Determinantes dos aditivos dos contratos de organização social na saúde: Avaliação sob a ótica da Teoria dos Contratos Incompletos

Abstract

Social Health Organizations (OSS) are private, non-profit entities that provide healthcare services through management contracts with the public sector. The Theory of Incomplete Contracts (TIC) emphasizes that long-term contracts are inherently incomplete, requiring ongoing adjustments through contractual amendments. In this context, this research aimed to identify the determining factors that lead to the execution of amendments in OSS management contracts, analyzing them through the lens of TIC. To achieve this, management contracts and their amendments signed in the city of São Paulo between 2013 and 2023 were examined, with a particular focus on the Covid-19 pandemic period (2020–2021). The analysis included the number of contracts and amendments, descriptions of the objectives, amounts involved, and duration periods. The results indicated that the main reasons for contract amendments were Operating Costs, Clause Changes, and Medical Consultations/Examinations, each accounting for more than 15% of the total amendments made. These findings underscore the need for constant contractual adjustments to ensure the continuity and quality of services provided by OSS. Furthermore, this study contributes to the improvement of public management by offering insights for the development of strategies that enhance the efficiency and transparency of health sector management contracts.