A regulação do setor de Saúde Suplementar Brasileiro vem nos últimos anos cada vez mais atuante. Gerir custos desse setor envolve lidar com variáveis com valor agregado alto e receitas estáveis de difíceis aumentos de valores. Torna-se imprescindível um esforço para repensar as formas de remuneração adequadas para criar um pagamento equitativo que contemple um ajuste nos resultados. Através de pesquisa bibliográfica primeiramente esse trabalho apresenta as principais formas de remuneração do trabalho médico nesse setor e os conceitos da Teoria da Economia dos Custos de Transação. O trabalho busca analisar através da Teoria dos Custos de Transação o modelo predominante de remuneração médica na saúde suplementar do Brasil. Através de entrevistas realizadas com gestores das Unimeds da região nordeste paulista analisa-se a existência dos fatores: oportunismo, incerteza e complexidade do ambiente para a ocorrência dos custos de transação no modelo de remuneração por produção / The regulation of the Brazilian Supplementary Health section has recently become more active. To manage the costs of this section involves dealing with changeable added values and stable incomes of difficult value increase. It takes an indispensable effort to rethink the proper maintenance reforms to create an equitable payment that shows and adjustment of the results. Through bibliographic research, firstly this article presents the main forms of medical labor remuneration in this section and the concepts of Transaction Cost Economics Theory. The article aims to analyze, through the Transaction Cost Theory, the predominant model of medical remuneration in the Brazilian supplementary health. Throughout interviews performed with UNIMEDs managers of the northeast region of São Paulo state, it could have been analyzed the existence of the factors: opportunism, uncertainty and a complex environment for the occurrence of transaction costs in the production-based remuneration model

A regulação do setor de Saúde Suplementar Brasileiro vem nos últimos anos cada vez mais atuante. Gerir custos desse setor envolve lidar com variáveis com valor agregado alto e receitas estáveis de difíceis aumentos de valores. Torna-se imprescindível um esforço para repensar as formas de remuneração adequadas para criar um pagamento equitativo que contemple um ajuste nos resultados. Através de pesquisa bibliográfica primeiramente esse trabalho apresenta as principais formas de remuneração do trabalho médico nesse setor e os conceitos da Teoria da Economia dos Custos de Transação. O trabalho busca analisar através da Teoria dos Custos de Transação o modelo predominante de remuneração médica na saúde suplementar do Brasil. Através de entrevistas realizadas com gestores das Unimeds da região nordeste paulista analisa-se a existência dos fatores: oportunismo, incerteza e complexidade do ambiente para a ocorrência dos custos de transação no modelo de remuneração por produção / The regulation of the Brazilian Supplementary Health section has recently become more active. To manage the costs of this section involves dealing with changeable added values and stable incomes of difficult value increase. It takes an indispensable effort to rethink the proper maintenance reforms to create an equitable payment that shows and adjustment of the results. Through bibliographic research, firstly this article presents the main forms of medical labor remuneration in this section and the concepts of Transaction Cost Economics Theory. The article aims to analyze, through the Transaction Cost Theory, the predominant model of medical remuneration in the Brazilian supplementary health. Throughout interviews performed with UNIMEDs managers of the northeast region of São Paulo state, it could have been analyzed the existence of the factors: opportunism, uncertainty and a complex environment for the occurrence of transaction costs in the production-based remuneration model

Since ancient times, roads have tied people and cultures together. Roads have been createdwith the aim of facilitating trade and cultural exchange among different regions in the world. After the technologic development in vehicle industry and dramatically increase of motoring in the world during the past century road communication has gained a great importance for transporting people and goods. Thus, good safety and accessibility on roads all year round is now a vital necessity for a healthy economy in all modern societies. In order to keep roads safe, available for use with high transport quality they need to be maintained in real time. One of the most difficult tasks in this context is to keep the roads in good condition and accessible even during winter. The main objective of this doctoral thesis is to attempt to specify the most efficient ways of executing winter road maintenance.  The preliminary issue in this context is whether it is the use of current assistive tools, that is, technical aspects that should be optimized and developed or whether it is the way in which winter maintenance services are procured and outsourced, that is, contractual aspects that should be improved which could give the optimal impact for both clients and contractors and make winter road maintenance more effective, or both issues. In order to define the outline of the research project a comprehensive state of the art survey was initiated with the intention of collecting and gaining insights into the earlier studies in the research area. Three basic areas associated with the performance of winter road maintenance were considered to be most relevant for review due to the anchorage between the areas. The selected areas were climatological, technical and contractual aspects. The literature review was followed by an electronic questionnaire survey. The results of the study in this stage showed that current technical methods almost functioned in a reasonable manner but there was an imprecise dissatisfaction with the current maintenance contract. The second stage of the research consisted of a number of additional empirical investigations in order to identify contractual problematic issues behind the current winter road maintenance in Sweden. Generally, those factors that are rarely considered as potential underlying causes to costly performance of winter road maintenance in Sweden were studied in this research project for example improper use of related technical assistive tools, procurement of improper bundled winter services and inappropriate contract structure. This thesis consists of six papers, five of which are related to each other, and the first one is completely independent but within research area. Findings in the thesis contributes to extend understanding about; how designing appropriate contracts can improve winter road maintenance, how proper use of assistive tools can reduce unnecessary winter road maintenance costs and minimize road traffic disruptions and delays, how a partnering structure in contracts can create confidence and trust between clients and contractors that in turn leads to minimizing or eliminating conflicts and disputes between parties involved, how choice of appropriate procurement methods through proper bundling of winter road services can contribute to shorten the procurement process and create incentives for contractors, and how selection of proper payment mechanisms can contribute to higher service quality of performed winter road measures. Additionally, an adequate knowledge and understanding of climate, proper knowledge of road weather and its impact on winter road traffic is essential for contribution of better planning of how to maintain the road network during winter. Since understanding about winter issues and its effect on winter road traffic is far from complete and winter road maintenance in the cold regions is a similar challenge, broad and complex, the results of this research may even contribute to improving winter maintenance problems in the countries with severe winters like Sweden. / <p>QC 20140227</p>

Submitted by Adriano Leite Soares (dr.asoares@uol.com.br) on 2012-03-27T00:28:30Z No. of bitstreams: 1 TESE REVISADA FINALCOM FICHA E CAPA.pdf: 2461287 bytes, checksum: 04852765664e2f8eeecb1e2688c53bfc (MD5) / Approved for entry into archive by Gisele Isaura Hannickel (gisele.hannickel@fgv.br) on 2012-03-27T12:37:14Z (GMT) No. of bitstreams: 1 TESE REVISADA FINALCOM FICHA E CAPA.pdf: 2461287 bytes, checksum: 04852765664e2f8eeecb1e2688c53bfc (MD5) / Made available in DSpace on 2012-03-27T13:01:21Z (GMT). No. of bitstreams: 1 TESE REVISADA FINALCOM FICHA E CAPA.pdf: 2461287 bytes, checksum: 04852765664e2f8eeecb1e2688c53bfc (MD5) Previous issue date: 2012-02-27 / Os prestadores de serviços de saúde e, para este estudo, principalmente o médico, cuja atuação interfere diretamente tanto nos resultados da terapêutica instituída, como também na determinação dos custos dos diversos sistemas de saúde, têm a remuneração profissional como prioridade na agenda dos diversos participantes do setor, quer seja no Sistema Único de Saúde, quer principalmente no setor de saúde suplementar. Devido ao ritmo inflacionário do setor e às exigências estabelecidas pela regulamentação dos planos de saúde, os valores de remuneração dos prestadores de serviços têm crescimento menor que os índices inflacionários gerais. Os modelos de remuneração existentes, de forma isolada, não suprem as expectativas de todos os recursos credenciados, e, mesmo em um único sistema de saúde, os diferentes mecanismos de pagamento podem combinar-se, não sendo obrigatória a existência de somente um método de remuneração para cada sistema, pois mesmo na remuneração do médico, por esta remuneração não atender às expectativas das diversas especialidades, poderá levar a um desequilíbrio entre oferta e demanda de profissionais de certas áreas da Medicina. O objetivo deste trabalho é elencar, dentre os diversos modelos de pagamento, os pressupostos básicos para a remuneração do médico-cirurgião, levando-se em consideração os recursos empregados no tratamento, bem como o risco inerente de cada paciente tratado, tentando traduzir tais pontos em uma fórmula de cálculo padrão e comparar este novo valor com os valores atuais de remuneração. O modelo de remuneração deve fomentar a eficiência do tratamento instituído e a equidade do pagamento, além de ser de fácil implantação e compreensão pelos players do setor, bem como ter neutralidade financeira entre o principal e o agente, mantendo a qualidade e a acessibilidade aos serviços, a fim de que os médicos sejam incentivados a promover um tratamento eficiente aos beneficiários. Deve ser baseado no tratamento de doenças em si e não na realização de procedimentos, bem como estar atrelado a índices de desempenho e ao risco assumido pelo profissional. Enfim, o trabalho médico deve ser remunerado de forma diretamente proporcional à quantidade de horas trabalhadas, por profissionais que possuam equivalente nível de graduação e qualificação, e ao risco inerente a cada paciente tratado. A fórmula encontrada leva em consideração não somente a idade do paciente a ser tratado, bem como os riscos inerentes ao tratamento deste paciente, e tem como base de remuneração a doença a ser tratada, e não os procedimentos que serão necessários, ou indicados pelos médicos para tratamento desses pacientes. Desta forma, a valorização do trabalho médico cresce com o aumento do risco de tratar o paciente, quer seja pelo risco inerente à própria idade do paciente, quer seja pelo risco inerente ao procedimento anestésico, quer seja pelo risco cardíaco, havendo, portanto, uma melhor proporcionalidade entre a remuneração hospitalar dos pacientes com mais gravidade, em que são utilizados, ou colocados à disposição, mais recursos, com a remuneração crescente, também neste caso, dos profissionais que estariam tratando tais pacientes. / Health providers services, and in this case, specially medical doctors, who's works interfere directly in outcomes and cost of the health system, has their methods of payment in the agenda of the most industry players, either in the public health system, but mainly in the supplementary health system, where because the continuous growth in cost, and the industry regulation dues, the providers gains has increments below the inflationary rates. Nowadays, the methods of payment, by itself, do not fulfill the gain goals of the health system providers, and even in a single health system, the different way of payment could be combined, and it is not obligated a unique payment method for each health system, just because the goals of remuneration moves around depending of the specialties, which contribute to keep the correct balance between demand and offer. The goals of this study is to enroll, between all of the payment methods, the basic assumptions for the surgeons payment, considering the sources applied in treatment, as well as life risk of each patient treated, trying to reproduce a standard formula to calculate the remuneration, and compare them with the present expenditure. The method of payment must encourage the treatment efficiency, and the equity of payment, and be easily understood by the industry players, and financial neutrality between principal and agency, keeping the quality and accessibility to medical services, and the doctors will be stimulate to increase the quality of the treatment to the users. Might be based on disease management, and not on procedures, and linked to performance index, and the risk owned by the patient. In conclusion, the medical labor remuneration proportionally by the total of work hours, by the same levels of the professional graduation and qualification, and the life risk of the patient treated. The new formula for calculate the medical payment consider not only the patient age, but also the risk involved on the treatment, and it is based on the disease, and not on a fee-forservice system. In this way, medical remuneration grows with the patient risk, as much as the increase of patient age, the increase of anesthetic and cardiac risks, resulting in a better correlation between hospitals costs, medical remuneration, and the resources used in the treatment.