Resumen

BAHIA, Ligia; SIMMER, Elaine  y  OLIVEIRA, Daniel Canavese de. Private health plans coverage and chronic diseases: notes on the use of high-cost procedures. Ciênc. saúde coletiva [online]. 2004, vol.9, n.4, pp. 921-929. ISSN 1413-8123.  http://dx.doi.org/10.1590/S1413-81232004000400013.

This article examines the use of selected medical procedures by private health plan clients and the use of those same procedures by population segments covered exclusively by SUS, seeking to identify the remuneration sources of high-cost procedures. This study is based on the comparison between use rates of selected procedures obtained by request from health plan enterprises as well as through consultation of official sources and through estimates of the proportion of provided care according to key informants. The parameters of cardiac surgery use were compared with international indicators. In spite of the possible taxonomical problems regarding the analyzed procedures, the use rate of private health plan clients for cardiac bypass, cardiac angioplasty, hip arthroplasty, and morbid obesity surgery are higher than the estimated ones for the population segments covered by SUS. On the other hand, the proportions of hepatic transplants and substitutive renal therapies directly paid by SUS vary from 89% to 96%. Such estimates signal that attributions concerning the remuneration sources of high-cost procedures are shared between the public and private spheres.

Palabras llave : Health plans; High-cost procedure use; Public and private remuneration sources.