Da arte de dizer não: a atividade do atendente em uma operadora de saúde

Abstract

There are a significant number of users of private health care plans in Brazil,distributed among the many different types of medical care. The relation between the users and the private health care plans is not always peaceful; in fact, in some cases it is very tense due to the many obstacles and norms created by the plans to prevent the users from getting health assistance not stipulated in their contracts.The bibliography about the service sector indicates that every service provision is based on a relation in which the operator aims at understanding the clients needs with the intention of saying yes. In the present study, evidence to the contrary was found: the many steps of the service are conducted in order to say that the clients request has been denied. Therefore, one could imagine that the operators activity is to inform repeatedly and monotonously an negative statement, as if he were a transmission gear to pass along an answer that has already been given in another level of the organization. This study addresses the strategies created by the operators to say no to the users requests. The proposed thesis is that there are certain autonomy margins and affective regulation strategies in the process of saying no, including alternatives that could eventually lead to accepting a request, despite the apparentstrictness, and bureaucratic and impersonal nature of the contractual arrangement between the client and the health care plan.The empiric study that took place in a health care cooperative from the city of BeloHorizonte, state of Minas Gerais, Brazil, made it possible to identify the different types of no used by the operators. This classification, proposed by the operators, was obtained through observation of the activity, recordings of conversations, and semi-structured interviews. The results show that the operators use strategies to regulate its affective load and to establish a interrelation with the clients and the other actors of the organization present in the process.