A ouvidoria como fator de redução da assimetria informacional nas operadoras de planos de saúde através da funcionalidade sistêmica

Abstract

The ombudsman works to bring customers and companies closer by resolving conflicts and improving work processes. Its activity, linked to people's needs, rights and values, guides its operations. In this sense, the ombudsman's office must be the appropriate means to exercise broad communication in order to formalize an important dialogue with the client that impacts sectoral results. In this context, the National Supplementary Health Agency (ANS), the agency that controls the activity and with the objective of improving customer service, edited Normative Resolution (RN) No. 323, for Health Plan Operators (OPS). This regulation determines the organization to create an organizational ombudsman unit. The problem comes up, precisely, in the operation of the ombudsman and the little or no efficiency in the communication processes that is peculiar to it to contribute to the efficient management of the sector. This represents a gap between priority interest groups that impact information asymmetry between companies and their consumer market. This work has the general objective of demonstrating that it is possible to make communication more efficient if there is a functional restructuring of the ombudsman within the supplementary health sector to reduce the distance between the actors involved in the sectoral relations. Among the specific objectives, present a practical proposal for the improvement of these communication processes to reduce informational asymmetry: a) verify the origins of the health sector; b) to investigate the need for permission for private companies to act in the health sector due to the problems faced by the State to reach the entire population; c) understand the concept and impacts of information asymmetry within the private supplementary health sector and the resulting risks; d) analyze the possibility of applying Luhmann's systems theory to build a vision of how the organization should promote communication with the environment in which it operates, in search of information and in order to satisfy the expectations of its consumers; e) analyze data collected from Health Plan Operators on the current composition and form of performance of the ombudsman sectors; f) present a practical proposal for the process and procedures for restructuring the performance of an ombudsman sector to reduce the incidence of information asymmetry in Health Plan Operators. The initial hypothesis is that it is possible to make this restructuring feasible if the internal processes of the ombudsman have new language patterns of communicational meaning with the actors involved that impact efficiency. The initial hypothesis is that it 8 is possible to make this restructuring feasible if the internal processes of the ombudsman have new patterns of language, of communicational meaning, with the actors involved that impact efficiency through the construction of a framework that will result in an ombudsman managed through systemic communication, with positive reflexes in the search for the expectations of both the client and the company throughout the ethic framework that structures the dissertation is based on the application of Niklas Luhmann's Theory of Systems applicable to organizations. This gives the researcher the possibility of observing the entire process of organizational communication and identifying the elementary and variables that directly affect decision making and the organizational existence itself as a result; it makes it possible to verify the irritations that are being offered by the environment because of the systemic interdependence relationship making the organization more efficient and socially evolved. This means that the ombudsman's office must include information about users and consumers in its communication processes in order to be considered in the organization's operational management. In order to arrive at the hypothesis and comply with the general research objective, the approach methodology involves Law and Economics. The applied research techniques contain: the sectorial market case study, data exploration, empirical research and bibliographic review, national and foreign.