title: [Procedures and perceptions of professionals and groups acting in the Brazilian health plan market].
abstract: This study analyzes the mechanisms used in Brazil by health plan and insurance operators, hospitals and physicians for organizing the access to health care services and their strategies towards cost reduction and decision-making. The study is based on the literature about regulation of the health services, with special focus on micro-management and managed care. From an intentional sample of health care organizations selected according to the number of beneficiaries, organizational modality and geographic criteria we selected probabilistic samples of doctors and hospital services. Data were collected through questionnaires applied to key informants from health care operators and affiliated doctors and hospitals. Results suggest that the relationships between health care organizations, physicians and hospitals follow basically patterns inherited from the former social security system, mainly with fixed pricing and open account payments. More complex financing mechanisms, risk sharing and efficiency strategies are of minor interest. Mechanisms for risk reduction and encouragement of adequate use of technologies are weak. Cost control is mainly based on co-payment and barriers to access to the services. We conclude that in Brazil managed care is still in its beginning.
authors.affiliation: Departamento de Ciências Sociais, Escola Nacional de Saúde Pública, Fiocruz, Rio de Janeiro, RJ. ribeiro@ensp.fiocruz.br
authors.forename: José Mendes
authors.initials: JM
authors.lastname: Ribeiro
authors.forename: Lenaura de Vasconcelos Costa
authors.initials: Lde V
authors.lastname: Lobato
authors.forename: Jeni
authors.initials: J
authors.lastname: Vaitsman
authors.forename: Luís Otávio
authors.initials: LO
authors.lastname: Farias
authors.forename: Maurício
authors.initials: M
authors.lastname: Vasconcellos
authors.forename: Eliane
authors.initials: E
authors.lastname: Hollanda
authors.forename: Carla Pacheco
authors.initials: CP
authors.lastname: Teixeira
mesh_terms: D001938:Brazil; D003363:Cost Control; D019981:Health Care Sector / Q000458:organization & administration; D006761:Hospitals; D007348:Insurance, Health / Q000191:economics; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration; D010820:Physicians