A study of the relations between health-assistance plans organizations and service providers

DOI: 10.15343/0104-7809.200630.2.3

Abstract

This article presents a study on the contractual relations between health organizations and of hospital services providers
aiming to identify the factors that influence the contractual relation and to delineate the basic elements that configure the enterprise
standards of supplementary healthcare market. Using questionnaires, interviews with Directors and Executives of three health-assis-
tance plans and three hospitals, an exploratory, descriptive and qualitative study has been done. The analysis of results was presented in
three stages: services qualification, assistance quality and contractualization. The research shows that health-assistance organizations
qualify their net of hospital service providers based on the net size net, technical definitions for net hierarchization and the clientele
size. Hospitals qualify health-assistance organizations based on competitive prices and image diffusion. One concludes that health-as-
sistance organizations evaluate assistance quality of services providers without using formal assistance-quality evaluation programs. It
was also verified that health-assistance organizations and hospital services providers monitor the fulfillment of contractual clauses the
parts convened, but use no item or clause that contemplates indices variations to be applied.