[ad_1]
Last week, the National Agency for Supplementary Health (ANS) regulated two health plan modalities acquired by about 24 million consumers, accounting for half of the total number of users. The standard sets the rules on coparticipation options, when the customer pays for the procedures, and the franchise system, where the consumer pays the cost of the service until a certain limit is reached. At first, the definition of the operating parameters for these popular products is positive.
According to regulations, the user can pay up to 40% of the payment of the proceedings (and up to 50% in the collective plans, if there is an agreement or a convention collective work in this direction) or to bear the expenses until the deductible is reached. A total of 250 consultations, often related to chronic disease surveillance, are partially or totally out of regulation. Hemodialysis, radiotherapy and chemotherapy, for example, can not be collected
The economy offsets?
The agency considers the rules as a consumer protection. According to the ANS, in addition to establishing the maximum amount to be charged by the companies, the regulation guarantees full coverage of the various procedures. In professional accounts accustomed to defend consumers, this is not the case. Standards leave users vulnerable to unpleasant surprises. The first point is not to address the issue of adjustments applied to co-participation and franchising. The consideration is that it does not make sense to adopt the same ratios used for the other plans since the user also helps to pay the expense account. "If it's up to the operator to have a lower cost with his client, this must be reflected in the increase," says lawyer Rafael Robba, who specializes in the law of the health. "It should be lower."
The client does not account for the conclusion of the plan. In general, he is attracted by the lower starting price compared to products that include full payment of expenses. On average, they cost between 20% and 30% cheaper. At the tip of the pencil, however, the economy may not compensate. "Initially, the models look interesting, but the monthly fees do not reflect what the user can really spend," says Ana Carolina Navarrete's attorney at the Institute of Consumer Protection. Depending on the need for use, what the customer will pay in addition, for example, will double the monthly minimum cost. "This increases the debt of the user," says Ana Carolina. In the opinion of the lawyer Rodrigo Araújo, specialized in health law, in the case of a franchise, it is enough to ask the need for a little more complex surgery and the total value of the limit will be spent. "Therefore, it is necessary to carefully badess whether the reduction in the monthly amount offsets the risk, which is unlikely in many cases," he estimates
"The system that supports health Araújo warns against the fact that the agency does not have the right to make a payment in the same way, conditioned their performance in a provider indicated by the operator: "C & Is abusive because it directly interferes with the relationship of trust that the user has with the doctor and the service provider. "
The regulation raised more doubts and concerns, already surprised by the successive increases in monthly payments, all higher than inflation.On last week, the ANS authorized the rise of up to 10% of the price of individual and family plans.In the collective, not subject to the regulation of the agency, readjustments have been e up to 18%, against inflation below 3%.
The model of the increases is unsustainable. In three years, three million Brazilians have left the system because they could no longer pay for the products. "The financial system that has supported additional health in Brazil in recent years, based on outright transmission of readjustment expenses, collapse.While quality and effective management of health costs are left behind the current model creates a senseless and incomprehensible price hike that no longer fits in the consumer's pocket, "says José Seripieri Junior, founder and president of the Qualicorp Group, the largest administrator and broker of group health plans in Brazil "The sector lacks a benchmark that reflects the real cost of health in Brazil. Then anyone who makes adjustments based on this index, or even below, will be more competent. Only then will we have a private market based on free competition, in which consumers and the most efficient companies will win. "
Source link
