Medicine has been changing its own concepts over time, which is a common reality across the planet, but even more evident in a country like Brazil, where working relationships in this area need to improve. Therefore, knowing how health service providers are remunerated is very important.

There is a paradigm shift in this context, as the focus seems to be shifting from the immediate concern of reducing costs to a medium and long-term strategy, with gains in the final result. Check out the content below and learn a little more about this topic!

Factors that increase operator costs

Loss of data and information

One of the problems that causes operators' costs to rise is inadequate management and the consequent loss of data that would be important for their operation. This is even more common in companies that do not rely on technological tools and, nowadays, still use paper spreadsheets.

They are much more volatile and subject to damage, as they can be torn, damaged and lost. Furthermore, they are more easily falsified, simplifying the work of unscrupulous employees who commit embezzlement or some type of fraud. With management software, for example, this becomes much more difficult to do.

Inadequate professional performance

Another factor that increases operators’ costs is inadequate professional performance. This occurs not only among internal employees, but above all with doctors who work with different companies and hospitals, not being loyal to any one specifically. This destandardizes your service and can create undesirable situations.

They often have to see several patients per hour as a way to compensate for low pay. As a result, they may end up requesting excessive tests and procedures, either because they do not dedicate enough time for an in-depth clinical analysis or even out of insecurity, especially in the case of younger people.

Occurrence of unforeseen events

Another cause that cannot be overlooked, although it is a little less common than the previous ones, is the occurrence of unforeseen events that impact the health of a large number of beneficiaries. This affects the operator's accident rate, generating a series of costs that were not planned by the company's regular budget.

Among the most serious situations of this type are calamities or natural catastrophes, which abruptly increase the number of users seeking emergency consultations and, logically, the severity of the cases. Hospitalization in ICU beds and surgeries, for example, require significant resources, increasing operators' costs.

Accreditation of hospitals and clinics

In the name of quality care, strict protocols are imposed, with exam routines that are not always ideal for the case, depending on the initial medical evaluation, and that generate increased costs and waste of resources.

Most common forms of remuneration on the market

Payment for service

Payment for service, also called “fee for service” in English, is very common among Brazilian operators. This involves paying providers for the number of procedures performed, without taking into account their quality. One of the defects of this option is that the focus is on the disease itself, and not on the causes.

Another important flaw is that, in this way, doctors can speed up the number of consultations and increase exam requests, as this is seen as a way to compensate for the low amounts received. By making this choice, they impact the operator's costs and worsen the final results of the assistance provided.

Per capita payment

The per capita payment method, as the name suggests, pays per person covered, paying providers a fixed amount per month for all services. The big advantage is that this amount can be adjusted according to the specific needs of each user, giving the parties a little more flexibility.

The definition of values depends on data related to geographically distributed population risks, which can be a huge problem for companies that do not have excellent control over their beneficiaries' information. Investing in a solid statistical base, therefore, is essential to use this alternative.

Payment per package

Package payment, also called payment per disease cycle, is not yet so common in Brazil, but it tends to gain space in the market in the coming years. This must occur because this is a more specific choice, in which you are remunerated through a single payment for a set of services, according to the diagnosis.

To bring more uniformity, the ICD is used, which is the International Classification of Diseases and other health problems. With the codes for each pathology, problem categories can be homogenized, defining distinct and individualized packages. You need to have some flexibility to make price adjustments throughout the process.

Pay for performance

Payment for performance is one of the biggest trends in the current market, as it is an option that considers not only the number of consultations or exams requested, but also the quality of the professionals involved throughout the process and the levels of patient satisfaction. , who generate income for operators.

It is a very interesting choice from a marketing point of view, as satisfied users reinforce the quality and authority of the company in its segment. It is also advantageous if we think about preventive measures, considering that professionals will be concerned with offering excellent performance, focusing less on their own remuneration.

What are operators doing to survive?

Logically, operators are taking steps to survive in this market, and definitely the most important of them is investing in technology. Through the adoption of a software focused on this market, it is possible to break paradigms and jump ahead of the competition, capturing and interpreting the available data with more precision.

This type of solution centralizes data in one place, facilitating everything from the administrator's work, through employees and up to the management processes. audit. It is also possible to analyze histories, measure the number of each procedure and generate valuable information for future decision making.

These are the ways in which healthcare service providers are compensated and the ways in which these companies are trying to survive in this very competitive market.

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