Until when will the health plan bill be closed?

nila44

Year after year, users of health plans (individual and group) are faced with monthly fee adjustments that far exceed inflation. The feeling is that rising costs, in the near future, will end up making the health system intermediated by private plan operators, which today reaches around 1/4 of the Brazilian population, unviable. If we can say that this is not happening yet.


The causes for this are very diverse. They range from the incorporation of new technologies and high-cost medications, through the aging of the population, leading to less noble issues, such as lack of rationality in use by users, excessive prescription of exams and procedures by doctors, inappropriate use of services and frauds.

In other words, there are several influences on the increase in cost. But, when we look at these factors individually, we realize that it is the increase in use, and not the price of health services, that is the main villain behind the evolution of plan prices. It's called accidents.

Within this scenario, it is undoubtedly the role of operators that perhaps causes the most perplexity, as they seem to be the ones best suited to modify, or at least initiate, changing this panorama.

This is because this increase in B2B Lead accident rates seems to be translated, solely and exclusively, into the passing on of ever-increasing costs to consumers and unfounded denials of coverage that often lead to the so-called “judicialization of healthcare”, with costs estimated at R$8 billion. only in 2017. An amount that ends up being transferred to consumers' accounts.


The question does not go away: what, specifically, has been done to control the increase in accident rates and costs instead of simply passing them on to consumers who are placed, literally, between a rock and a hard place: either they pay the extortionate adjustment or lose coverage?

As expecting a more agile and effective stance from the ANS in regulating the sector seems like an innocuous measure, co-participation (a modality in which the user participates by paying part of the value of the services used) is now presented as a saving measure. It would be as if it were capable of, at the same time, alleviating the growing costs of operators — without considering that it could represent even more costs for the consumer if they do not receive compensation in the reduction of the value of the plans — and also “educating” customers in the more judicious use of the plan.



But is this, in fact, the only possible solution to the sector’s problems?

Couldn't an effective concern with the flagrant inefficiency of the system and a more effective fight against its causes bring better results? Why not discuss greater transparency for consumers in relation to the costs incurred by operators?

Another point would be to demand greater clarity in the explanation of the criteria for calculating the maximum rate set by the ANS, which, it is known, ends up transferring to individual plans, in an absolutely illegal way, the effects of accidents in collective plans, which serve as a basis for the definition of the index.