[ad_1]
Age group that pays the highest monthly fees when placing a health plan , the elderly are the fastest public among medical convention clients in the country, mainly in (ANS) data tabulated by the O Estado de São Paulo newspaper show that in ten years, the number of beneficiaries of more than 80 years jumped 62%. The index is more than three times higher than the general customer volume (18%) and higher than the growth rate of this group of the population in the period – by 55%, according to IBGE.
A client she was the only one to have grown up in the sector in the last three years, a period of economic crisis during which the number of additional health users decreased in Brazil. The phenomenon, mainly explained by the increase in longevity, must be maintained. By 2030, 20% of all plan clients will be older, according to a projection made in an unpublished study from the Institute for Complementary Health Studies (IESS).
more The aging of the population will result in a significant increase in operator costs and, consequently, monthly payments. A patient over 80 years costs an average of 19,000 reais per year, compared to 1.5 thousand reais per patient under 18 years of age.
Considering the impact of the aging population Hospital costs over the period, the IESS estimated that health care spending plans will jump 157.3% from R $ 149 billion to R $ 383 billion in 2030.
The study warns that if the health care system does not change to prevent high expenses, the scheme can become a very expensive and almost "priceless" service for most. Luiz Augusto Carneiro, IESS executive superintendent, said: "There is no way to imagine that such an increase will be absorbed by operators, this increase will result in readjustments for the beneficiaries or at the end of the economic and financial sustainability of the sector. "It would be very bad for the operators, the beneficiaries and the rest of the country, because an additional 47.3 million would depend on the SUS, which already has excess demand."
Currently, the average monthly value of the agreement for a senior is four times higher than that practiced for young people under 18, according to ANS. Retired teacher Aico Nakamura, 84, struggles to pay the monthly fee of $ 800. "It is not easy, it is very expensive. Even without serious health problems, she has contracted for fear of having problems at this stage of life. "My health, thank God, is fine, but even using little, it can not be without."
Solutions
For Ram, measures should be implemented such as the fight against fraud and waste, which he said consumed 19% of operator spending in 2016. "It is also important to encourage disease prevention and healthy aging."
President of the National Federation of Complementary Health (Fena Saúde), Solange Mendes need to adopt a compensation model for service providers "based on the quality and effectiveness of treatments, and not on the number of procedures performed, to avoid unnecessary consultations and examinations. "
Chief Economist of the Brazilian Association of Health Insurance Plans (Abramge), Marcos Novais says that operators and hospitals will also have to adapt. "
Asked, the National Agency for Supplementary Health said that rapid aging is" very important, One of the most urgent issues to be addressed "and stressed that the solution involves a change in In this context, ANS emphasizes the creation of the Elderly Well Care project, an initiative which involves' partner institutions engaged in the development of the health care model, with a stronger focus on prevention and health promotion actions. research and implementation of measures in the field of active aging, quality of care, costs and
Last week, the ANS published a resolution that sets out rules for two terms of commitment: joint ownership and franchise What is co-participation and franchise?
In co-participation, in addition to monthly fees , the customer pays part of the cost In the plans with deductible, the recipient pays the monthly payments and all the badistance expenses up to the set value for the year or for each procedure. Once this limit is reached, the operator pays the full cost of care. In both cases, the annual expenditure with these additional payments can not exceed 12 monthly months
2) Are these plans new?
Plans with co-participation and franchise already exist and are widely used by the market. More than 52% of the beneficiaries of medical and hospital plans (ie 24.7 million beneficiaries) have a contract with one of these mechanisms
3) Why did ANS have he changed the changes?
4) What changes in co-participation plans?
The rules that generate these mechanisms were considered generic and did not clearly specify conditions, criteria and limits.
The recipient can afford up to 40% of the value of each service. This amount can not, however, exceed the maximum planned per year by the agency. ANS ordered the operators not to practice values higher than 30%.
5) What about the franchise?
There are two incidents. In the accumulated deductible, the operator is not responsible for covering expenses until the amount established in the contract as a franchise is reached in the year. In limited access, a franchise value will be stipulated by procedure and not by year
6) Are there procedures exempt from these fees?
Yes. The new standard states, unlike today, that there can be no incidence of co-participation and openness on more than 250 procedures, including consultations, preventive, prenatal and neonatal reviews and therapies for certain chronic diseases, as well as radiotherapy and chemotherapy. 19659003] 7) Are the modifications valid for existing plans?
No. They come into effect in 180 days.
Source link
