Auditoria e qualidade dos planos de saúde: percepções de gestores de operadoras da cidade de São Paulo a respeito do programa de qualificação da saúde suplementar da ANS

• Ano de defesa: 2006
• Autor(a) principal: Koyama, Marcos Fumio
• Orientador(a): Escrivão Junior, Álvaro
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Palavras-chave em Português: Qualidade; Avaliação em saúde; Auditoria médica; Operadoras de saúde; Planos de saúde
• Link de acesso: http://hdl.handle.net/10438/2271

This study approached the issue of quality of health assistance offered by private Health Management Organizations, discussing several aspects of medical audit management, specifically, the using of health indicators based in Supplemental Health Care Qualification Program (SHQP) of National Supplemental Health Care Agency (NSA). Fourteen managers of different types of Health Management Organizations, headquartered in São Paulo, were consulted and three of them were interviewed with objective to know: motivations of the organizations to improve health assistance supplied to insureds; aspects of relations between health audit and quality improvement; perceptions and expectations about SHQP, verifying implications of this NSA initiative over Health Audit operational work-flow, and existence of strategic management to quality improvement and models adopted. The identified motivations are the “mission of the company”, marketing motivation, and the reduction of health costs. The initiatives are punctual, not widely adopted, and directed to cost reduction or marketing purpose. It was verified that medical audit and network provider aren't completely prepared for quality driven health service. The perception of the interviewed managers related to the PQSS is positive, considering that it brings the subject of the quality towards Supplemental Health Agenda, but they believe beneficiaries won't value SHQ program, paying more attention to factors as size of network and purchase prices of health plan.