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- Title
DETERMINANTES DA INADIMPLÊNCIA DAS OPERADORAS DE ASSISTÊNCIA À SAÚDE EM RELAÇÃO AO RESSARCIMENTO AO SUS.
- Authors
Carvalho Santos, Larissa; Bomgiovani Cazzari, Roberto
- Abstract
Purpose: Reimbursement to the Sistema Único de Saúde (SUS) establishes that whenever a health plan beneficiary enjoys SUS services, the operators must bear this burden, reimbursing the SUS - which allocates the amount received to the Fundo Nacional de Saúde, manager which plays an important social role in financing public health. However, when looking at the numbers charged, there is a significant rate of default by Health Care Plan Operators (OPS). Thus, given the scenario, the purpose of this work was to identify the factors determining this default. Foundation: Reimbursement to the SUS is a way of mitigating what is considered “unjust enrichment in OPS. Additionally, it is a source of financing for the SUS. Therefore, failure to comply with this OPS obligation has a social and economic impact on public health financing. Method: A logistic model was used with the objective of identifying which organizational and economic-financial variables were capable of explaining which characteristics of the OPS explained the default in reimbursement to the SUS. The sample made up a total of 637 OPSs with data in 2019. Results: The results indicated that larger health care plan operators (over 100,000 costumers) were more likely to default in the reimbursement with SUS when compared to the others. Contributions: The results highlight the social and economic dimension associated with the problem, highlighting that large OPS are contributing to the compromise of public health financing.
- Subjects
ECONOMIC impact; SOCIAL finance; UNJUST enrichment; SOCIAL role; DEFAULT (Finance); FINANCING of public health
- Publication
Revista Evidenciação Contábil & Finanças, 2023, Vol 11, Issue 2, p138
- ISSN
2318-1001
- Publication type
Article
- DOI
10.22478/ufpb.2318-1001.2023v11n2.66169