:Cadernos EBAPE.BR
instname:Fundação Getulio Vargas (FGV)
instacron:FGV
instname_str Fundação Getulio Vargas (FGV)
instacron_str FGV
institution FGV
reponame_str Cadernos EBAPE.BR
collection Cadernos EBAPE.BR
repository.name.fl_str_mv Cadernos EBAPE.BR - Fundação Getulio Vargas (FGV)
repository.mail.fl_str_mv cadernosebape@fgv.br||cadernosebape@fgv.br
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