Contracting in the Private Inpatient Care Market of the Metropolitan Region of Salvador (Bahia, Brazil): Models and Performance

AUTOR(ES)
DATA DE PUBLICAÇÃO

1998

RESUMO

This study explored the contracts between private health insurers, users and providers, so as to determine the effects of specific contractual arrangements on the rates of admissions and expenditure per admission. The study proposed and tested a theoretical model built with the determinants of rates of admission and expenditure per admission in a health insurance context. The admissions studied occurred in hospitals of Salvador (Brazil), during the period January 1995 to December 1996. The patients came from three health insurance schemes established to manage and sell employment-based health coverage. The research employed both qualitative and quantitative methods. The qualitative aspect focussed on the characterisation of the context and the nature of the contractual arrangements. Once each schemes main features were identified, hypotheses were established in reference to the proposed theoretical framework. The hypotheses were empirically tested with the data concerning rates of admissions and expenditures per admission. Approximately 5500 admissions from about 90000 people were analysed. The analysis revealed that co-payment by users was a important deterrent factor in relation to the number of admissions. The exclusion of diseases from the coverage also seems to reduce the number of admissions. Patients sex and co-payment did not influence the expenditure per admission. Length of stay, standard of accommodation, hospital category, patients age and the procedure performed (surgical or medical), were identified as good predictors of the expenditure per admission. However, the predictors behaviour varied from scheme to scheme. Each scheme has a distinct multivariate model which appears to be associated to their respective contractual characteristics and case mix. There is evidence that the schemes have different case mix and that each case mix is partially a resultant of the characteristics of the respective scheme. While the proposed theoretical model provided useful guidelines, its predictive power can be improved by incorporating a number of other factors and quantitative measurements of the variables involved with the determination of number of admissions and expenditure per admission.

ASSUNTO(S)

private health insurers setor privado de saúde assistencia hospitalar brazilian health system health care market políticas de saúde instituiçoes médicas saude publica health policy

ACESSO AO ARTIGO

Documentos Relacionados