Improving quality through accreditation: The health insurance case

As a result of the economic environment of the 90’s, the globalization and health systems reforms, there was an enlargement of private health insurance markets around the world. The state also extended its activities to regulate these markets. The accreditation of health organizations, public and private, is one of the strategies for monitoring health care quality that becomes a distinguishing feature in the new environment. It has the feature to be voluntary and carried out by agencies not directly involved with the evaluated organization. It verifies the organization adequacy to established standards.
The paper presents results of an international literature review on accreditation of private health plans to subsidize proposals for the implementation of this process in Brazil, a policy patronized by the Ministry of Health
Unlike the accreditation of health providers, the accreditation of health plans is not a relevant theme in the academic literature nor national programs are easily found. We examined three experiments: United States, Colombia and Australia (whose formulation is under way).
The results are presented in accordance with: the governmental or private character of the accreditation institution, the uses, and the incentives of the state, the standards, the dimensions of analysis and the indicators.
In Brazil, where the accreditation of health providers has existed since the 90’s decade, there is a very low coverage (about 80 hospitals in 7000), it discusses in what conditions this result wouldn’t repeat. Also, it discuss the advantages of the accreditation vis-à-vis other quality improvement strategies.
It is expected that the work can contribute to the evaluation of international strategies for improving productivity and performance of health systems, and for better delineation of indicators that focus on the specific role of health insurers and providers.