Private health plan systems, also known as health plans, serve around 50 million people in Brazil. Their regulation is based on Law 3656, from 1998 , which, according to specialists, needs to be reformulated as it is relatively old. Thus, more than 260 proposed changes were made to the legislation.
The theme involves issues such as readjustment of monthly fees, reimbursement of procedures, assistance coverage, among others. Professor Roberto Augusto Pfeiffer, from the Commercial Law Department of the USP Faculty of Law, comments that the theme is extremely complex and that cost is one of the themes most touched upon by the new proposals.
plan types
It is interesting to note that most of the plans currently offered are collective or business plans. According to Pfeiffer, this happens because these plans are less regulated by the National Supplementary Health Agency (ANS) than individual and family plans. In addition, the initial monthly fee for these plans ends up being lower, an attractive factor for most individuals who need a plan. However, the expert makes a caveat about them: “Collective and business plans suffer more readjustments, because there is no limitation for them. It ends up being practically a trap for the consumer”, explains the expert.
Roberto Augusto Castellanos Pfeiffer – Photo: FD-USP
In addition, false collectives stand out in this debate, since, instead of involving thousands of individuals — as it should be done — they can count on the presence of a few dozen, a situation that harms a large part of the population. The professor also highlights the presence of coverage exclusion in some plans. Thus, the consumer signs the contract and, when he needs it most, it is not met. On the other hand, the high prices are also alarming, these values have increased, as the cost of medicine increased during this period. “I think that maybe the ideal thing is to sit down at the table with the parties involved and try to find a solution that addresses all this complexity.”
Judicialization
Despite its extreme importance, it is noted that the Unified Health System (SUS) does not have the capacity to cover and provide complete services for the entire national population. This factor makes the existence of health plans necessary to meet the demand of Brazilian health, however, when problems with these systems appear, the judicialization of the subject shows growth.
According to the professor, no extremely judicial means is positive, since the process ends up being very tense for all parties — especially for patients. Thus, the regulation of these plans turns out to be the best path, together with a broader reform of the SUS.