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Ciência & Saúde Coletiva

Print version ISSN 1413-8123

Abstract

ESCRIVAO JUNIOR, Álvaro  and  KOYAMA, Marcos Fumio. The relationship between hospitals and health plans organizations in the scope of ANS Health Insurance Qualification Program. Ciênc. saúde coletiva [online]. 2007, vol.12, n.4, pp. 903-914. ISSN 1413-8123.  http://dx.doi.org/10.1590/S1413-81232007000400012.

In Brazilian health insurance sector, the fee-for-service model still remains the major payment method for health services, and predominates in the relationship between hospitals and private health insurance companies. After the creation of Health Insurance Qualification Program (HIQP), which focuses on the quality of the assistance given to consumers, the health insurance companies will be evaluated by health care performance indicators, established by this program. The present study discusses the impact of this pattern on the relationship between health insurance companies and hospitals, by analyzing data from interviews carried through with 18 health insurance managers, regarding the use - in hospital management - of performance indicators compatible to those adopted by HIQP. According to the managers perception, only three hospitals use this sort of indicators, two of them which are hospitals managed by the health insurance companies. The alignment of interests between health plans organizations and health care providers, at the HIQP proposed template, will imply changes in payment models between these market players, towards the inclusion of performance and quality of assistance given to users by providers, as components of wage determination.

Keywords : Quality; Health insurance sector; Performance; Evaluation.

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