Health promotion in the health insurance: relationships and tensions between private plan providers, beneficiaries and state regulatory agency

Abstract

The relations between private plan providers, beneficiaries and the state agency in the provision, use and regulation of health promotion programs will be analyzed. Multiple case studies will be investigated, cases whose data were obtained from interviews with 40 participants (managers, professionals and beneficiaries) of 6 health operators in Belo Horizonte/MG, besides participant's observation developed in the programs. The analysis revealed tensions between the logics that guide the actions of the regulatory agency, the provision of programs and the interests of the beneficiaries. Providers aim to reduce costs and attract customers. Beneficiaries seek comprehensive care, but face restrictions on access. The regulatory agency encourages further rapprochement between the industry and public health guidelines, but the means have reduced transformation potential. There is logic of capital accumulation that determines and tensions health promotion in health insurance.