Planos de saúde

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Odontologia, Florianópolis, 2010.The promulgation of the 1988 Brazilian Constitution, and, through it, the creation of the Unified Health System (SUS) meant relevant changes, as well as an improvement of the public health services offered to the population. On the other hand, this Unified System (SUS) wasn't able to supply all of the needs for all the individuals, which was caused along with the expansion and implementation of the new public health system, a significant growth of the suplementary health insurance. The sector of the private health plans involves more than 50 million beneficiaries, out of which approximately 75% are health plans, including or not dentistry, and 25% of the plans are exclusively dental care; supplemental system is made up of almost two thousand operating companies - in hospitals, labs, clinics and offices. In the same way, there was a large growth of labor cooperatives, and the recent growth of doctors, dentists, and other professionals joining some sort of organization process, as well as the new form of cooperatives. Due to the fact that this is an emerging subject, this research was developed as to understand how the insertion in the suplementary health sector interferes in the professional daily routine of the surgeon-dentist, according to their understanding. For such, it was necessary a long and persistent observation process, and an elaboration of a theoretical milestone which contributed to the construction of the qualitative research. The later was based in the analysis of the content suggested by Bardin (1979) which allows itself the comprehension of the speech trying to surpass the simple description, resulting in a deeper interpretation. The participants of the research were eleven surgeon-dentists from the county of Itajai in the State of Santa Catarina, enrolled as services providers to a very influent odontologic health insurance operating company, located in that State. After the transcription of the interviews, the analysis was iniciated, and from this parting point, three thematic axis and thirteen categories which possessed similar features have been formed. By thinking about dentistry work, it is needed to think about it as a professional category in crisis, which is intrinsecally a liberal means of work, because this profession possesses an autonomous nature. On the other hand, this profession encounters itself with a diverse reality of its own utopy, in which the odontologic health plan operating companies have effectively interfered in the roots of the professional imaginary, and make, so to speak, changes in the organization forms, management and orientation of the work of the surgeon-dentist. It has also been seen, that the coverage of the services of the supplementary health sector is far beyond the real demands, because they only concern, prioritarily, medical-hospital assistance, therefore not covering holistic health assistance. Social investments are extremely necessary in the sense of upgrading and adapting the public and private health assistance to the ever-changing Brazilian society. It is important to reinforce, therefore, that the desired model is that one which best responds with dignity, efficiency, and that it be accessible to everyone who needs it. In a country where its health system makes sure everyone has access to public health, the proportion of the plans and health insurance should be residual, that is, it should be present as complementary, and, at the same time it should be less complementary. As for this to happen, it is necessary that the health system be well regulated so that SUS may own all the needed structure and investment, so it will accomplish its role, to which it exists