Gestão da cadeia de fornecedores de serviços na saúde suplementar: elementos indutores ao credenciamento e diretrizes para o desenvolvimento da rede credenciada

Abstract

The government regulation of health plan operators in Brazil, with its operating and inspection standards, has brought about significantadvancements as regards the way health plans serve their customers. The health plan operators, however, are faced with the increasing pressure from soaring operating costs. The health plan operators use the services of a chain of accredited health care providers to serve their beneficiaries with a full range of health care services. When these health care providers join up with the health plan operators, they start acting as their representatives in providing the services beneficiaries require. This research work looks into the elements that induce the suppliers to join up with the health plan operators and proposes a set of guidelines for the development of a management system for the chain of non-governmental health service providers. Two casestudies were carried out and presented in distinct articles. In the first case study, which looks into the elements that lead health care providers to join the health plan operators, 12 health care providers were interviewed. In the second case study, aimed at proposing guidelines for the development of the chain of health care providers, 10 health care providers and 10 managers were interviewed who work closely with health plan operators. The findings indicate that the major elements that induce health care providers to join up are the prospect of an assured demand, assurance of payment and an increased customer base. The research proposed a set of guidelines for the development of a management system for the chain of providers, taking into account elements such as provider selection and evaluation, operator guidance, compensation, operator incentive and indicators. The results show that the health care providers andthe health plan operators still lack development as regards the management of the chain and the services rendered.