EVALUATION OF THE PERFORMANCE OF OPERATORS OF HEALTH PLANS WITH CERTIFICATE OF ACCREDITATION
Descriptors: Accreditation, Supplementary Health, Quality Improvement, Management of Quality.
Abstract
Introduction: Accreditation is a recent initiative in supplementary health and aims to evaluate the processes of health plan operators. Studies that prove its impacts regarding quality in health are scarce, as well as the analysis of performance in other government programs.
Objective: To analyze the relationship between the accreditation of health operators and their performance in relation to the quality assessed by the National Supplementary Health Agency in the Operator Qualification Program.
Method: Observational study carried out with a sample of 636 operators evaluated in the Operator Qualification Program (base year 2018) and among them, 53 operators accredited in the same period. Data collection was carried out through public reports available on the website of the National Supplementary Health Agency. For the analysis of the data, the profile of the accredited operators was drawn up; Student T test to assess whether accredited operators perform better in the Operator Qualification Program and the Mann-Whitney test to assess whether performance is increasing among accredited operators according to the classification level (Level I, III and III).
Results: The accredited operators (n = 53) comprise 8.3% of active operators, 77.36% are in the most developed cities in the country; 89% are classified in Level I and 9% in Level II and only one Level III (2%); 51% are large and 38% are medium-sized. Performance in the Qualification Program averaged 0.7959 for accredited operators and 0.6118 for non-accredited operators (p value 0.00). The operators' performance did not present an increasing performance according to the level of accreditation classification.
Conclusions: The tests carried out proved that accredited operators have better performance than those not accredited in the Operator Qualification Program. The indicator related to the management of access to services presented the worst performance of the operators. The results of this work can be used as an incentive to the accreditation and implementation of improvement processes.