[Regulation of radiotherapy and chemotherapy services by health plan organizations in Brazil].
This paper characterizes regulatory procedures applied by private health plan operators on their outpatient radiotherapy and chemotherapy services, especially via contracts, and outlines the health care providers’ perception on regulation. The study relied on primary data, taking into consideration 638 hospitals and outpatient health care units with the services in question. A stratified random sample was selected, resulting in the inclusion of 54 units that are representative of the population, excluding hospitals that only provide radiotherapy. Private chemotherapy services are largely funded by health insurance plans (75.0%), while radiotherapy services are predominantly covered by the public health system (49.0%). Contracts are not applied by third part payers, in their potential, as regulatory and health care coordination instruments. The mechanisms of regulation applied by third part payers are centered on services use control and administrative aspects. It is recognized the need of adjustments for a health care quality focus, and contracts may contribute in this sense.
Sheyla Maria Lemos
SM
Lima
Margareth Crisóstomo
MC
Portela
Maria Alicia Domíngues
MA
Ugá
Maurício Teixeira Leite
MT
de Vasconcellos
D001938:Brazil; D003430:Cross-Sectional Studies; D004358:Drug Therapy / Q000592:standards*; D006288:Health Planning Organizations; D006801:Humans; D011878:Radiotherapy / Q000592:standards*