Determining factors for implementation of internal controls and management of subscription risks through impact indicators on medical cooperatives

Abstract

This study, part of a broader interventionist research, seeks the theoretical relationship of the determining factors to implement internal control processes and underwriting risk management practices in light of Normative Resolution No. 443 applied to health plan operators. To identify the theoretical variables, a literature review was carried out, and an adaptation of the UK model (2009) was proposed with three components (environment, processes and results) measured in the variables: Leadership, Policies and Strategies, People, Risk Identification and Analysis, Risk Assessment and Response, Monitoring and Communication, Effectiveness of Risk Management and Organizational Results. In the environment dimension, hybridism and agency conflict arising from the business model of medical cooperatives were considered, weighted by corporate governance, discussed in the theoretical framework. In the process dimension, the risk management literature is considered, especially the COSO II framework, in addition to the requirements established by the ANS.