Percepção do médico sobre pagamento por desempenho no gerenciamento de doenças cardiovasculares: O caso de uma operadora de plano de saúde

Abstract

Since the '50s, people began to give increasing value to the risk factors for cardiovascular disease. The management of cardiovascular disease (CMP) seeks the construction of patient autonomy and improved quality of life. In some countries, to reach these goals, the use of pay-per-performance (PPP) to physicians has been mentioned as one of the elements of improvement in the process, in patient outcomes and in remuneration conditions. Our goal is to study the medical perspective of the implementation of performance payment linked to the CMP. This is a qualitative research, a case study, using semi-structured interviews with PGC participating and non-participating doctors. The interviews were conducted in September 2009, based on the actions implemented in 2008. We interviewed 23 doctors (14 men and 9 women). The main reason cited for the inclusion of CMP patients was the organization of their care, in which the patient is well controlled and monitored and medical work is evaluated by preestablished parameters. The financial incentive is recognized as important but not determining of the inclusion of patients. The CMP and the PPP have the potential to transform health care, improving outcome indicators. Multidisciplinary work and increased productivity in appointments in the practice were the main positive effects identified. Further studies are required to observe the progress and effects of performance payment.