Fatores da heterogeneidade do desempenho econômico-financeiro das autogestões em saúde no Brasil

Abstract

The health sector is one of the most complex and important in the economy, and an efficient administration of health insurance companies is crucial to guarantee the quality and accessibility of services provided to beneficiaries and to deal with the growing hospital medical costs. In this context, self-management operators died as an alternative to contracting market health plans, offering participants greater autonomy and control over the health care they receive. However, despite the advantages of these organizations, the number of operators and beneficiaries receive hospitality and the differences in economic and financial performance between them are wide. Thus, this work aims to analyze the heterogeneity factors of the economic-financial performance of self-management operators in Brazil, describing the main determinants of the results. This is a descriptive research with a quantitative and qualitative approach. Data were collected from the regulatory agent, including operators' inspectors, for the year 2021, for further analysis using descriptive and relational statistics. In the qualitative stage, the primary data originated from semi-structured interviews, carried out with high-ranking managers of five different port operators and the association that represent the self-managements, later condensed through content analysis. The research revealed a positive relationship between average age, territorial coverage and per capita expenses, but the "size" variable affects expenses in a "U" shape. The variables "immobilization of equity" and "foundation data" were not statistically significant. Qualitative research has shown that controls are necessary for financial performance and that governance and labor causes influence it. Other environmental factors also compromise financial performance, including systemic risks such as changes in regulatory policies and competition. Finally, it is recommended that future research can address the heterogeneity of organizational performance of health self-management operators, considering financial determinants and other individual factors, in addition to evaluating their instructors in the quality of services. The current study was limited by one-year statistical data, therefore, new research with broader data and including operators of other modalities of care in the supplementary health system are suggested for statistically more relevant results.