O relacionamento entre hospitais e operadoras de planos de saúde no âmbito do Programa de Qualificação da Saúde Suplementar da ANS

An Artifact for Evaluating the Quality of Health Service Providers: Evidence From Brazil

The aim of this article is to present an artifact for evaluating the quality and performance of service providers in the field of health care: the UNIPLUS Program. To verify the scientific nature of the artifact and ensure that it meets the criteria set by the community and the environment, the premises of Design Science Research (DSR) were used. As this research field lacks empirical evidence, the artifact was tested from 2013 to 2015 with 25 health care service providers from different categories, with an emphasis on hospitals and clinics located in 7 cities in the south of Brazil. This article makes 3 main contributions to the field: (1) the artifact can be applied to any health insurance operator in Brazil and other countries, as it meets the legal norms and requirements established by current legislation; (2) it helps health service providers by generating information that identifies shortfalls and possibilities for improvement for every aspect analyzed in the evaluation process; and (3) it uses the DSR methodology in an evaluation artifact that evaluates the quality and performance of services in the field of health care. The artifact proved to be adequate for the purpose in question, helping to improve the quality of care and institutional performance.

[Trend analysis of the claim rate and the impact on the reduction of the number of private healthcare providers in Brazil]

Alarming data on the part of health care providers on the increase of the claim rate and its potential risk has emerged. It is a descriptive study, with the objective of understanding the changes in the healthcare provider sector in recent years, using the temporal analysis of historical series related to the sector. The variables selected for this study were the claim rate, the coverage rate, and the number of private healthcare providers in activity, observed from 2003 to 2014. The method used for evaluation of the temporal trend was Linear Regression. The claim rate and the coverage rate show an upward trend in the period, while the number of operators in Brazil showed a decreasing trend during the same period. These results show that even with the increase in demand, there was a decrease in the number of operators active in the country. The claim rate is one of the possible causes observed this inverse relationship because the increased offers risks of survival and the opening of new operators. Moreover, the decrease in the number of providers, is leading the country to an oligopolistic industry with an increasing demand in the number of beneficiaries. This decrease is also associated with regulatory processes, which regulates the sector's relationship with the beneficiary.

The need to establish a national patient safety program in Brazil

The aim of the study was to promote reflection on the need to create a national incident notification system based on a brazilian patient safety program. Incidents in health care harm patients and encumber the health care system. Although a quality assessment program has been recently launched in health care institutions, the Brazilian Ministry of Health does not yet have a program which systematically assesses negative outcomes of health care. This article discusses the need to establish a national patient safety program in Brazil, aiming to promote a culture of patient safety and quality health care in the Brazilian Unified Health System.

Tendências da função do enfermeiro auditor no mercado em saúde

Este estudo objetivou identificar tendências atuais e futuras (próximos cinco anos) da função do enfermeiro auditor no mercado de trabalho. Metodologicamente a investigação foi estruturada utilizando-se a técnica Delphi, por meio de duas rodadas, com a participação final de 34 enfermeiros de instituições de saúde e ensino brasileiras. Os dados foram tratados mediante estatística descritiva. Os resultados evidenciam que na atualidade, está focada na dimensão burocrática, de cunho contábil e financeiro, contemplando exigências das instituições de saúde. Quando essa tendência é reportada para o futuro, observa-se uma projeção de mudança incorporando a avaliação da qualidade da assistência. Quanto aos métodos, a situação atual, é de proceder segundo a forma retrospectiva, do tipo interna, contemplando a coleta e análise dos pagamentos de contas. À medida que a auditoria de enfermagem incorporar à sua prática a avaliação da qualidade, conforme tendência futura, os métodos agregarão diferentes maneiras para sustentar a nova realidade.