Ressarcimento ao SUS: análise do repasse das operadoras de planos de saúde no período de 2001 a 2012

Detalhes bibliográficos
Ano de defesa: 2015
Autor(a) principal: Queiroz, Thiago Faustino de
Orientador(a): Matos, Paulo Rogério Faustino
Banca de defesa: Não Informado pela instituição
Tipo de documento: Tese
Tipo de acesso: Acesso aberto
Idioma: por
Instituição de defesa: Não Informado pela instituição
Programa de Pós-Graduação: Não Informado pela instituição
Departamento: Não Informado pela instituição
País: Não Informado pela instituição
Palavras-chave em Português:
Economia da saúde
Planos pré pagos em saúde
Link de acesso: http://www.repositorio.ufc.br/handle/riufc/19364
Resumo: The repayment to Unified Health System (Sistema Único de Saúde, SUS) is a legal obligation of the care of plans to reimburse the health care services provided in contracts, provided to its customers and their dependents, in public or private institutions, conveniadas or contractors, members of Single System health. The National Health Agency (Agência Nacional de Saúde Suplementar, ANS), the body responsible for the oversight of these operators and the collection of the reimbursement to SUS, has many difficulties to implement the effective reimbursement. This research aims to analyze the transfer of the health plan operators to the National Health System, and the use of health services financed by the SUS by beneficiaries of health plans and their costs generated to public funds for such uses as well to describe the main causes of low effectiveness of reimbursement to SUS. This is a statistical and quantitative study based on the financial figures of data relating to the 2001 to 2012 of ANS and secondary databases from the Ministry of Health (Ministério da Saúde) to system integration. A linear regression model was developed with SUS costs variables, by categories of beneficiaries with plans of health, and subjected to stress tests for validation. As a result it was concluded that, despite the achievements in the regulation of supplementary sector, ANS has a timid action regarding the reimbursement to SUS, as the R $ 5.38 billion charged of operators in the period 2001 to 2012, only R$ 350 million was effectively reimbursed. Such factors limiting the effective reimbursement are arranged in scope legal, institutional and operational.
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spelling Queiroz, Thiago Faustino deMatos, Paulo Rogério Faustino2016-09-01T20:21:21Z2016-09-01T20:21:21Z2015QUEIROZ, Thiago Faustino de. Ressarcimento ao SUS: análise do repasse das operadoras de planos de saúde no período de 2001 a 2012 / Thiago Faustino de Queiroz. - 2015. Dissertação (mestrado profissional) - Universidade Federal do Ceará, Programa de Pós Graduação em Economia, CAEN, Fortaleza, 2015. 42f.http://www.repositorio.ufc.br/handle/riufc/19364The repayment to Unified Health System (Sistema Único de Saúde, SUS) is a legal obligation of the care of plans to reimburse the health care services provided in contracts, provided to its customers and their dependents, in public or private institutions, conveniadas or contractors, members of Single System health. The National Health Agency (Agência Nacional de Saúde Suplementar, ANS), the body responsible for the oversight of these operators and the collection of the reimbursement to SUS, has many difficulties to implement the effective reimbursement. This research aims to analyze the transfer of the health plan operators to the National Health System, and the use of health services financed by the SUS by beneficiaries of health plans and their costs generated to public funds for such uses as well to describe the main causes of low effectiveness of reimbursement to SUS. This is a statistical and quantitative study based on the financial figures of data relating to the 2001 to 2012 of ANS and secondary databases from the Ministry of Health (Ministério da Saúde) to system integration. A linear regression model was developed with SUS costs variables, by categories of beneficiaries with plans of health, and subjected to stress tests for validation. As a result it was concluded that, despite the achievements in the regulation of supplementary sector, ANS has a timid action regarding the reimbursement to SUS, as the R $ 5.38 billion charged of operators in the period 2001 to 2012, only R$ 350 million was effectively reimbursed. Such factors limiting the effective reimbursement are arranged in scope legal, institutional and operational.O ressarcimento ao Sistema Único de Saúde (SUS) é a obrigação legal das operadoras de planos de saúde privados de ressarcirem os serviços de atendimento à saúde, previstos em contratos, prestados a seus consumidores e respectivos dependentes, em instituições públicas ou privadas, conveniadas ou contratadas, integrantes do SUS. A Agência Nacional de Saúde Suplementar (ANS), órgão responsável pela fiscalização dessas operadoras e da cobrança do ressarcimento ao SUS, encontra muitas dificuldades para sua implementação e cobrança efetiva. A presente pesquisa tem como objetivo analisar o repasse das operadoras de planos de saúde ao Sistema Único de Saúde, bem como a utilização de serviços de saúde financiados pelo SUS por beneficiários de planos de saúde e seus custos gerados aos cofres públicos por essas utilizações, além de descrever as principais causas da baixa efetividade do ressarcimento ao SUS. Trata-se de um estudo estatístico e quantitativo baseado nos dados de valores financeiros ligados ao ressarcimento de 2001 a 2012 da ANS e em dados secundários provenientes de bases de dados de sistemas de integração do Ministério da Saúde. Foi elaborado um modelo de regressão linear com as variáveis de custos do SUS, por categorias com atendimentos de beneficiários de planos, e submetidos a testes de estresses para validações. Concluiu-se que, a despeito dos avanços alcançados com a regulamentação do setor suplementar, a ANS possui uma tímida atuação no que tange o ressarcimento ao SUS, pois dos R$ 5,38 bilhões cobrados às operadoras no período de 2001 a 2012, apenas R$ 350 milhões foi efetivamente ressarcido. Tais fatores limitantes ao efetivo ressarcimento estão dispostos no âmbito jurídico, institucional e operacional.Economia da saúdePlanos pré pagos em saúdeRessarcimento ao SUS: análise do repasse das operadoras de planos de saúde no período de 2001 a 2012info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisporreponame:Repositório Institucional da Universidade Federal do Ceará (UFC)instname:Universidade Federal do Ceará (UFC)instacron:UFCinfo:eu-repo/semantics/openAccessORIGINAL2015_dis_tfqueiroz.pdf2015_dis_tfqueiroz.pdfapplication/pdf799176http://repositorio.ufc.br/bitstream/riufc/19364/1/2015_dis_tfqueiroz.pdf98999eacdf6c9bc78aa8e174d8d3e3e9MD51LICENSElicense.txtlicense.txttext/plain; charset=utf-81748http://repositorio.ufc.br/bitstream/riufc/19364/2/license.txt8a4605be74aa9ea9d79846c1fba20a33MD52riufc/193642023-08-17 17:59:31.387oai:repositorio.ufc.br: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Repositório InstitucionalPUBhttp://www.repositorio.ufc.br/ri-oai/requestbu@ufc.br || repositorio@ufc.bropendoar:2023-08-17T20:59:31Repositório Institucional da Universidade Federal do Ceará (UFC) - Universidade Federal do Ceará (UFC)false
dc.title.pt_BR.fl_str_mv Ressarcimento ao SUS: análise do repasse das operadoras de planos de saúde no período de 2001 a 2012
title Ressarcimento ao SUS: análise do repasse das operadoras de planos de saúde no período de 2001 a 2012
spellingShingle Ressarcimento ao SUS: análise do repasse das operadoras de planos de saúde no período de 2001 a 2012
Queiroz, Thiago Faustino de
Economia da saúde
Planos pré pagos em saúde
title_short Ressarcimento ao SUS: análise do repasse das operadoras de planos de saúde no período de 2001 a 2012
title_full Ressarcimento ao SUS: análise do repasse das operadoras de planos de saúde no período de 2001 a 2012
title_fullStr Ressarcimento ao SUS: análise do repasse das operadoras de planos de saúde no período de 2001 a 2012
title_full_unstemmed Ressarcimento ao SUS: análise do repasse das operadoras de planos de saúde no período de 2001 a 2012
title_sort Ressarcimento ao SUS: análise do repasse das operadoras de planos de saúde no período de 2001 a 2012
author Queiroz, Thiago Faustino de
author_facet Queiroz, Thiago Faustino de
author_role author
dc.contributor.author.fl_str_mv Queiroz, Thiago Faustino de
dc.contributor.advisor1.fl_str_mv Matos, Paulo Rogério Faustino
contributor_str_mv Matos, Paulo Rogério Faustino
dc.subject.por.fl_str_mv Economia da saúde
Planos pré pagos em saúde
topic Economia da saúde
Planos pré pagos em saúde
description The repayment to Unified Health System (Sistema Único de Saúde, SUS) is a legal obligation of the care of plans to reimburse the health care services provided in contracts, provided to its customers and their dependents, in public or private institutions, conveniadas or contractors, members of Single System health. The National Health Agency (Agência Nacional de Saúde Suplementar, ANS), the body responsible for the oversight of these operators and the collection of the reimbursement to SUS, has many difficulties to implement the effective reimbursement. This research aims to analyze the transfer of the health plan operators to the National Health System, and the use of health services financed by the SUS by beneficiaries of health plans and their costs generated to public funds for such uses as well to describe the main causes of low effectiveness of reimbursement to SUS. This is a statistical and quantitative study based on the financial figures of data relating to the 2001 to 2012 of ANS and secondary databases from the Ministry of Health (Ministério da Saúde) to system integration. A linear regression model was developed with SUS costs variables, by categories of beneficiaries with plans of health, and subjected to stress tests for validation. As a result it was concluded that, despite the achievements in the regulation of supplementary sector, ANS has a timid action regarding the reimbursement to SUS, as the R $ 5.38 billion charged of operators in the period 2001 to 2012, only R$ 350 million was effectively reimbursed. Such factors limiting the effective reimbursement are arranged in scope legal, institutional and operational.
publishDate 2015
dc.date.issued.fl_str_mv 2015
dc.date.accessioned.fl_str_mv 2016-09-01T20:21:21Z
dc.date.available.fl_str_mv 2016-09-01T20:21:21Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/doctoralThesis
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dc.identifier.citation.fl_str_mv QUEIROZ, Thiago Faustino de. Ressarcimento ao SUS: análise do repasse das operadoras de planos de saúde no período de 2001 a 2012 / Thiago Faustino de Queiroz. - 2015. Dissertação (mestrado profissional) - Universidade Federal do Ceará, Programa de Pós Graduação em Economia, CAEN, Fortaleza, 2015. 42f.
dc.identifier.uri.fl_str_mv http://www.repositorio.ufc.br/handle/riufc/19364
identifier_str_mv QUEIROZ, Thiago Faustino de. Ressarcimento ao SUS: análise do repasse das operadoras de planos de saúde no período de 2001 a 2012 / Thiago Faustino de Queiroz. - 2015. Dissertação (mestrado profissional) - Universidade Federal do Ceará, Programa de Pós Graduação em Economia, CAEN, Fortaleza, 2015. 42f.
url http://www.repositorio.ufc.br/handle/riufc/19364
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