experiências de avaliação do setor suplementar de saúde: contribuições da integralidade evaluation experiences of the supplementary care sector: contributions of integrality

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2008
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Abstract
Este trabalho identifica aspectos de integralidade nas propostas de avaliação de assistência à saúde da Agência Nacional de Saúde Suplementar (ANS), no Brasil, e do National Commitee for Quality Assurance (NCQA), nos Estados Unidos. A metodologia adotada foi a da análise documental das propostas encontradas nos sítios eletrônicos das instituições no segundo semestre de 2006. Os dados foram sistematizados numa matriz analítica com atributos das práticas de gestão e organização de serviços; dos conhecimentos e práticas dos trabalhadores de saúde; e das práticas de controle pela sociedade. Os resultados apresentados destacam, no caso brasileiro, uma ênfase no primeiro e terceiro atributos, com a avaliação centrada nas operadoras os planos de saúde não foram avaliados. No caso americano, houve um equilíbrio nos três conjuntos de atributos, sendo a avaliação direcionada aos planos de saúde. Ambas as propostas mensuraram a satisfação dos beneficiários e divulgam os resultados das avaliações em sítios eletrônicos. Em conclusão, destaca-se a importância de conceitos e abordagens avaliativas da integralidade nas operadoras de planos privados de saúde no setor suplementar brasileiro.
This work identifies aspects of comprehensiveness in the proposals for healthcare evaluation of the Agência Nacional de Saúde Suplementar (ANS) in Brazil, and of the National Commitee Quality Assurance (NCQA) in the U.S.A. The investigation was based on a documental analysis of the proposals found in the websites of both institutions in the second semester of 2006. The data were systemized according to pre-established attributes, building an analytical matrix for evaluating the following three dimensions: management practices and service organization; quality of knowledge and of practices of the health workers; and quality of the control practices of the society. In the Brazilian case there was an emphasis on the first and the third dimensions. The evaluation focalized the operators; the health plans were not evaluated. In the American case there was a balance between the three sets of attributes and the evaluation was focused on the health plans. Both proposals measured the satisfaction of the beneficiaries and made the results of the evaluations available in their websites. In conclusion we emphasize the importance of evaluative concepts and approaches for measuring the integrality of private health plan operators in the Brazilian supplementary health sector.
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Authors ;Aluísio Gomes da Silva Junior;Marcia Guimarães de Mello Alves;Monica Tereza Machado Mascarenhas;Valeria Marinho Nascimento Silva;Luis Cláudio de Carvalho
Journal journal of physical activity & health
Year 2008
DOI
10.1590/S1413-81232008000500014
URL
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232008000500014
Keywords
health services quality of health care performance measurement serviços de saúde

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