Pressupostos e proposta de modelo para a remuneração do trabalho do médico cirurgião nas operadoras de planos de saúde

• Ano de defesa: 2012
• Autor(a) principal: Soares, Adriano Leite
• Orientador(a): Escrivão Junior, Álvaro
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Palavras-chave em Português: Plano de saúde; Sistemas de saúde; Trabalho médico; Modelos de remuneração
• Palavras-chave em Inglês: Health care plan; Health systems; Medical work; Remuneration models
• Link de acesso: https://hdl.handle.net/10438/9492

Health providers services, and in this case, specially medical doctors, who's works interfere directly in outcomes and cost of the health system, has their methods of payment in the agenda of the most industry players, either in the public health system, but mainly in the supplementary health system, where because the continuous growth in cost, and the industry regulation dues, the providers gains has increments below the inflationary rates. Nowadays, the methods of payment, by itself, do not fulfill the gain goals of the health system providers, and even in a single health system, the different way of payment could be combined, and it is not obligated a unique payment method for each health system, just because the goals of remuneration moves around depending of the specialties, which contribute to keep the correct balance between demand and offer. The goals of this study is to enroll, between all of the payment methods, the basic assumptions for the surgeons payment, considering the sources applied in treatment, as well as life risk of each patient treated, trying to reproduce a standard formula to calculate the remuneration, and compare them with the present expenditure. The method of payment must encourage the treatment efficiency, and the equity of payment, and be easily understood by the industry players, and financial neutrality between principal and agency, keeping the quality and accessibility to medical services, and the doctors will be stimulate to increase the quality of the treatment to the users. Might be based on disease management, and not on procedures, and linked to performance index, and the risk owned by the patient. In conclusion, the medical labor remuneration proportionally by the total of work hours, by the same levels of the professional graduation and qualification, and the life risk of the patient treated. The new formula for calculate the medical payment consider not only the patient age, but also the risk involved on the treatment, and it is based on the disease, and not on a fee-forservice system. In this way, medical remuneration grows with the patient risk, as much as the increase of patient age, the increase of anesthetic and cardiac risks, resulting in a better correlation between hospitals costs, medical remuneration, and the resources used in the treatment.