Mechanisms of microregulation of private hospitals by health plan operators
| Autor(a) principal: | |
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| Data de Publicação: | 2009 |
| Outros Autores: | , , , |
| Tipo de documento: | Artigo |
| Idioma: | por eng |
| Título da fonte: | Revista de Saúde Pública |
| Texto Completo: | https://www.revistas.usp.br/rsp/article/view/32686 |
Resumo: | OBJECTIVE: To analyze the mechanisms employed by health plan operators for microregulation of clinical management and health care qualification within care-providing hospitals. METHODS: A nation-wide cross-sectional study was carried out. The universe consisted of hospitals which provided care to health plan operators in 2006. A sample of 83 units was selected, stratified by Brazilian macroregion and type of hospital. Data were obtained by means of a questionnaire administered to hospital managers. RESULTS: Microregulation of hospitals by health plan operators was minimal or almost absent in terms of health care qualification. Operator activity focused predominantly on intense control of the amount of services used by patients. Hospitals providing services to health plan operators did not constitute health micro-systems parallel or supplementary to the Sistema Único de Saúde (SUS - Brazilian National Health System). The private care-providing hospitals were predominantly associated with SUS. However, these did not belong to a private care-provider network, even though their service usage was subject to strong regulation by health plan operators. Operator intervention in the form of system management was incipient or virtually absent. Roughly one-half of investigated hospitals reported adopting clinical directives, whereas only 25.4% reported managing pathology and 30.5% reported managing cases. CONCLUSIONS: Contractual relationships between hospitals and health plan operators are merely commercial contracts with little if any incorporation of aspects related to the quality of care, being generally limited to aspects such as establishment of prices, timeframes, and payment procedures. |
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Mechanisms of microregulation of private hospitals by health plan operators Mecanismos de microregulación aplicados por operadoras de seguros de salud en hospitales privados Mecanismos de microrregulação aplicados por operadoras de planos de saúde sobre hospitais privados Saúde Suplementar^i1^sorganização & administraSistemas Pré-Pagos de SaúdeServiços Contratados^i1^snorServiços HospitalaresHospitais PrivadosSalud Complementaria^i3^sorganización & administracSistemas Prepagos de SaludServicios Contratados^i3^snorServicios HospitalariosHospitales PrivadosSupplemental Health^i2^sorganization & administratHealth Maintenance OrganizationsContract Services^i2^sstandaHospital ServicesHospitalsPrivate OBJECTIVE: To analyze the mechanisms employed by health plan operators for microregulation of clinical management and health care qualification within care-providing hospitals. METHODS: A nation-wide cross-sectional study was carried out. The universe consisted of hospitals which provided care to health plan operators in 2006. A sample of 83 units was selected, stratified by Brazilian macroregion and type of hospital. Data were obtained by means of a questionnaire administered to hospital managers. RESULTS: Microregulation of hospitals by health plan operators was minimal or almost absent in terms of health care qualification. Operator activity focused predominantly on intense control of the amount of services used by patients. Hospitals providing services to health plan operators did not constitute health micro-systems parallel or supplementary to the Sistema Único de Saúde (SUS - Brazilian National Health System). The private care-providing hospitals were predominantly associated with SUS. However, these did not belong to a private care-provider network, even though their service usage was subject to strong regulation by health plan operators. Operator intervention in the form of system management was incipient or virtually absent. Roughly one-half of investigated hospitals reported adopting clinical directives, whereas only 25.4% reported managing pathology and 30.5% reported managing cases. CONCLUSIONS: Contractual relationships between hospitals and health plan operators are merely commercial contracts with little if any incorporation of aspects related to the quality of care, being generally limited to aspects such as establishment of prices, timeframes, and payment procedures. OBJETIVO: Analisar os mecanismos de microrregulação aplicados pelas operadoras de planos de saúde nas práticas de gestão da clínica e de qualificação assistencial em hospitais prestadores de serviços. MÉTODOS: Estudo transversal realizado em inquérito de abrangência nacional, cujo universo foi constituído pelos hospitais prestadores de serviços às operadoras de planos de saúde em 2006. Foi construída uma amostra de 83 unidades, estratificada segundo macrorregião do Brasil e tipo de hospital. Os dados foram obtidos por meio de aplicação de questionário em entrevista aos dirigentes dos hospitais. RESULTADOS: A microrregulação que as operadoras de planos de saúde exercem sobre os hospitais em termos da qualificação da assistência foi muito baixa ou quase nula. A atuação das operadoras foi majoritariamente destinada ao intenso controle da quantidade de serviços utilizados pelos pacientes. Os hospitais que prestavam serviços a operadoras de planos de saúde não constituíam micro-sistemas de saúde paralelos ou suplementares ao Sistema Único de Saúde (SUS). Observou-se que os prestadores hospitalares privados eram majoritariamente vinculados ao SUS. Entretanto, não pertenciam à rede alguma de prestadores privados, ainda que fossem objeto de forte regulação da utilização de seus serviços, exercida pelas operadoras de planos de saúde. A intervenção das operadoras de planos de saúde enquanto gestoras de sistemas de cuidado foi incipiente ou quase ausente. Aproximadamente a metade dos hospitais declarou adotar diretrizes clínicas, enquanto apenas 25,4% afirmaram exercer a gestão da patologia e 30,5% mencionaram a gestão dos casos. CONCLUSÕES: As relações contratuais entre hospitais e operadoras de planos de saúde se constituem em contratos meramente comerciais com pouca ou nenhuma incorporação de aspectos relativos à qualidade da assistência contratada, limitando-se, em geral, a aspectos como definição de valores, de prazos e procedimentos para pagamento. OBJETIVO: Analizar los mecanismos de microregulación aplicados por las operadoras de seguro de salud en las prácticas de gestión de la clínica y de calificación asistencial en hospitales prestadores de servicios. MÉTODOS: Estudio transversal realizado en pesquisa de amplitud nacional, cuyo universo fue constituido por los hospitales prestadores de servicios a las operadoras de seguro de salud en 2006. Fue construida una muestra de 83 unidades, estratificada según macroregión del Brasil y tipo de hospital. Los datos fueron obtenidos por medio de aplicación de cuestionario en entrevista a los directores de los hospitales.. RESULTADOS: La microregulación que las operadoras de seguro de salud ejercen sobre los hospitales en términos de la calificación de la asistencia fue muy baja o casi nula. La actuación de las operadoras fue mayoritariamente destinada al intenso control de la cantidad de servicios utilizados por los pacientes. Los hospitales que prestaban servicios a operadoras de seguro de salud no constituían micro-sistemas de salud paralelos o suplementarios al Sistema Único de Salud (SUS). Se observó que los prestadores hospitalarios privados eran mayoritariamente vinculados al SUS. Mientras tanto, no pertenecía a alguna red de prestadores privados, aún siendo objeto de fuerte regulación de la utilización de sus servicios, ejercida por las operadoras de seguros de salud. La intervención de las operadoras de seguros de salud con respecto a gestoras de sistemas de cuidado fue incipiente o casi ausente. Aproximadamente la mitad de los hospitales declaró adoptar directrices clínicas, mientras sólo 25,4% afirmaron ejercer la gestión de la patología y 30,5% mencionaron la gestión de los casos. CONCLUSIONES: Las relaciones contractuales entre hospitales y operadoras de seguros de salud se constituyen en contratos meramente comerciales con poca o ninguna incorporación de aspectos relativos a la calidad de la asistencia contratada, limitándose, en general, a aspectos como definición de valores, de plazos y procedimientos para pagamento. Universidade de São Paulo. Faculdade de Saúde Pública2009-10-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttps://www.revistas.usp.br/rsp/article/view/3268610.1590/S0034-89102009005000053Revista de Saúde Pública; Vol. 43 No. 5 (2009); 832-838 Revista de Saúde Pública; Vol. 43 Núm. 5 (2009); 832-838 Revista de Saúde Pública; v. 43 n. 5 (2009); 832-838 1518-87870034-8910reponame:Revista de Saúde Públicainstname:Universidade de São Paulo (USP)instacron:USPporenghttps://www.revistas.usp.br/rsp/article/view/32686/35105https://www.revistas.usp.br/rsp/article/view/32686/35106Copyright (c) 2017 Revista de Saúde Públicainfo:eu-repo/semantics/openAccessUgá, Maria Alicia DomínguezVasconcellos, Miguel MuratLima, Sheyla Maria LemosPortela, Margareth CrisóstomoGerschman, Silvia2012-07-09T02:11:57Zoai:revistas.usp.br:article/32686Revistahttps://www.revistas.usp.br/rsp/indexONGhttps://www.revistas.usp.br/rsp/oairevsp@org.usp.br||revsp1@usp.br1518-87870034-8910opendoar:2012-07-09T02:11:57Revista de Saúde Pública - Universidade de São Paulo (USP)false |
| dc.title.none.fl_str_mv |
Mechanisms of microregulation of private hospitals by health plan operators Mecanismos de microregulación aplicados por operadoras de seguros de salud en hospitales privados Mecanismos de microrregulação aplicados por operadoras de planos de saúde sobre hospitais privados |
| title |
Mechanisms of microregulation of private hospitals by health plan operators |
| spellingShingle |
Mechanisms of microregulation of private hospitals by health plan operators Ugá, Maria Alicia Domínguez Saúde Suplementar^i1^sorganização & administra Sistemas Pré-Pagos de Saúde Serviços Contratados^i1^snor Serviços Hospitalares Hospitais Privados Salud Complementaria^i3^sorganización & administrac Sistemas Prepagos de Salud Servicios Contratados^i3^snor Servicios Hospitalarios Hospitales Privados Supplemental Health^i2^sorganization & administrat Health Maintenance Organizations Contract Services^i2^sstanda Hospital Services Hospitals Private |
| title_short |
Mechanisms of microregulation of private hospitals by health plan operators |
| title_full |
Mechanisms of microregulation of private hospitals by health plan operators |
| title_fullStr |
Mechanisms of microregulation of private hospitals by health plan operators |
| title_full_unstemmed |
Mechanisms of microregulation of private hospitals by health plan operators |
| title_sort |
Mechanisms of microregulation of private hospitals by health plan operators |
| author |
Ugá, Maria Alicia Domínguez |
| author_facet |
Ugá, Maria Alicia Domínguez Vasconcellos, Miguel Murat Lima, Sheyla Maria Lemos Portela, Margareth Crisóstomo Gerschman, Silvia |
| author_role |
author |
| author2 |
Vasconcellos, Miguel Murat Lima, Sheyla Maria Lemos Portela, Margareth Crisóstomo Gerschman, Silvia |
| author2_role |
author author author author |
| dc.contributor.author.fl_str_mv |
Ugá, Maria Alicia Domínguez Vasconcellos, Miguel Murat Lima, Sheyla Maria Lemos Portela, Margareth Crisóstomo Gerschman, Silvia |
| dc.subject.por.fl_str_mv |
Saúde Suplementar^i1^sorganização & administra Sistemas Pré-Pagos de Saúde Serviços Contratados^i1^snor Serviços Hospitalares Hospitais Privados Salud Complementaria^i3^sorganización & administrac Sistemas Prepagos de Salud Servicios Contratados^i3^snor Servicios Hospitalarios Hospitales Privados Supplemental Health^i2^sorganization & administrat Health Maintenance Organizations Contract Services^i2^sstanda Hospital Services Hospitals Private |
| topic |
Saúde Suplementar^i1^sorganização & administra Sistemas Pré-Pagos de Saúde Serviços Contratados^i1^snor Serviços Hospitalares Hospitais Privados Salud Complementaria^i3^sorganización & administrac Sistemas Prepagos de Salud Servicios Contratados^i3^snor Servicios Hospitalarios Hospitales Privados Supplemental Health^i2^sorganization & administrat Health Maintenance Organizations Contract Services^i2^sstanda Hospital Services Hospitals Private |
| description |
OBJECTIVE: To analyze the mechanisms employed by health plan operators for microregulation of clinical management and health care qualification within care-providing hospitals. METHODS: A nation-wide cross-sectional study was carried out. The universe consisted of hospitals which provided care to health plan operators in 2006. A sample of 83 units was selected, stratified by Brazilian macroregion and type of hospital. Data were obtained by means of a questionnaire administered to hospital managers. RESULTS: Microregulation of hospitals by health plan operators was minimal or almost absent in terms of health care qualification. Operator activity focused predominantly on intense control of the amount of services used by patients. Hospitals providing services to health plan operators did not constitute health micro-systems parallel or supplementary to the Sistema Único de Saúde (SUS - Brazilian National Health System). The private care-providing hospitals were predominantly associated with SUS. However, these did not belong to a private care-provider network, even though their service usage was subject to strong regulation by health plan operators. Operator intervention in the form of system management was incipient or virtually absent. Roughly one-half of investigated hospitals reported adopting clinical directives, whereas only 25.4% reported managing pathology and 30.5% reported managing cases. CONCLUSIONS: Contractual relationships between hospitals and health plan operators are merely commercial contracts with little if any incorporation of aspects related to the quality of care, being generally limited to aspects such as establishment of prices, timeframes, and payment procedures. |
| publishDate |
2009 |
| dc.date.none.fl_str_mv |
2009-10-01 |
| 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://www.revistas.usp.br/rsp/article/view/32686 10.1590/S0034-89102009005000053 |
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https://www.revistas.usp.br/rsp/article/view/32686 |
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10.1590/S0034-89102009005000053 |
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por eng |
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por eng |
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https://www.revistas.usp.br/rsp/article/view/32686/35105 https://www.revistas.usp.br/rsp/article/view/32686/35106 |
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Copyright (c) 2017 Revista de Saúde Pública info:eu-repo/semantics/openAccess |
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Copyright (c) 2017 Revista de Saúde Pública |
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openAccess |
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application/pdf application/pdf |
| dc.publisher.none.fl_str_mv |
Universidade de São Paulo. Faculdade de Saúde Pública |
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Universidade de São Paulo. Faculdade de Saúde Pública |
| dc.source.none.fl_str_mv |
Revista de Saúde Pública; Vol. 43 No. 5 (2009); 832-838 Revista de Saúde Pública; Vol. 43 Núm. 5 (2009); 832-838 Revista de Saúde Pública; v. 43 n. 5 (2009); 832-838 1518-8787 0034-8910 reponame:Revista de Saúde Pública instname:Universidade de São Paulo (USP) instacron:USP |
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Universidade de São Paulo (USP) |
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USP |
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USP |
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Revista de Saúde Pública |
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Revista de Saúde Pública |
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Revista de Saúde Pública - Universidade de São Paulo (USP) |
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revsp@org.usp.br||revsp1@usp.br |
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1800221790143774720 |