Gestão na saúde suplementar em um plano de saúde frente a regulamentação 358 da Agência Nacional de Saúde

Abstract

The market of health insurance in Brazil is regulated through the National Agency of Health, defining several criteria to service installment, inside of these installment stands out the RN 358, that determines the reimbursement to SUS through the operators. The present study has the objective to identify the actions that are taken by the operator front the regulation of NAH - RN 358. It is an exploratory and descriptive, quantitative and qualitative research. The data were collected in the NAH’s website, in the federal government and in the web portal of the company in the study. Also, a questionnaire was applied to the manager of the company and interviews open with two collaborators of different sections. Among the topics, we find: the analysis of categories incorporated the panorama of the healthy insurances in Brazil and the qualification program and classification of these operators; the administration (planning, organization, direction, and control) processes; and the practices adopted for the health operator to attend the normative of NAH. In relation to RN 358, it was identified how works the system of collecting the reimbursement. The results indicate about the planning, the organization applies the analyzes SWOT, aiding in the definition of the objectives to be reached, however, the decisions of immediate impact have the own beneficiaries' participation considering being a self-management plan. The control of the activity is possible through analysis of the data, indicators and statistics. For the organization process and direction, the company has been looking for to professionalize through the collaborators' training and adaptation of the available resources to maintain the balance. The regulatory agency of the plan of attendance to the health, through normative, standardizes several areas in the segment of the supplemental health, being highly one of the factors that interfere directly in the maintenance and permanence of those companies in that niche market, turning that activity branch selective. It was verified that NAH possesses direct interference in the administration of the health insurances, consisting to be a challenge to maintain the balance in that activity division, where it is necessary the updating constant front the regulations and the need of an administration proactive.