Os usuários e a transição tecnológica no setor de saúde suplementar: estudo de caso de uma operadora de plano de saúde

Meneses, Consuelo Sampaio; Cecílio, Luiz Carlos de Oliveira; Chioro, Arthur; Araújo, Eliane Cardoso de; Cuginotti, Aloísio Punhagui

doi:10.1590/s1413-81232013000100007

Cited by 6 publications

(10 citation statements)

References 2 publications

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“…On the other hand, there are problems related to the coverage of materials, medications and tests in some health plans, such as delay in authorization for the procedures and hospitalization to be conducted. As a result of these difficulties, the institutions responsible for patients avoid the beginning of the prescribed treatments or interrupt some already started, also making it difficult to perform home care (22) .…”

Section: Discussionmentioning

confidence: 99%

Out-of-pocket payments in hospital bills: a challenge to management

et al. 2018

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Objetive: To analyse out-of-pocket payments (OOP) by health insurance company in hospital bills. Method: Cross-sectional study with quantitative approach. The information was obtained in the database of a health insurance company in the north of Paraná State and categorised into administrative and technical OOP. We analysed reports regarding OOP made in eight hospitals of the accredited network company, from 2013 to 2015. Results: The analysed data totalled 36 thousand items paid out-of-pocket. The highest OOP rates occurred in hospital 1 (67.6%); emergency room service (50.1%); time of hospitalization, ≤ 1 day (70.8%) and medical-hospital materials (59.2%). The year with the highest rates of administrative (54.51%) and technical (48.05%) OOP was 2013. Conclusion: We concluded that OOP are indicators for the institutions to check the critical topics to be improved and that managers must work on originator aspects of OOP, to prevent greater loss.

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Section: Discussionmentioning

confidence: 99%

Out-of-pocket payments in hospital bills: a challenge to management

et al. 2018

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“…A suspensão da assistência por decisão unilateral da operadora e a transferência de responsabilidades para o sistema público de saúde e para as famílias afrontam o direito dos usuários de receberem serviços na modalidade que melhor respondam a determinadas situações de saúde. Conclui-se que a atenção domiciliar na saúde suplementar é permeada por tensões que evidenciam a urgência de maior regulamentação no campo (26,27) .…”

Section: Atenção Domiciliar Na Suplementação à Saúdeunclassified

Atenção domiciliar em saúde no brasil: visão dessa política por uma revisão integrativa

Sousa

2019

RBPS

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Artigo de Revisão Este artigo está publicado em acesso aberto (Open Access) sob a licença Creative Commons, que permite uso, distribuição e reprodução em qualquer meio, sem restrições, desde que o trabalho seja corretamente citado. ATENÇÃO DOMICILIAR EM SAÚDE NO BRASIL: VISÃO DESSA POLÍTICA POR UMA REVISÃO INTEGRATIVA Home health care in Brazil: a glance at this policy through an integrative review Atención domiciliaria en salud de Brasil: opinión sobre esa política a través de una revisión integrativa

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“…Studies by Unifesp point to huge gaps in these "affordable" health plans: when the policyholders experience more serious health situations, the health plan simply abandons them to their own devices. That is, when people most need help, they end up turning to the public SUS 54 . Since basic health care has still not occupied its projected position as the coordinator of care, Brazilians circulate between the two subsystems (with no formal contacts to each other), where patients are increasingly left to manage their care on their own.…”

Section: Final Remarksmentioning

confidence: 99%

Apontamentos sobre os desafios (ainda) atuais da atenção básica à saúde

Cecílio

Chioro

2018

Cad. Saúde Pública

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In recent decades, Brazil has witnessed a proposal to create an extensive basic health care network as the main portal of entry to a universal public health system. Based on the recognition of consistent strides in that direction, the article addresses four issues on some important challenges for the consolidation of the basic health care proposal: (1) the use of the term "basic health care" as opposed to the usual, hegemonic concept of "primary health care"; (2) the disconnect or mismatch between the policy's wording and its real-life implementation, underscoring the need for a review of the Brazilian National Basic Health Care Policy (PNAB), which centralizes and standardizes rules and routines for the entire country while overlooking Brazil's continental dimensions, heterogeneity, and wide local diversity; (3) the isolation of basic health care and its peripheral position in the health system, pointing to the need for more complex arrangements in the coordination of care, not left merely under the organization and responsibility of basic health care; and (4) the lack of health policymakers, administrators, and professionals who are prepared and aligned with a project aimed at transforming the country's prevailing health care model.

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Os usuários e a transição tecnológica no setor de saúde suplementar: estudo de caso de uma operadora de plano de saúde

Abstract: Os usuários e a transição tecnológica no setor de saúde suplementar: estudo de caso de uma operadora de plano de saúde Users and the technological transition in the supplemental health sector: case study of a health insurance plan company

Cited by 6 publications

References 2 publications

Out-of-pocket payments in hospital bills: a challenge to management

Out-of-pocket payments in hospital bills: a challenge to management

Atenção domiciliar em saúde no brasil: visão dessa política por uma revisão integrativa

Apontamentos sobre os desafios (ainda) atuais da atenção básica à saúde

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