cobertura de planos privados de saúde e doenças crônicas: notas sobre utilização de procedimentos de alto custo private health plans coverage and chronic diseases: notes on the use of high-cost procedures
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ID: 154637
2004
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Abstract
Com o objetivo de contribuir para especificar a origem das fontes de remuneração dos procedimentos de alto custo, relacionados com a assistência a doenças crônicas, o presente trabalho examina a utilização de procedimentos médicos selecionados por clientes vinculados a planos privados de saúde e pelos segmentos populacionais cobertos exclusivamente pelo SUS. O estudo se baseia na comparação entre taxas de utilização dos procedimentos selecionados, obtidos por meio de informações solicitadas a empresas de planos de saúde, consultas às fontes oficiais e estimativas fornecidas por informantes-chave. Apesar de possíveis problemas de classificação, as taxas de utilização dos clientes de planos privados de saúde para revascularização do miocárdio, angioplastia, artroplastia de quadril, e cirurgia de obesidade mórbida são mais elevadas do que as estimadas para os segmentos populacionais exclusivamente cobertos pelo SUS. Por outro lado, as proporções de transplantes hepáticos e terapias renais substitutivas remuneradas diretamente pelo SUS variam de 89% a 96%. Tais resultados sinalizam uma divisão de atribuições entre as esferas pública e privada no que se refere às fontes de remuneração dos procedimentos de alta complexidade.
This article examines the use of selected medical procedures by private health plan clients and the use of those same procedures by population segments covered exclusively by SUS, seeking to identify the remuneration sources of high-cost procedures. This study is based on the comparison between use rates of selected procedures obtained by request from health plan enterprises as well as through consultation of official sources and through estimates of the proportion of provided care according to key informants. The parameters of cardiac surgery use were compared with international indicators. In spite of the possible taxonomical problems regarding the analyzed procedures, the use rate of private health plan clients for cardiac bypass, cardiac angioplasty, hip arthroplasty, and morbid obesity surgery are higher than the estimated ones for the population segments covered by SUS. On the other hand, the proportions of hepatic transplants and substitutive renal therapies directly paid by SUS vary from 89% to 96%. Such estimates signal that attributions concerning the remuneration sources of high-cost procedures are shared between the public and private spheres.
This article examines the use of selected medical procedures by private health plan clients and the use of those same procedures by population segments covered exclusively by SUS, seeking to identify the remuneration sources of high-cost procedures. This study is based on the comparison between use rates of selected procedures obtained by request from health plan enterprises as well as through consultation of official sources and through estimates of the proportion of provided care according to key informants. The parameters of cardiac surgery use were compared with international indicators. In spite of the possible taxonomical problems regarding the analyzed procedures, the use rate of private health plan clients for cardiac bypass, cardiac angioplasty, hip arthroplasty, and morbid obesity surgery are higher than the estimated ones for the population segments covered by SUS. On the other hand, the proportions of hepatic transplants and substitutive renal therapies directly paid by SUS vary from 89% to 96%. Such estimates signal that attributions concerning the remuneration sources of high-cost procedures are shared between the public and private spheres.
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bahia2004cinciacobertura
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| Authors | ;Ligia Bahia;Elaine Simmer;Daniel Canavese de Oliveira |
| Journal | journal of physical activity & health |
| Year | 2004 |
| DOI |
10.1590/S1413-81232004000400013
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