Proposta de um modelo informacional para intercâmbio eletrônico de dados entre hospitais e operadoras de planos de saúde

Abstract

The aim of this study is to recommend an informational model to support the billing and accountability process of the services performed by hospitals for beneficiaries of healthcare plan companies. The proposed informational model aims at allowing the control of the data in a timely manner, being based on the concepts of Electronic Data Interchange. This is a qualitative research which used Design Research method. Sources of information include specialist managers of hospitals or healthcare plan companies, as well as academic publications, standards and technical documents. Data collection was performed through semi-structured interviews, on-site observations and documentary analysis, and the extraction of information was performed through Content Analysis. As a result, were identified: the impacts of compensation models on the relationship between hospitals and healthcare plan companies; information, rules, parameters and periodicity required to implement the new informational model proposed to support billing; and potential impacts of the informational model proposed in the billing process, in the view of hospitals and healthcare plan companies.