Análise de perfil epidemiológico de um plano de saúde para apoio à decisão estratégica

Abstract

The demographic transition in Brazil has led to population aging and an increase in life expectancy. Simultaneously, along with improved financial and social conditions, the pattern of prevalent diseases among Brazilians has shifted from acute to chronic conditions. As a consequence of these phenomena, there is a change in healthcare utilization patterns and a rising trend in healthcare costs for healthcare organizations. This increase necessitates assertive decision-making by private health insurance companies to ensure their economic sustainability. This study aims to analyze the epidemiological profile of a health insurance beneficiary portfolio in order to support strategic decisions for cost reduction through prevention and health promotion. A stratified proportional sample of 368 beneficiaries was selected to collect data on the epidemiological profile of the associated population, who underwent a sociodemographic questionnaire regarding dietary habits, lifestyle, and health conditions. Graphical analysis of the collected data and statistical tests were performed to examine the association between health status variables and potential risk factors. The main challenges identified from the analysis include high percentages of age groups with hypertension and diabetes, a portion of diagnosed individuals with hypertension and depression not using medication to control their conditions, obesity rates among the elderly and adults, and age groups with low levels of physical activity and high sedentary behavior. Proposed interventions include the creation of periodic awareness and monitoring programs on priority topics, improvement and expansion of the current quality of life program for the elderly to include other age groups, and investment in informational management of the beneficiary portfolio to promote more efficient and effective care guided by data.