Microrregulação produzida pelos prestadores de serviços na linha do cuidado cardiovascular na saúde suplementar em Belo Horizonte, Minas Gerais

Abstract

Modern societys way of life has a significant contribution to the rise of chronic non-communicable diseases. Nowadays, they represent 46% of all diseases around the world. It is estimated that 17 million deaths per year are caused by cardiovascular disorders. About 80% of these deaths could be avoided with tobacco, cholesterol, obesity and hypertension control. The Government is gradually developing a system of care oriented towards the bio-psychic-social dimension of the individuals, with actions of health promotion and protection, prevention, diagnosis, treatment, rehabilitation and state of health maintenance, these being barely used in supplementary health programs. This study is a reflection regarding the implementation of health insurance qualification program and the existence of actions performed by the health companies and health delivery professionals that indicate changes within the biological model of care, in the view of the health care professional. Approved by UFMGs COEP under the number ETIC 013/07, its objective was to analyze the micro regulatory mechanisms that exist in the relation between health delivery professionals - health care companies - health insurance beneficiaries in Belo Horizonte, and their relationship with the rationality of the cardiovascular care line. It was guided by the description of the main conflicts between companies, users and professionals and in identifying the mechanisms that influence the guidelines of the operational care in the industry. It has an exploratory, descriptive, as well as a qualitative character. The study subjects consisted of eight cardiologists related to health insurance companies in Belo Horizonte. The adopted instrument of data collection was the individual in-depth interviews with a semi-structured script. The analysis and interpretation of data show that the logic of assistance is not focused on the user of health insurance needs yet. The relations established between health companies and health professionals, including hiring practices, compensation and non-financial regulatory instruments interfere in the assistance model, leading to a fragmented care for patients. The practices of health promotion and disease/risk prevention are still incidental or disregarded, with small or no impact on the beneficiaries health. The way of caring creates no bound, and does not prioritize the use of low-level technologies. Evidences show that the limiting of access to health services covered by insurance, the policy of exam authorization requests for the beneficiaries and the presence of audits enclose the quantity and quality of the health service and influence the provision of medical care, thus the full development of care guidelines.