A judicialização da saúde suplementar: a cobertura das despesas oriundas de serviços de home care
Tipo
Relatório de Pesquisa
Data de publicação
2020-05
Periódico
Citações (Scopus)
Autores
Ohnuki, Brenda Costacurta
Orientador
Lima, Fernando Rister de Sousa
Título da Revista
ISSN da Revista
Título de Volume
Membros da banca
Programa
Resumo
A pesquisa, cujo objetivo foi investigar o motivo pelo qual a discussão acerca da cobertura dos gastos dos serviços de home care passou a ser judicializada, realizou-se através do método indutivo, baseado em pesquisa bibliográfica e documental. Procurou-se compreender o conflito existente entre as operadoras de planos de saúde e seus beneficiários, que se deu em decorrência do fato de que aquelas se recusavam a cobrir os gastos oriundos dos serviços de atendimento domiciliar, levando os beneficiários a demandarem tal cobertura ao judiciário, provocando um consequente inchaço deste poder e intensificando o fenômeno da judicialização. O resultado da pesquisa demonstrou que judicialização da saúde suplementar, no caso do conflito acerca do home care, se deu em decorrência da insuficiência na atuação da Agência Nacional de Saúde Suplementar (ANS), responsável pela regulamentação das relações estabelecidas pelos prestadores de serviço de saúde privada.
This research, whose objective was to investigate the reason why the discussion about the coverage of the expenses of home care services started to be judicialized, was carried out through the inductive method, based on bibliographical and documentary research. An attempt was made to understand the existing conflict between health plan operators and their beneficiaries, which occurred as a result of the fact that they refused to cover expenses arising from home care services, leading beneficiaries to demand such coverage from the judiciary , causing a consequent swelling of this power and intensifying the phenomenon of judicialization. The result of the research showed that judicialization of supplementary health, in the case of the conflict over home care, was due to the insufficiency in the performance of the National Supplementary Health Agency, responsible for regulating the relationships established by private health service providers.
This research, whose objective was to investigate the reason why the discussion about the coverage of the expenses of home care services started to be judicialized, was carried out through the inductive method, based on bibliographical and documentary research. An attempt was made to understand the existing conflict between health plan operators and their beneficiaries, which occurred as a result of the fact that they refused to cover expenses arising from home care services, leading beneficiaries to demand such coverage from the judiciary , causing a consequent swelling of this power and intensifying the phenomenon of judicialization. The result of the research showed that judicialization of supplementary health, in the case of the conflict over home care, was due to the insufficiency in the performance of the National Supplementary Health Agency, responsible for regulating the relationships established by private health service providers.
Descrição
Palavras-chave
judicialização da saúde suplementar , agência reguladora , planos de saúde , home care , tratamento domiciliar , beneficiários , operadoras de saúde , direito à saúde , ANS