Introdução - A Agência Nacional de Saúde Suplementar determinou, em 2008, que os planos de saúde oferecessem seis consultas anuais com nutricionista. Objetivo - Avaliar os determinantes da demanda por consultas de nutrição em uma operadora de autogestão em saúde entre 2009 e 2011. Métodos - Trata-se de um estudo retrospectivo realizado a partir dos registros administrativos dos beneficiários da Sabesp Previdência. A demanda foi estimada por meio de um modelo tobit para os gastos com consultas de nutricionista. Foram incluídas variáveis demográficas, socioeconômicas, de estado de saúde e de influência familiar. Resultados - A influência familiar, o sexo, o estado civil, a escolaridade e o estado de saúde no período e passado foram os principais determinantes do gasto com consultas de nutrição. A elasticidade renda da demanda, embora estatisticamente significante (p<0,1), foi pequena em relação ao efeito das demais variáveis e a idade não teve impacto significativo. A baixa probabilidade estimada de realizar gastos mostrou que ele é subutilizado. Conclusão - Os resultados evidenciaram a necessidade de estímulo à utilização, numa perspectiva de prevenção de doenças, promoção da saúde e redução dos custos assistenciais no setor de saúde suplementar. / Introduction - The Brazilian private health sector regulatory agency determined, back in 2008, that the insurance plans should offer six nutrition consultations. Objective - To assess the nutrition consultations demand determinants in health insurance plan between 2009 and 2011. Methods - This is retrospective study performed using data from Sabesp Previdência. We used Tobit model to analyze the expenditure on nutritional consultations and tested demographic, socioeconomic, health status and family influence variables. Results - Family influence, sex, marital status, education and health status were the expenditure main. Income elastic of demand, although statistically significant, wasn\'t expressive when compared to other variables effects. Age had no significant impact on individual nutrition consultation expenditure. The low probability of having expends with nutrition consultations showed it is an underutilized service. Conclusion- The results highlighted the need to stimulate the demand for nutrition consultations, in concordance with a disease prevention, health promotion and healthcare care reduction perspective in private health care sector.

O presente estudo tem como objetivo analisar a lucratividade dos clientes em uma operadora de saúde do segmento de baixo custo no Brasil. O mercado de saúde suplementar enfrenta inúmeros desafios para prosperar. Com a expansão nos últimos anos da classe média brasileira - a classe C - houve um aumento da demanda por serviços de planos de saúde privados de baixo ticket-médio. Foi realizada uma revisão da literatura, para embasar os princípios de modelos de negócios, a análise de lucratividade do cliente e a segmentação de clientes em uma operadora de saúde. O método utilizado foi um estudo de caso único, com pesquisa de dados de ordem qualitativa e quantitativa. Foram realizadas algumas entrevistas com os três principais executivos da operadora investigada, com o intuito de compreender o modelo de negócio construído e todos os seus diferenciais e inovações que garantiram seus resultados superiores à média do setor. Foram coletados dados contábeis, bases de receita e custo por beneficiário para análise quantitativa do resultado. Foi apresentado o modelo de negócio do estudo de caso investigado, bem como avaliada a lucratividade de clientes da operadora. Iniciou-se por uma análise quantitativa geral de variação contábil, com aprofundamento de análises na base de receita e custo de clientes, por sinistralidade, margem de contribuição absoluta e demais parâmetros, além da aplicação do conceito de CLV - Customer Lifetime Value. Ao analisar os resultados associados à avaliação da lucratividade, foram constatadas ações que pudessem ser tomadas para a melhora da mensuração do resultado final. O final das análises por cliente e por CLV se concentraram em grandes clientes corporativos, pois estes representam mais de 70% da carteira da operadora investigada. A conclusão apresentada foi a seguinte: para aumentar a margem de lucro absoluta bruta (R$) do negócio, ao subtrair as despesas assistenciais das receitas, deve-se segmentá-la por tipo de cliente e encontrar a margem de contribuição de cada. Na sequência, é necessário reajustar os clientes com margem de contribuição negativa, logo, obtém-se o maior resultado possível em termos de margem bruta total absoluta. Porém, mesmo para os clientes com margem de contribuição positiva, deve-se aprofundar sua análise de valor no tempo com o conceito do CLV. Verificou-se que clientes de margem positiva podem apresentar um CLV negativo para o mesmo período analisado. Esses clientes não devem ser desconsiderados, porque afetariam o resultado final, porém devem ser destacados na gestão, para serem mais bem renegociados numa revisão de valores contratuais e aumento do seu ticket-médio. / This study aims to analyze the profitability of customers in a health maintenance organization (HMO) of low-cost segment in Brazil. The health insurance market faces numerous challenges to thrive. With the expansion in recent years of Brazilian middle class - the class \'C,\' there was an increase in demand for private health plans to low-average ticket services. A literature review was conducted to support the principles of business models, customer profitability analysis and customer segmentation in a health provider. The method used was a single case study, with qualitative and quantitative research data. Interviews were conducted with the top three executives in the investigated company, to understand the business as presented, as well as the analysis of HMO\'s customer profitability. It´s began as a general quantitative analysis of accounting variation, with deeper analysis on revenue and cost base per members, by MLB (Medical Loss Benefit), gross margin and other parameters, in addition to applying the concept of CLV - Customer Lifetime Value. When analyzing the results associated with the evaluation of profitability, actions were found that could be taken to improve the measurement of the final result. The end of the analysis by customer and by CLV was focused on large corporate clients, as they represent more than 70% of the investigated portfolio. The conclusion was presented: to increase model built and all its advantages and innovations that have ensured their results above the industry average. We collected accounting data, revenue and cost base by membership for quantitative analysis. The business model of the investigated case study the margin of gross profit absolute (R$) in the business, by subtracting the medical cost from revenues, it should be segmented by customer type and find the contribution margin of each one. Further, it should be reajusted all customers with a negative contribution margin, so it could be obtained the highest possible result in terms of absolute gross margin. But even customers with positive contribution margin, should be deepen in their analysis of value in time with the concept of CLV. It was found that positive margin accounts may have a negative CLV for the same reported period. Those customers should not be disconsidered, because affect the final result, but should be highlighted in the management review, to be better renegotiated as contract values and increased its ticket-average.

The South African health industry can be divided into public and private health institutions. The public health institutions are subsidised by the South African government, whereas the private institutions generate income from medical aids and out-of-pocket payments. Three major groups currently control the private health sector and include Medi-Clinic, Life Healthcare and Netcare. Due to the competitiveness of the private health sector with limited role players, institutions need to differentiate themselves on the service quality provided by these institutions. The purpose of the study was to measure service quality in a private hospital. This was done by setting the following objectives: Determining the importance of service quality, determining the current standard of service quality, determining the gap between the importance and satisfaction of service quality dimensions as well as the influence of gender on the perception of service quality. The literature consisted of two topics, which included the private healthcare sector and the standards of service quality. The private health care sector lightens the load on the current overburdened public sector, but in doing so utilises the majority of qualified personnel as well as half of the financial resources available. Medical schemes are the main contributor the private institutions and are only available to the individuals privileged enough to afford these schemes. Service quality pertains to the ability of the service provider to meet or exceed the expectations of the customer. Thus, the importance of such ability lies in the fact that institutions can use this to differentiate them from other role players in this highly competitive market. Several models exist to evaluate service quality, but the SERVQUAL model has been utilised in various health institutions. Furthermore, gender could also have an effect on the manner in which customers perceive service quality. The study made use of the SERVQUAL model, with a 38-item survey questionnaire forming the basis of the data collecting technique. The 38 items were divided into seven sections, which included premises/employees, doctors‟ medical services, diagnostics, nursing medical services, admissions, meals and wards. A response rate of 71% was obtained. The demographic profile of the study resembled the current demographic of the town and 35.85% of the respondents were male with 64.15% being female. The validity and the reliability of the study were confirmed by means of an exploratory factor analysis and Chronbach alpha coefficients. The analysis of the difference in means of the various factors indicated that tangibles 2 and responsiveness 1 required attention from management to improve customer satisfaction. The analysis of data pertaining to gender indicated that no difference in satisfaction levels was evident. In conclusion, management needs to focus on the factors highlighted during the study, with proper maintenance and improvement of the appearance of the facility and providing training to staff to promote patient relationships. Furthermore, the recommendations include that the model is used in all institutions to evaluate service quality levels to highlight possible shortfalls, thus providing management with ability to address these shortfalls, in an effort to improve the level of service quality across the whole health sector. / MBA, North-West University, Potchefstroom Campus, 2014

The South African health industry can be divided into public and private health institutions. The public health institutions are subsidised by the South African government, whereas the private institutions generate income from medical aids and out-of-pocket payments. Three major groups currently control the private health sector and include Medi-Clinic, Life Healthcare and Netcare. Due to the competitiveness of the private health sector with limited role players, institutions need to differentiate themselves on the service quality provided by these institutions. The purpose of the study was to measure service quality in a private hospital. This was done by setting the following objectives: Determining the importance of service quality, determining the current standard of service quality, determining the gap between the importance and satisfaction of service quality dimensions as well as the influence of gender on the perception of service quality. The literature consisted of two topics, which included the private healthcare sector and the standards of service quality. The private health care sector lightens the load on the current overburdened public sector, but in doing so utilises the majority of qualified personnel as well as half of the financial resources available. Medical schemes are the main contributor the private institutions and are only available to the individuals privileged enough to afford these schemes. Service quality pertains to the ability of the service provider to meet or exceed the expectations of the customer. Thus, the importance of such ability lies in the fact that institutions can use this to differentiate them from other role players in this highly competitive market. Several models exist to evaluate service quality, but the SERVQUAL model has been utilised in various health institutions. Furthermore, gender could also have an effect on the manner in which customers perceive service quality. The study made use of the SERVQUAL model, with a 38-item survey questionnaire forming the basis of the data collecting technique. The 38 items were divided into seven sections, which included premises/employees, doctors‟ medical services, diagnostics, nursing medical services, admissions, meals and wards. A response rate of 71% was obtained. The demographic profile of the study resembled the current demographic of the town and 35.85% of the respondents were male with 64.15% being female. The validity and the reliability of the study were confirmed by means of an exploratory factor analysis and Chronbach alpha coefficients. The analysis of the difference in means of the various factors indicated that tangibles 2 and responsiveness 1 required attention from management to improve customer satisfaction. The analysis of data pertaining to gender indicated that no difference in satisfaction levels was evident. In conclusion, management needs to focus on the factors highlighted during the study, with proper maintenance and improvement of the appearance of the facility and providing training to staff to promote patient relationships. Furthermore, the recommendations include that the model is used in all institutions to evaluate service quality levels to highlight possible shortfalls, thus providing management with ability to address these shortfalls, in an effort to improve the level of service quality across the whole health sector. / MBA, North-West University, Potchefstroom Campus, 2014

Bakgrund: Den privata vårdsektorn är en sektor som karaktäriseras av stark tillväxt. Behovet av vård kommer alltid att finnas och i takt med att människan lever längre ökar även trycket på vården. Den privata vårdsektorn har skapat en debatt i samhället där man ifrågasätter att offentliga medel går till vinster i privata vårdföretag. Därav är det av allmänt intresse att analysera vårdföretagens ekonomiska utveckling och risk. Syfte: Att utreda vilka finansiella strategier privata vårdföretag tillämpar och om de byggt upp tillräcklig finansiell styrka (kapitalstruktur) för en långsiktig utveckling. Metod: Uppsatsen bygger på en kvantitativ metod där information baseras på årsredovisningar under en 10-årsperiod. Utifrån den finansiella informationen beräknas nyckeltal för att beskriva företagens kapitalstruktur och prestation. Därefter görs en ingående analys av resultat- och balansräkning för respektive företag. Uppsatsen använder sig av hävstångsformeln som huvudsakligt analysverktyg för att analysera om företagen vinstmaximerar eller om de har en mer långsiktig finansiell strategi för att uppnå finansiell styrka. Resultat, slutsatser: Genom vår analys av vårdföretagens rörelserisk har utredningen funnit att en rimlig balans mellan rörelserisk och finansiella styrka uppnås vid en soliditet på 40 % som är genomsnittet för bolag på Stockholmsbörsen. De små vårdbolagen (som är den dominerande företagsformen) uppnår mer än väl balans mellan rörelserisk och finansiell styrka. Deras soliditet uppgår i regel till ca 50 %. Företagen har hög lönsamhet och som finansiell strategi väljer de att inte vinstmaximera genom att belåna sig och utnyttja hävstångseffekten. Tre av de marknadsledande företagen har en dålig lönsamhet och en soliditet som är betydligt lägre än börsgenomsnittet. Den låga soliditeten kompenseras helt eller delvis av att företagen har starka ägare med möjlighet att tillföra kapital via aktieägartillskott och nyemissioner vid behov. Den fjärde av de marknadsledande större vårdföretagen har hög lönsamhet och högre soliditet än börsgenomsnittet. Även detta företag väljer att liksom de mindre vårdföretagen att inte belåna sig och utnyttja hävstångseffekten för att maximera vinster. / Background: The private health sector is a sector that is characterized by growth. The need for care will always be, and as the human lives longer it will also increase the pressure on health care. The private health sector has created a debate in the community in which the dividends allocation is being questioned. Hence, it is of general interest to analyze healthcare companies' financial performance and risk. Purpose: To investigate the financial strategies that private health care companies apply and if they have built up sufficient financial strength (capital structure) for long term development. Methodology: The essay is based on a quantitative method where information is based on annual reports over a 10-year period. Based on the financial information financial ratios are calculated to describe firms' capital structure and performance. Thereafter, a detailed analysis of the income statement and balance sheet is made for each company. The essay uses effects of leverage as the main analytical tool for analyzing how firms maximize profits or if they have a more long-term financial strategy. Conclusion: Through our analysis of healthcare companies operating risk, the investigation found that a reasonable balance between business risk and financial strength is achieved at an equity ratio of 40 % which is an average for companies on the Stockholm stock exchange. The small healthcare company (which is the dominant company form) achieve a balance between business risk and financial strength. Their equity ratio is usually around 50 %. Companies have high profitability and as financial strategy they choose not to maximize profits by leveraging themselves and use the effects of leverage. Three of the market leaders have a poor performance and a solvency that is significantly lower than the market average. Their strong owners compensate the low equity ratio with the ability to provide capital through shareholder contributions and new issues as necessary. The fourth of the leading major healthcare companies have high profitability and higher solvency than the market average. This company also chooses to, like the smaller healthcare companies not to use leverage and use the effect of leverage to maximize their profit.

Current day organisations must revert to many measures to survive in the very competing business environment. One of these measures is to reduce the number of employees. This leads to perceptions of job insecurity, not only in the employees who are not made redundant but also in employees in so-called stable organisations who are aware of these measures being implemented in other organisations. Researchers found conflicting results of job insecurity regarding performance of employees experiencing job insecurity. On the one hand it was reported that job insecurity leads to higher job performance and on the other that it leads to lower job performance. To reconcile these conflicting findings Jordan, Ashkanasy and Hartel (2002) developed a model. In their two stage model in which they postulate that perceptions of job insecurity could lead to lower affective organisational commitment and higher job-related stress and this in turn could lead to negative coping behaviour (stage one). They then include emotional intelligence (EI) as moderator of all the links between the above mentioned constructs (stage two). They are of the opinion that employees with high EI will experience higher affective organisational commitment and lower job-related stress than employees with low EI when perceptions of job insecurity are experienced. They also postulate that employees with high EI will be less inclined to revert to negative coping behaviour. The main objective of this study was to investigate whether this model would be applicable to employees of private health care organisations in Gauteng. In the first article a literature review was conducted to determine how job insecurity, affective organisational commitment, job-related stress and coping were conceptualised as well as the relationships between these constructs. This was done to investigate the first stage of the model of Jordan et al. (2002). In the second article a literature review was conducted to determine how job insecurity, affective organisational commitment, job-related stress, coping and EI were conceptualised. The relationships between these constructs and the role of EI as moderator of these relationships were also determined. This was done to investigate the second stage of the model of Jordan et al. (2002). A non-experimental correlation research design was used. Employees of private health care organisations were the participants. The Job Insecurity Inventory, the Organisational Commitment Questionnaire, the Experience of Work Life and Circumstances Questionnaire, the Cope Questionnaire and the Emotional Intelligence Scale were used, as well as a biographical questionnaire. The SPPS program and partly STATISTIKA were used to perform the statistical analysis. Descriptive statistics were used to analyse the data. Cronbach alpha coefficients and factor analyses were used to assess the reliability and validity of the measuring instruments. Pearson product-moment correlation coefficients were used to specify the relationships between the variables. Multiple regression analysis was used to determine the moderating influence of emotional intelligence. It was determined that, in this specific research group, job insecurity has a negative correlation with affective organisational commitment. Job insecurity has a positive correlation with job-related stress levels. A positive correlation was found between job-related stress levels and certain negative coping behaviours, such as denial, behavioural disengagement and mental disengagement. A negative correlation was found between affective organisational commitment and negative coping behaviour, specifically the use of drugs or alcohol. All of these correlations were statistically and practically significant. It was found that job insecurity as independent variable explains 12.1% of the total variance in affective organisational commitment. It was also found that job insecurity as independent variable explains 21.1 % of the total variance in the job -related stress levels. These findings indicated that the first stage of the model of Jordan et al. (2002) could be supported. Multiple regression analyses were performed to determine the moderating effect of EI as discussed above. The results indicated that EI had only a slight but significant moderating effect on the job insecurity -affective organisational commitment relationship and no effect on the job insecurity - job-related stress relationship. The results also indicate that EI moderates the strength of the relationship between affective organisational commitment and coping behaviour to such an extent that affective organisational commitment's predictive value is reduced to closely insignificant whilst EI emerges as the primary predictor of coping behaviour (both positive and negative). This may imply that emotionally intelligent employees will tend to use more problem-focused coping behaviour irrespective of the affective organisational commitment that they experience. Although to a lesser extent in this study, it was found that emotionally intelligent employees also make use of emotion-focused coping behaviour appropriate for managing affective states associated with experienced stress. Concerning avoidant coping strategies EI significantly negatively moderates alcohol-drug disengagement as a coping strategy, meaning employees with high EI will tend not to revert to the use of drugs or alcohol as coping strategy. It was concluded that EI does not buffer employees against the emotional consequences of job insecurity in this research group, as proposed by the model of Jordan et al. (2002), but rather enables them to cope with these emotional effects using problem-focused- and emotion- focused coping strategies, but not avoidant strategies. The latter finding is in line with the proposed model of Jordan et al.(2002). Conclusions, the limitations of this research and recommendations for private health care organisations and for future research were made. / Thesis (M.A. (Industrial Psychology))--North-West University, Vaal Triangle Campus, 2009.

Current day organisations must revert to many measures to survive in the very competing business environment. One of these measures is to reduce the number of employees. This leads to perceptions of job insecurity, not only in the employees who are not made redundant but also in employees in so-called stable organisations who are aware of these measures being implemented in other organisations. Researchers found conflicting results of job insecurity regarding performance of employees experiencing job insecurity. On the one hand it was reported that job insecurity leads to higher job performance and on the other that it leads to lower job performance. To reconcile these conflicting findings Jordan, Ashkanasy and Hartel (2002) developed a model. In their two stage model in which they postulate that perceptions of job insecurity could lead to lower affective organisational commitment and higher job-related stress and this in turn could lead to negative coping behaviour (stage one). They then include emotional intelligence (EI) as moderator of all the links between the above mentioned constructs (stage two). They are of the opinion that employees with high EI will experience higher affective organisational commitment and lower job-related stress than employees with low EI when perceptions of job insecurity are experienced. They also postulate that employees with high EI will be less inclined to revert to negative coping behaviour. The main objective of this study was to investigate whether this model would be applicable to employees of private health care organisations in Gauteng. In the first article a literature review was conducted to determine how job insecurity, affective organisational commitment, job-related stress and coping were conceptualised as well as the relationships between these constructs. This was done to investigate the first stage of the model of Jordan et al. (2002). In the second article a literature review was conducted to determine how job insecurity, affective organisational commitment, job-related stress, coping and EI were conceptualised. The relationships between these constructs and the role of EI as moderator of these relationships were also determined. This was done to investigate the second stage of the model of Jordan et al. (2002). A non-experimental correlation research design was used. Employees of private health care organisations were the participants. The Job Insecurity Inventory, the Organisational Commitment Questionnaire, the Experience of Work Life and Circumstances Questionnaire, the Cope Questionnaire and the Emotional Intelligence Scale were used, as well as a biographical questionnaire. The SPPS program and partly STATISTIKA were used to perform the statistical analysis. Descriptive statistics were used to analyse the data. Cronbach alpha coefficients and factor analyses were used to assess the reliability and validity of the measuring instruments. Pearson product-moment correlation coefficients were used to specify the relationships between the variables. Multiple regression analysis was used to determine the moderating influence of emotional intelligence. It was determined that, in this specific research group, job insecurity has a negative correlation with affective organisational commitment. Job insecurity has a positive correlation with job-related stress levels. A positive correlation was found between job-related stress levels and certain negative coping behaviours, such as denial, behavioural disengagement and mental disengagement. A negative correlation was found between affective organisational commitment and negative coping behaviour, specifically the use of drugs or alcohol. All of these correlations were statistically and practically significant. It was found that job insecurity as independent variable explains 12.1% of the total variance in affective organisational commitment. It was also found that job insecurity as independent variable explains 21.1 % of the total variance in the job -related stress levels. These findings indicated that the first stage of the model of Jordan et al. (2002) could be supported. Multiple regression analyses were performed to determine the moderating effect of EI as discussed above. The results indicated that EI had only a slight but significant moderating effect on the job insecurity -affective organisational commitment relationship and no effect on the job insecurity - job-related stress relationship. The results also indicate that EI moderates the strength of the relationship between affective organisational commitment and coping behaviour to such an extent that affective organisational commitment's predictive value is reduced to closely insignificant whilst EI emerges as the primary predictor of coping behaviour (both positive and negative). This may imply that emotionally intelligent employees will tend to use more problem-focused coping behaviour irrespective of the affective organisational commitment that they experience. Although to a lesser extent in this study, it was found that emotionally intelligent employees also make use of emotion-focused coping behaviour appropriate for managing affective states associated with experienced stress. Concerning avoidant coping strategies EI significantly negatively moderates alcohol-drug disengagement as a coping strategy, meaning employees with high EI will tend not to revert to the use of drugs or alcohol as coping strategy. It was concluded that EI does not buffer employees against the emotional consequences of job insecurity in this research group, as proposed by the model of Jordan et al. (2002), but rather enables them to cope with these emotional effects using problem-focused- and emotion- focused coping strategies, but not avoidant strategies. The latter finding is in line with the proposed model of Jordan et al.(2002). Conclusions, the limitations of this research and recommendations for private health care organisations and for future research were made. / Thesis (M.A. (Industrial Psychology))--North-West University, Vaal Triangle Campus, 2009.

O presente estudo tem como objetivo analisar a lucratividade dos clientes em uma operadora de saúde do segmento de baixo custo no Brasil. O mercado de saúde suplementar enfrenta inúmeros desafios para prosperar. Com a expansão nos últimos anos da classe média brasileira - a classe C - houve um aumento da demanda por serviços de planos de saúde privados de baixo ticket-médio. Foi realizada uma revisão da literatura, para embasar os princípios de modelos de negócios, a análise de lucratividade do cliente e a segmentação de clientes em uma operadora de saúde. O método utilizado foi um estudo de caso único, com pesquisa de dados de ordem qualitativa e quantitativa. Foram realizadas algumas entrevistas com os três principais executivos da operadora investigada, com o intuito de compreender o modelo de negócio construído e todos os seus diferenciais e inovações que garantiram seus resultados superiores à média do setor. Foram coletados dados contábeis, bases de receita e custo por beneficiário para análise quantitativa do resultado. Foi apresentado o modelo de negócio do estudo de caso investigado, bem como avaliada a lucratividade de clientes da operadora. Iniciou-se por uma análise quantitativa geral de variação contábil, com aprofundamento de análises na base de receita e custo de clientes, por sinistralidade, margem de contribuição absoluta e demais parâmetros, além da aplicação do conceito de CLV - Customer Lifetime Value. Ao analisar os resultados associados à avaliação da lucratividade, foram constatadas ações que pudessem ser tomadas para a melhora da mensuração do resultado final. O final das análises por cliente e por CLV se concentraram em grandes clientes corporativos, pois estes representam mais de 70% da carteira da operadora investigada. A conclusão apresentada foi a seguinte: para aumentar a margem de lucro absoluta bruta (R$) do negócio, ao subtrair as despesas assistenciais das receitas, deve-se segmentá-la por tipo de cliente e encontrar a margem de contribuição de cada. Na sequência, é necessário reajustar os clientes com margem de contribuição negativa, logo, obtém-se o maior resultado possível em termos de margem bruta total absoluta. Porém, mesmo para os clientes com margem de contribuição positiva, deve-se aprofundar sua análise de valor no tempo com o conceito do CLV. Verificou-se que clientes de margem positiva podem apresentar um CLV negativo para o mesmo período analisado. Esses clientes não devem ser desconsiderados, porque afetariam o resultado final, porém devem ser destacados na gestão, para serem mais bem renegociados numa revisão de valores contratuais e aumento do seu ticket-médio. / This study aims to analyze the profitability of customers in a health maintenance organization (HMO) of low-cost segment in Brazil. The health insurance market faces numerous challenges to thrive. With the expansion in recent years of Brazilian middle class - the class \'C,\' there was an increase in demand for private health plans to low-average ticket services. A literature review was conducted to support the principles of business models, customer profitability analysis and customer segmentation in a health provider. The method used was a single case study, with qualitative and quantitative research data. Interviews were conducted with the top three executives in the investigated company, to understand the business as presented, as well as the analysis of HMO\'s customer profitability. It´s began as a general quantitative analysis of accounting variation, with deeper analysis on revenue and cost base per members, by MLB (Medical Loss Benefit), gross margin and other parameters, in addition to applying the concept of CLV - Customer Lifetime Value. When analyzing the results associated with the evaluation of profitability, actions were found that could be taken to improve the measurement of the final result. The end of the analysis by customer and by CLV was focused on large corporate clients, as they represent more than 70% of the investigated portfolio. The conclusion was presented: to increase model built and all its advantages and innovations that have ensured their results above the industry average. We collected accounting data, revenue and cost base by membership for quantitative analysis. The business model of the investigated case study the margin of gross profit absolute (R$) in the business, by subtracting the medical cost from revenues, it should be segmented by customer type and find the contribution margin of each one. Further, it should be reajusted all customers with a negative contribution margin, so it could be obtained the highest possible result in terms of absolute gross margin. But even customers with positive contribution margin, should be deepen in their analysis of value in time with the concept of CLV. It was found that positive margin accounts may have a negative CLV for the same reported period. Those customers should not be disconsidered, because affect the final result, but should be highlighted in the management review, to be better renegotiated as contract values and increased its ticket-average.

Introdução - A Agência Nacional de Saúde Suplementar determinou, em 2008, que os planos de saúde oferecessem seis consultas anuais com nutricionista. Objetivo - Avaliar os determinantes da demanda por consultas de nutrição em uma operadora de autogestão em saúde entre 2009 e 2011. Métodos - Trata-se de um estudo retrospectivo realizado a partir dos registros administrativos dos beneficiários da Sabesp Previdência. A demanda foi estimada por meio de um modelo tobit para os gastos com consultas de nutricionista. Foram incluídas variáveis demográficas, socioeconômicas, de estado de saúde e de influência familiar. Resultados - A influência familiar, o sexo, o estado civil, a escolaridade e o estado de saúde no período e passado foram os principais determinantes do gasto com consultas de nutrição. A elasticidade renda da demanda, embora estatisticamente significante (p<0,1), foi pequena em relação ao efeito das demais variáveis e a idade não teve impacto significativo. A baixa probabilidade estimada de realizar gastos mostrou que ele é subutilizado. Conclusão - Os resultados evidenciaram a necessidade de estímulo à utilização, numa perspectiva de prevenção de doenças, promoção da saúde e redução dos custos assistenciais no setor de saúde suplementar. / Introduction - The Brazilian private health sector regulatory agency determined, back in 2008, that the insurance plans should offer six nutrition consultations. Objective - To assess the nutrition consultations demand determinants in health insurance plan between 2009 and 2011. Methods - This is retrospective study performed using data from Sabesp Previdência. We used Tobit model to analyze the expenditure on nutritional consultations and tested demographic, socioeconomic, health status and family influence variables. Results - Family influence, sex, marital status, education and health status were the expenditure main. Income elastic of demand, although statistically significant, wasn\'t expressive when compared to other variables effects. Age had no significant impact on individual nutrition consultation expenditure. The low probability of having expends with nutrition consultations showed it is an underutilized service. Conclusion- The results highlighted the need to stimulate the demand for nutrition consultations, in concordance with a disease prevention, health promotion and healthcare care reduction perspective in private health care sector.

The theme of work is private health insurance. First is it described in the system of health insurance and then in the territory of Czech Republic. In the work is analyzed a new draft bill of Public health insurance and systems of health insurance in the Europe. Main goal of the thessis is to find suitable privat insurance product for Czech Republic.