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Revista Panamericana de Salud Pública

Print version ISSN 1020-4989

Abstract

SOUZA, Marcos Antônio de  and  SALVALAIO, Dalva. Self-owned versus accredited network: comparative cost analysis in a Brazilian health insurance provider. Rev Panam Salud Publica [online]. 2010, vol.28, n.4, pp. 305-310. ISSN 1020-4989.  http://dx.doi.org/10.1590/S1020-49892010001000010.

OBJECTIVE: To analyze the cost of a self-owned network maintained by a Brazilian health insurance provider as compared to the price charged by accredited service providers, so as to identify whether or not the self-owned network is economically advantageous. METHODS: For this exploratory study, the company's management reports were reviewed. The cost associated with the self-owned network was calculated based on medical and dental office visits and diagnostic/laboratory tests performed at one of the company's most representative facilities. The costs associated with third parties were derived from price tables used by the accredited network for the same services analyzed in the self-owned network. The full-cost method was used for cost quantification. Costs are presented as absolute values (in R$) and percent comparisons between self-owned network costs versus accredited network costs. RESULTS: Overall, the self-owned network was advantageous for medical and dental consultations as well as diagnostic and laboratory tests. Pediatric and labor medicine consultations and x-rays were less costly in the accredited network. CONCLUSIONS: The choice of verticalization has economic advantages for the health care insurance operator in comparison with services provided by third parties.

Keywords : Insurance, health; prepaid health plans; costs and cost analysis; health services research; health care economics and organizations; Brazil.

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