A tese buscou verificar se os fatores considerados pelas Operadoras de Planos de Saúde quando tomam a decisão de se integrar verticalmente encontram respostas na Teoria dos Custos de Transação. Para tanto, reconstruiu a história dos planos de saúde no Brasil, enfocando o processo de regulamentação do mercado de saúde suplementar, que restringiu mecanismos utilizados para reduzir o comportamento oportunista de beneficiários e prestadores de serviços e que contribuiu para aumentar a complexidade e incerteza. Além disso, o maior ativo específico do setor, a relação médico-paciente, está em grande medida fora das Operadoras. Soma-se aos fatos a impossibilidade de se prever contratualmente todas as circunstâncias futuras e se tem o cenário ideal para a integração vertical em direção aos prestadores de serviços. As demonstrações financeiras das Operadoras entre 2007 e 2011 confirmam a crescente verticalização nas modalidades nas quais é permitida, com destaque para as Cooperativas Médicas. Entrevistas realizadas com gestores de cinco Operadoras, selecionadas dentre aquelas que mais incorreram em despesas assistenciais em rede própria no período 2007-2011, permitiram verificar a presença dos determinantes da integração vertical previstos na Teoria dos Custos de Transação. Constatou-se, ainda, que as referidas Operadoras estão internalizando atividades de prestação de serviços assistenciais e aquisição de insumos, além de desejarem internalizar a gestão da atenção médica dispensada a seus beneficiários, como forma de prover um serviço mais eficaz e sustentável economicamente. / The thesis verifies if the factors considered by the Health Insurance Companies (HICs) when they decide to integrate vertically are coherent with the Transaction Cost Theory. In order to do so, the history of the health plans in Brazil was reviewed, with a focus on the process of regulation of the health plans market which restricted the mechanisms typically used to refrain opportunistic behavior of clients and service providers, what contributed to increase the market's uncertainty and complexity. Besides, the health market's greatest asset – the doctor-patient relationship – is outside of the HICs control. If you add to these factors the impossibility to put in a contract all possible situations that may happen in the future, you get the ideal scenario for the vertical integration of the HICs with those who provide services for them. The analysis of the HICs' financial statements between 2007 and 2011 confirms an increased verticalization on those niches where it is allowed, with a special emphasis on the Physician Cooperatives. Interviews conducted with the managers of five HICs, selected among those that incurred in the largest expenses for providing healthcare services in their self-owned facilities between 2007 and 2011, allowed for the verification of the existence of the determinants of vertical integration predicted by the Transaction Cost Theory. Moreover, it was also verified that the analyzed HICs are internalizing healthcare assistance and procurement services, besides intending to internalize the management of the medical services provided to their clients, as a way to provide a more efficient and economically sustainable service. / Tese (doutorado) - Universidade Federal do Rio de Janeiro. Instituto de Economia, Rio de Janeiro, 2013 / Bibliografia: p. 243-248

No presente estudo tem-se o objetivo de analisar a efetiva implantação de um produto de Assistência à Saúde como estratégia empresarial, em suas diversas etapas de execução. A compreensão das dificuldades e dos desafios na implantação de uma estratégia empresarial é o ponto de partida desta pesquisa. Separadas conceitualmente, estratégia e execução são, em verdade, etapas de igual importância que merecem uma visão conjunta. A execução efetiva, entretanto, de uma estratégia, carrega em si uma complexidade de tarefas e uma quantidade de fatores. Também as novas demandas criadas pelo mercado de baixa renda desafiam as organizações, propiciando o lançamento de novos produtos destinados a um novo tipo de consumidor. O desafio de tornar a organização um ofertante ful-line no mercado de saúde suplementar, agregando ao seu portfólio um produto para as classes emergentes, constituiu o cenário e as proposições estratégicas que deveriam ser implementadas como importante decisão da Unimed Porto Alegre. Em relação ao método, adotou-se a pesquisa-ação, em um conceito de pleno envolvimento do pesquisador nas ações desenvolvidas. A execução da estratégia na implantação de um produto de assistência à saúde para o mercado de baixa renda abrangeu o período de 2008 a 2011. Analisaram-se as diversas etapas na implantação do produto e foram considerados os indicadores de desempenho empresarial e mercadológicos, consolidando-se a busca dos objetivos estratégicos propostos. O conjunto de evidências apresentadas consolidou o êxito na execução e nos resultados obtidos. O estudo se justifica por analisar, na prática, o desafiador conjunto de fatores no desenvolvimento de produtos para o público de baixa renda e a dedicação necessária à execução exitosa de uma estratégia empresarial. / Understanding the difficulties and challenges in the implementation of an effective business strategy is the starting point of this research. Conceptually separate, strategy and execution are in fact equally important steps that deserve a joint vision. The effective execution from a strategy carries with it a complexity of tasks and a number of factors that can frustrate even a brilliant design. Also the new demands created by the low-income market challenge organizations providing opportunities to launch new products for a new type of consumer. The challenge of making the organization a bidder ful-line health supplement on the market, adding to its portfolio a product for emerging classes constituted the scenario and strategic propositions that should be implemented as an important decision from Unimed Porto Alegre. Thus this dissertation was developed as a method of study and action research, within the concept of full involvement of the researcher in the actions developed. Strategy execution in deploying a product of health care for low-income market studies the period from 2008 to 2011. The study analyzed the different stages in product deployment. Business performance indicators and market were considered, consolidating the pursuit of strategic objectives proposed. The body of evidence presented consolidates the successful implementation and results. The study is justified by analyzing, in practice, challenging set of factors in the development of products for the low-income public and the dedication needed to run a successful business strategy.

O presente trabalho analisa as relações de consumo nos planos privados de assistência à saúde a partir dos princípios da vulnerabilidade e da confiança. Aborda o contexto pós-moderno no qual este pacto está inserido e os reflexos que o avançar da idade podem trazer aos serviços médico-ambulatoriais. Analisa o tema a partir da doutrina, legislação e jurisprudência, investigando qual a resposta dada pelos operadores do direito para enfrentar os desafios que o agravamento da vulnerabilidade do consumidor-idoso traz aos planos e seguros de saúde. Busca verificar quais os instrumentos necessários para a tutela da saúde do idoso e de sua confiança, permitindo que ingressem nestes pactos com padrões mínimos e inderrogáveis de proteção, para que haja um desenvolvimento social harmônico e um crescimento econômico equilibrado desta importante parcela do mercado de consumo. Aborda a vulnerabilidade inerente à relação de consumo e a imprescindibilidade de uma hermenêutica jurídica adequada à proteção dos idosos nos contratos de planos e seguros de assistência à saúde, bem como a importância do diálogo das fontes para reconstruir a confiança dos consumidores-idosos. Examina o fenômeno crescente da judicialização da saúde suplementar no Brasil para o controle de cláusulas e práticas abusivas neste importante setor do mercado de consumo. Por fim, ressalta a necessidade de ações afirmativas no campo dos serviços privados médico-assistenciais através do diálogo das instituições como forma de reconstruir e reforçar a confiança do consumidor. / The present work analyzes consumer relations in the healthcare plans and in the health insurance based on the principles of vulnerability and trust. It addresses the postmodern context in which this pact is inserted and the reflexes that advancing age can bring to the medical outpatient services. It analyzes this issue from the doctrine, legislation and jurisprudence, investigating the response given by legal operators to the challenges that the aggravation of the vulnerability of the elderly consumer can bring to health insurance and healthcare plans. It seeks to verify the necessary mechanisms to protect the health of the elderly and their confidence, allowing them to enter in these contracts with minimum and non-derogable standards of protection, so it can be had a harmonious social development and balanced economic growth of this important part of the consumer market. It discourses the vulnerability inherent in the relationship of consumption and the indispensability of proper legal interpretation to the protection of the elderly in healthcare plans and health insurance, and the importance of the dialogue of the sources to rebuild elderly consumer confidence. Examines the growing phenomenon of the development of the number of claims at the Judiciary, associated to matters related to health insurance and healthcare plans in Brazil and to the control of clauses and abusive practices in this important sector of the consumer market. Finally, it emphasizes the need for affirmative action in the field of private medical care services through institutional dialogue to rebuild consumer confidence and strengthen the principle of trust, contributing to a harmonious social development and balanced economic growth. Finally, it emphasizes the need for affirmative action in the field of private medical care services through institutional dialogue to rebuild consumer confidence and strengthen the principle of trust.

Inhabitants´ Opinions to the Health Service Problems in the Czech Republic The diploma thesis {\clqq}Inhabitants´ Opinions to the Health Service Problems in the Czech Republic`` deals with the problems of the Czech health service. The theoretic part treats of the definitions of the main terms, legislative framework, state health service policy, public health insurance, public finances reform and first of all treats of the new Act on Public Budget Stabilization n. 261/2007 Law Code, effective from January 1st, 2008. Recently there have been discussed the Czech health service problems within the context of publication of the health service reform. The implementation of the regulation fees evokes the atmosphere of disagreement and fear from financial non-capacity in the inhabitants resulting from the fees implementation on particular items of health care. It is necessary to realize that there have been health service problems all the time. But this situation doesn´t apply to the Czech Republic solely. Quite a number of states have to solve the problems and shortcomings of the health service system. To point out these problems, to find out the cause but first of all to find the ways to deal and eliminate problems should be the main objective of the state. The Czech health service needs badly the alternation. It has to tackle the 21st century challenges and at the same time to continue in european tradition which is based on the availibility of health care for all our inhabitants. There are no doubts that population ageing, new medical procedures, services quality requirements and the possibility of co-determination will lead to the significant changes of financing and organization of the health service all over the world. (18) The aim of the diploma thesis is to survey the ideas applying to the health service problems in the Czech Republic by the inhabitants over 18 years old living in Nachod region. In the framework of quantitative research there were used the questioning method (questionnaire) and the method of document analysis (the technique of secondary data analysis). The diploma thesis {\clqq}Inhabitants´Opinion to the Health Service Problems in the Czech Republic`` tries to illustrate comprehensive aspect of the general public to the Czech health service and challenge to study this problem.

Die Palliativversorgung (PV) verfolgt das Ziel, die Lebensqualität in der noch verbleibenden Lebenszeit von Patienten mit lebensbedrohlichen Erkrankungen zu maximieren. Deutschland verfügt mittlerweile über ein umfassendes PV-System im ambulanten und stationären Sektor und einen Anspruch auf PV als Teil der Regelversorgung. Im Rahmen dieser Untersuchung soll überprüft werden, ob die Inanspruchnahme der PV-Institutionen der vom Gesetzgeber und medizinischen Experten intendierten Reihenfolge entspricht und ob es Überlebenszeit- oder Gesundheitsausgabenunterschiede gibt (jeweils im Vergleich zu Nicht-Palliativpatienten). Dazu wird ein Paneldatensatz der AOK PLUS (Sachsen und Thüringen) mit Patienten verwendet, die zwischen 2009 und 2012 an einer Krebserkrankung litten (n=447.191). PV-Patienten werden entsprechend ihres Inanspruchnahmeverhaltens in vier Interventionsgruppen eingeteilt, von denen jeder mittels Propensity Score Matchings eine eigene Kontrollgruppe zugeordnet wird. Als statistische Werkzeuge werden v.a. Übergangswahrscheinlichkeiten, Kaplan-Meier-Überlebensfunktionen sowie lineare und nicht-lineare Regressionsmodelle verwendet. Die Ergebnisse legen nahe, dass die Reihenfolge der Inanspruchnahme im Einklang mit Gesetzen und Richtlinien ist. Überlebensnachteile der PV-Patienten können nicht festgestellt werden. Die Gesundheitsausgaben steigen nach erstmaliger Inanspruchnahme einer PV-Institution in allen Stichproben stark an. Dieses Ergebnis ist sehr robust gegenüber Änderungen der Modellspezifikation, des Modelltyps und der Stichprobe. Die Ergebnisse lassen auf eine hohe Struktur- und Prozessqualität der PV-Angebote schließen. Jedoch führt die Inanspruchnahme von PV in ihrer derzeitigen Form offenbar nicht zu Einsparungen. Ein weiterer Ausbau des PV-Systems finanziert sich demnach nicht „von selbst“. Aufgrund der sehr kurzen Nachbetrachtungszeiträume bleibt die gesundheitsökonomische Analyse der PV weiterhin herausfordernd. / Palliative Care (PC) is an approach for patients with life-threatening diseases that focuses on improving quality of life rather than maximizing the remaining life time. Meanwhile, Germany possesses a comprehensive PC system in the ambulatory and inpatient sector where PC treatments are part of standard care. The objective of this research is to evaluate whether patients are using PC institutions as intended by law and medical experts and whether PC patients differ in terms of survival time or health care expenditures (HCE) in comparison to non-PC patients. For this purpose, a panel data set from the statutory health insurance AOK PLUS (covering the German federal states Thuringia and Saxony) is used, that includes all deceased cancer patients between 2009 and 2012 (n=447,191). According to their usage of PC institutions, PC patients were grouped into four different intervention groups and thus each of them was paired with a control group derived from a propensity score matching. A variety of statistical tools has been used, e.g. transition probabilities, Kaplan-Meier survival functions as well as linear and non-linear regression models. Results show that the intended sequences of PC usage are in accordance with law and medical guidelines. There are no disadvantages in survival of PC patients. In all four samples, HCE of PC patients are higher after the initial contact with a PC institution. This result is very robust against adjustments to the model specification, the model type and the sample. Results suggest that structural and process quality of PC is high. However, no saving effect can be identified for PC in its current form. A further extension of the PC system is therefore not “self-financing”. Due to the very short post treatment time, health economic analysis of PC remains challenging.

A presente dissertação analisa como a ausência de incentivos adequados no seguro saúde ocasiona o surgimento do fenômeno conhecido como risco moral e suas conseqüências na determinação da demanda de serviços médicos. O trabalho envolve a revisão da literatura e a estimação de um modelo econométrico que avalia a efetividade dos mecanismos de regulação no controle do risco moral por parte do paciente. A principal conclusão é que o risco moral por parte do paciente é importante para os serviços ambulatoriais, mas não ocorre nos serviços hospitalares. / This dissertation analyses how the lack of appropriate incentives motivates the emergence of moral hazard in health insurance and its consequences in the determination of medical services demand. The involves the literature review and the estimation of a econometric model, which evaluates the effectiveness of rationing mechanisms in the control of moral hazard motivated by the patient. The main conclusion is that moral hazard motivated by the patient is significant for ambulatory care, but it does not occur for inpatient care.

No presente estudo tem-se o objetivo de analisar a efetiva implantação de um produto de Assistência à Saúde como estratégia empresarial, em suas diversas etapas de execução. A compreensão das dificuldades e dos desafios na implantação de uma estratégia empresarial é o ponto de partida desta pesquisa. Separadas conceitualmente, estratégia e execução são, em verdade, etapas de igual importância que merecem uma visão conjunta. A execução efetiva, entretanto, de uma estratégia, carrega em si uma complexidade de tarefas e uma quantidade de fatores. Também as novas demandas criadas pelo mercado de baixa renda desafiam as organizações, propiciando o lançamento de novos produtos destinados a um novo tipo de consumidor. O desafio de tornar a organização um ofertante ful-line no mercado de saúde suplementar, agregando ao seu portfólio um produto para as classes emergentes, constituiu o cenário e as proposições estratégicas que deveriam ser implementadas como importante decisão da Unimed Porto Alegre. Em relação ao método, adotou-se a pesquisa-ação, em um conceito de pleno envolvimento do pesquisador nas ações desenvolvidas. A execução da estratégia na implantação de um produto de assistência à saúde para o mercado de baixa renda abrangeu o período de 2008 a 2011. Analisaram-se as diversas etapas na implantação do produto e foram considerados os indicadores de desempenho empresarial e mercadológicos, consolidando-se a busca dos objetivos estratégicos propostos. O conjunto de evidências apresentadas consolidou o êxito na execução e nos resultados obtidos. O estudo se justifica por analisar, na prática, o desafiador conjunto de fatores no desenvolvimento de produtos para o público de baixa renda e a dedicação necessária à execução exitosa de uma estratégia empresarial. / Understanding the difficulties and challenges in the implementation of an effective business strategy is the starting point of this research. Conceptually separate, strategy and execution are in fact equally important steps that deserve a joint vision. The effective execution from a strategy carries with it a complexity of tasks and a number of factors that can frustrate even a brilliant design. Also the new demands created by the low-income market challenge organizations providing opportunities to launch new products for a new type of consumer. The challenge of making the organization a bidder ful-line health supplement on the market, adding to its portfolio a product for emerging classes constituted the scenario and strategic propositions that should be implemented as an important decision from Unimed Porto Alegre. Thus this dissertation was developed as a method of study and action research, within the concept of full involvement of the researcher in the actions developed. Strategy execution in deploying a product of health care for low-income market studies the period from 2008 to 2011. The study analyzed the different stages in product deployment. Business performance indicators and market were considered, consolidating the pursuit of strategic objectives proposed. The body of evidence presented consolidates the successful implementation and results. The study is justified by analyzing, in practice, challenging set of factors in the development of products for the low-income public and the dedication needed to run a successful business strategy.

O estudo Judicialização dos planos e seguros de saúde coletivos no Tribunal de Justiça de São Paulo trata das ações judiciais relacionadas a planos e seguros de saúde coletivos, julgadas pela segunda instância do Tribunal de Justiça de São Paulo nos anos de 2013 e 2014. São descritas e analisadas as demandas levadas ao Poder Judiciário pelos consumidores de planos de saúde. Os conflitos envolvem coberturas, reembolso, aposentados e demitidos, reajustes aplicados sobre a mensalidade, cancelamento de contrato e descredenciamento de hospitais. Também são analisados o comportamento e as argumentações da Justiça nas decisões. Conclui-se pela necessidade de aprimoramento da regulamentação e da fiscalização das atividades dos planos e seguros de saúde / The Judicialization of plan and collective health insurance study at the Court of Law of Sao Paulo treats legal actions related to plans and collective health insurances judged by the Court of Law of São Paulo of Second Instance in 2013 and 2014. It was described and analyzed the demands referred to Judiciary branch by health plan consumers. The conflicts involve coverage, reimbursement, retired and dismissed people, readjustments applied on the monthly payment, contract cancelling and hospital loss of accreditation. It is also analyzed the behavior and arguments of Justice on decisions. It is evidenced the need of improving the regulation and supervision of health plans and insurances

The diploma thesis contains a comprehensive view of the health system in the Federal Republic of Germany in 1995-2015. The main aim of this work is to establish recommendations for improvement of the Czech health system based on the evaluation of the findings on the German health system. The partial aims of the diploma thesis are the characteristics of the health system and the analysis of income and expenditure in health care in Germany. The thesis is divided into six chapters. The first chapter is focused on the information obtained from professional literature. In particular, it describes the different concepts related to healthcare and its financing. The second chapter focuses on the economic concept and the issue of the health system. The third part contains a description of the country's health system. Here are also some selected data about Germany, organization or authority at federal, state and local levels. The fourth chapter deals with the insurance market in Germany. The fifth part summarizes the fundamental reforms of the health system of the Federal Republic. The last chapter is an analysis of income and expenditure of the health system. This section analyzes the data available from statistics from the German Statistical Office or from multinational organizations such as WHO, OECD or the World Bank.

This master thesis is about change in revenue of the householdes without children and with children. The thesis is divided into several parts. I used avialable literature in the theoretical part and this part should explain what factors affect family income. These are the chapters that deal with family politicy, welfare benefits and taxes benefits for family. The second part is practical and it is divided in two chapters. In the first chapter I analysed the dats of Czech statistics and in the second I modelized income of some types of families income.