Managing health insurance providers: getting to know their lives

Sustaining finite resources is a constant exercise in business. Health operators and insurers need to make management decisions that reduce the fearful effect of moral hazard and control utilizations. Managing the ＂uses for the uses＂ may not be the best indicator for a better decision. Knowing consumer behavior has much to contribute in this process. This study was based on the theory of health demand, fruit of a seminal research conducted by M. Grossman, in 1972. The universe was expanded, in this empirical study, conducted in a health plan operator, the variables were tested: contract with co-participation and full payment, versus the utilization of users. Hypertensive individuals and pregnant women had their minimum necessary utilization assessed and the variation in the type of health insurance contract proved to be a decisive determinant in the demand for health care. Knowing the client’s profile is not enough to achieve better results. The manager needs to have a command of the behaviour and determinants that influence the choices of his consumers, their ＂lives＂.