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Custo efetividade da auditoria concorrente em uma operadora de saúde

Authors: Ana Fátima Souza Melo de Andrade; Luiza Nauane Borges Benevides;

Custo efetividade da auditoria concorrente em uma operadora de saúde

Abstract

A busca por qualidade, faturamento correto da conta hospitalar e redução de gastos indevidos é a perspectiva atual das operadoras de saúde. Nessa linha de pensamento, o objetivo principal foi analisar a redução de custos hospitalares de uma operadora de saúde do estado de Sergipe, Brasil, entre janeiro e outubro de 2018, por meio da auditoria concorrente. Trata-se de um estudo descritivo, com abordagem quanti-qualitativa, do tipo relato de experiência. A análise qualitativa tratou-se de observações a partir da vivência como profissional. Na análise quantitativa, utilizou-se da estatística univariada para descrição dos indicadores e das variações. Para identificar a relação entre o indicador econômico, financeiro e os de qualidade, foi utilizada a técnica de correlação de Pearson. Como resultado, analisou-se que as glosas recuperaram perdas econômicas, mas não aumentaram de forma linear o custo efetividade para a operadora de saúde. Houve correlação moderada negativa (p<0,001) entre permanência hospitalar e custo-efetividade da auditoria concorrente. Enquanto que a desospitalização obteve uma correlação positiva forte (p<0,001), com o custo efetividade da auditoria concorrente. A partir destes dados, concluiu-se que o crescimento da desospitalização e a diminuição da permanência hospitalar impactaram no aumento da eficácia da auditoria concorrente.Palavras-chave: Auditoria de Enfermagem. Avaliação de Custo-Efetividade. Economia e Organizações de Saúde. ABSTRACTThe search for quality, correct billing of the hospital bill and reduction of undue expenses is the current perspective of health care providers. In this line of thought, the main objective was to analyze the reduction of hospital costs of a health care provider in the state of Sergipe, Brazil, between January and October of 2018, through a concurrent audit. This is a descriptive study, with quantitative-qualitative approach, of the type of experience report. The qualitative analysis was about observations from the experience as a professional. In the quantitative analysis, univariate statistics were used to describe indicators and variations. In order to identify the relationship between economic, financial and quality indicators, the Pearson correlation technique was used. As a result, it was analyzed that the glosses recovered economic losses, but did not linearly increase the cost effectiveness for the health care provider. There was a moderate negative correlation (p <0.001) between hospital stay and cost-effectiveness of the concurrent audit. While the de-hospitalization obtained a strong positive correlation (p <0.001), with the cost effectiveness of the concurrent audit. Based on these data, it was concluded that the increase in de-hospitalization and the decrease in hospital stay had an impact on the effectiveness of the concurrent audit. Keywords: Nursing Audit. Cost-effectiveness Evaluation. Health Care Economics and Organizations.

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
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