MULTI-PAYERS COMPARISON OF DAILY REIMBURSEMENT VALUES OF DISTINCT HOSPITAL FACILITIES IN THE BRAZILIAN PRIVATE HEALTH SYSTEM

Author(s)

Araújo GTB*1;Abicalaffe CL2;Savian J2;Decimoni TC1;Santos AM1, Fonseca M3 1Axia.Bio Consulting, São Paulo, Brazil, 22iM S/A, Curitiba, Brazil, 3Federal University of São Paulo / Axia.Bio Consulting, São Paulo, Brazil

OBJECTIVES: In the Brazilian public health care system, the government establishes one value to reimburse the entire country for the use of different health care facilities. In the supplementary/private system, as a business-to-business negotiation, each the hospital negotiates different reimbursement values with each payer for the use of distinct hospital facilities. There are eight different types of hospital facilities available in the supplementary system: standard, cardiovascular unit, surgery unit, psychiatric, day hospital, nursery, adult and pediatric ICU. The objective of this study is to find out and compare hospital facilities daily reimbursement values and establish a mean reimbursement value for each facility type in the private health care. METHODS: Data was obtained from BI.2iM database, a 5 million people sample of the Brazilian supplementary health care market. All values are in 2009 Brazilian reais (US$1.00 = R$ 2.00). Data are presented as mean ± standard deviation RESULTS: 65% of the patients are from medical cooperatives, HMOs 20%, self-management 11%, others 4%. A total of 303,573 hospitalizations were reviewed with a total expenditure of R$ 82.9 million. The mean reimbursement for each facility type was: standard R$ 152.43 ± R$ 148.80; cardiovascular unit R$ 183.03 ± R$ 92.63; surgery unit R$ 202.06 ± R$ 87.74; psychiatric R$ 121.42 ± R$ 50.66; day hospital R$ 79.60 ± R$ 23.50; nursery R$ 73.25 ± R$ 30.67; adult ICU R$ 625.82 ± R$ 305.71 and pediatric ICU R$ 762.91 ± R$ 330.58. CONCLUSIONS: There is not a single reimbursement list (health plans to the providers) or fixed values for hospital facilities daily reimbursement values. We found different mean values of hospital facilities daily reimbursement that vary according to the facility type. Even within the same facility type there is also reimbursement value variation.

Conference/Value in Health Info

2013-05, ISPOR 2013, New Orleans, LA, USA

Value in Health, Vol. 16, No. 3 (May 2013)

Code

PHS125

Topic

Health Policy & Regulatory

Topic Subcategory

Reimbursement & Access Policy

Disease

Multiple Diseases

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