Health plans for death

Nuno19junKIKO ART

Published at 19:00 on 06/19/2022

In a country where the public system is not sufficient to meet the needs of the entire population and where the middle class has to turn to private insurance to ensure access to doctors, laboratories and hospitals, the value of the monthly fee will increase by 15.5%. the shot is a significant blow. That’s why the National Supplemental Health Agency (ANS) was an adjustment made for individual and family plans across Brazil at the end of last month. It is the highest index ever applied to agreements in history. The previous record, 13.57%, was set in 2016.

For other groups of policyholders, the situation may be even worse. For business plans or those that were included in a collective plan, in some cases the blow was close to 20%. The coldness of these numbers is rebellious and the question it provokes in this way is fully justified. How is it possible that the middle class (which is most dependent on health plans) has been losing ground since the Covid-19 pandemic began?

This is one of the questions that has been asked since the monthly fee was readjusted. It reflects the outrage and inability of the population to suffer the economic losses and setbacks that have taken place in the past. But before the health plan operator can be stoned and demanded that measures be taken to prevent this situation from progressing, it is advisable to stop and try to understand what is behind the situation.

If the authorities are concerned about the impact of rising fuel prices and are in a hurry to take action to show that they are tackling the problem, why not ask them to show interest in health insurance? Is this the solution? Probably not: a complex problem, health insurance, all attempts to fix it immediately fall into populist temptation and eventually lead to changes that make the situation even worse than before.

STATE ORDER

This is a discussion that sparks passions and divides opinions in many parts of the world, and not just among us. Health insurance is a relatively new service in Brazil, and the expansion of this modality, which currently has 709 operators authorized to operate by the ANS, is a indirect consequence of the universalization of the health system proposed by the 1988 Constitution. Creation of a Integrated Health System, SUS.

What does one thing have to do with another? Very simple. As more people began to have the right to public care, they turned to plans and agreements that ensured access to private hospitals that they wanted (or could have) less attention to. Over time, the system grew, gained complexity, and of course began to reveal its flaws. Until he understood that the government needed to act to put the situation in order.

The Health Insurance Act No. 9656 was signed in June 1998 by then-President Fernando Henrique Cardoso and Health Minister José Serra. Amended by a number of subsequent laws (most recently passed by President Jair Bolsonaro in March this year), the instrument sets out the obligations and limits of action of private plans and makes clear their complementary role to the system provided. SUS to all Brazilian citizens.

The number of people covered by private health plans is not negligible. According to the latest statistics, one in four Brazilians is covered by a private plan. More specifically, nearly 49 million people today are covered by health insurance for about 220 million people.

In total, more than 34 million business plans have been covered. About 6 million are linked to collective partnership plans (mostly in cooperatives, professional associations, trade unions and even companies). The remaining $ 9 million is covered by individual and family plans, a modality that is not offered to new policyholders and only covers contracts that were currently in the system before 2013.

In that year, the big operators admitted that they were no longer interested in offering this modality, in order to escape the control that the ANS, created in 2000, had begun to carry out over the readjustment policy. Since then, business plans and partnership agreements have been preferred. In the case of these plans, operators have the autonomy to define readjustments, but because they are subject to stiff competition and insurers can migrate from one plan to another without having to submit to grace periods, they usually do not increase the dose. .

SINGLE PROBLEMS

Under normal circumstances, the private health care system works well. But in the midst of crisis, mistakes that were dormant emerge, and in such cases, there is always someone who is willing to offer such a populist solution. In recent years, for example, courts have frequently been called upon to resolve coverage claims for cases that were not included in the list of illnesses covered by the contract.

Although there are humanitarian justifications for these types of resources, it must be acknowledged that this practice changed the financial balance of companies that had to comply with a business plan. And the conclusion is that the exemption costs allowed by first instance judges across the country are shared by all users of the plan.

Last week, with 9 votes against, the High Court ruled that the plans are not required to cover unforeseen treatments in the so-called ANS Tax Census. This is the list of diseases that, according to health authorities, should be covered by the plan. The question is: what to do with a patient caused by a disease that is not included in this list? To let a patient who cannot afford treatment die without any help? Of course!

In exceptional cases, as seen in the Covid-19 pandemic, the public system enters the field and generally does the work. With the exception of occasional problems, usually caused by corruption or incompetence — in the systemic way of Manaus and in isolated cases in many parts of the country, including Rio de Janeiro — the system was pushed to its limit and nevertheless did not collapse. Contrary to what has been seen in Italy as well as in some parts of the United States, cases of death due to lack of attention have been rare.

This, by the way, is a point worth considering. Brazil’s public health system is known to be imperfect and often the most vulnerable population suffers from drastic reductions, such as delays in scheduling appointments and surgeries, barriers to accessing exams, and, in some cases, cases. , lack of vacancies for hospitalization. However, it is more effective than many rich countries.

Based on the UK National Health Service (NHS), our SUS is a well-designed and well-structured network. There, the council is responsible for examining and dealing with cases of low complexity. States are responsible for dealing with cases of medium complexity and operations. Finally, it is up to the Union to provide a comprehensive system of resources and to find solutions to the most complex cases.

QUALITY OF SERVICE

What does all this have to do with health plans? Lots of things. While it’s not convenient to accept, the truth is that cutting-edge medicine is an expensive and elite service anywhere in the world. And while this may not be the case, it is understandable that the most advanced treatments are not available to everyone. What is unacceptable, however, in the case of Brazil is the difference between the quality of services in private primary hospitals and the number of public hospitals that provide services to most of the population.

Rather than the readjustment index applicable to private health plans, the ways to make the universalization of services provided for in the 1988 letter a reality for all citizens should be discussed at this time. And this, as in Portugal and other European countries, is that first-line hospitals, which currently provide care only to clients at the top of the pyramid, also receive citizens who do not have health insurance. The state pays the bill to those who cannot afford their treatment.

It is certainly a complex issue that should be on the list of enduring concerns of any candidate for President of the Republic. But that, unfortunately, is only discussed when an event, such as a major readjustment of monthly plan fees, pays attention to the seriousness of the situation.

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