As mudanças advindas da regulação das ouvidorias das operadoras de planos privados de saúde: estudo de caso na Unimed Fortaleza

Abstract

The Ombudsman operates approaching the customer to the company through solving conflicts and by work process improvement. Its activity is linked to respect the needs, rights and values of users. The National Regulatory Agency for Private Health Insurance and Plans (ANS), aiming at improving service to beneficiaries, regulated the Normative Resolution n. 323 establishing the private health insurers implement an organization unit of ombudsman. This work aims to analize the changes caused by the interference of the government's regulatory agency and can contribute with a critical reflection about ombudsman's intitute for your continuous improvement. This is an exploratory and qualitative research, whose data were obtained through a document review and annotated bibliography of books on the subject. It was made a case study research in a large network of healthcare provider in the state of Ceará, where alterations were observed in its organizational structure, internal procedures and the resolutions demands. A new structure given by the company with increased staff and shift focus to the recommendations of improvements in process has been is identified. The dealings flow of complaints started to have the same importance of external demand punishable by penalties. It can be seen even an improvement in the mediations of conflicts and an improvement in the relationship of trust with the customer, generated by the investment.