Desafios dos Sistemas de Informação na Aplicação dos Modelos de Remuneração de Prestadores de Serviços na Saúde Suplementar

Abstract

The Supplementary Health System (SHS) "refers to the activity that involves the operation of private health care plans under government regulation" (Ministry of Health, 2012). This article aims to present an introduction to the SHS in Brazil, including the Regulation of Supplementary Health (RSH) by the National Supplementary Health Agency (ANS), and the challenges of Information Systems for implementing these models. The methodology of systematic literature review and a case study of a health insurance operator in Campo Grande-MS, which has its own hospital, was used for the development. In the end, it presents the challenges of Information Systems found in the literature and the case study for the Application of Healthcare Service Provider Remuneration Models in Supplementary Health, as well as possible technological solutions. It was found that the challenges encountered are related to providing information and support for decision-making, to predict, monitor, and reconcile the performance of providers according to their contracted terms, rates, and metrics. It was also verified, through the case study, that the application of performance-based models led to greater engagement of teams and higher quality in the provision of patient care.