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Despite the recent decision of the President of the Federal Supreme Court (STF), the Minister Carmen Lúcia, to suspend the rule that up to 40% of the payment of examinations and consultations in health plans coparticipation, the Director of Sectoral Development of the National Agency of Supplementary Health (ANS), Rodrigo Aguiar, continued to defend, in an exclusive interview with Agência Brasil by e-mail, maintaining the 39; index. "There are no technical reasons to change the index."
Aguiar said that the agency's competence to edit the Normative Resolution No. 433, which addresses this issue , was established by the general law of the Union (AGU), which has already considered the proposal. The director also commented on a recent controversy involving the role of ANS: the role of regulatory agencies, he said, is to promote the balance of the sector, without acting for a single audience.
The ANS director also categorized as "totally" the statement that there was an "irresponsible expansion" of the boundaries of co-participation. According to him, such mechanisms have existed for more than 20 years without any limit imposed on operators. " Today percentages of 50%, 60%, 70% are applied.The standard has set a ceiling of 40%." He also denied that ANS had, in recent years, recommended that this index is at 30%.
The ANS director, Rodrigo Aguiar, says that the cost-shared client pays up to 40% of medical expenses. ANS / Derechos Reservados
Although he continues to defend the ceiling of 40%, Rodrigo Aguiar acknowledges that "if the judiciary and legislature …] to make a decision determining the modification of such a percentage, ANS will do it quickly. "
Check the interview:
Agência Brasil: In her decision, the Minister Carmen Lúcia says that ANS does not have" The competence appropriate "to regulate the financial regulatory mechanisms and that the issue goes through the Congress, since it involves the right to health. Aguiar: An badessment of the legality and / or competence of the NSA to edit a standard is made by the General Law of the Union (AGU), which, as in all regulations issued by ANS, the proposed standard that resulted in the publication of the RN No. 433/18 and has not identified any illegality or unconstitutionality in the action of the regulatory agency.
Agência Brasil: The Brazilian Institute of Consumer Protection) filed the Normative Resolution No. 433 as "retrocession" and accused the ANS of extending so "Irresponsible" the limits of co-participation in the plans. Did the agency expect such a reaction from society and the judiciary itself?
Rodrigo Aguiar: Criticism does not apply. The process of standardization of co-participation and franchising has fully followed the rite for the participation of several audiences of interest, with several different opportunities (working group, technical chamber, public hearing, public consultation and search for grants) representatives of civil society and the general population, to record suggestions and criticisms before the definition of the standard. Representatives of consumer protection agencies made some 140 contributions to the regulation, of which 74 were fully or partially complied with.
by ANS. Only Idec had 15 proposals fully or partially completed by the regulator during the process. In general figures, the public consultation on the subject received 1,177 contributions from the society and public research counted on 645 contributions.
The statement on "irresponsible expansion" of co-participation limits is completely misleading. Such mechanisms have existed for more than 20 years without any limit imposed on the operators. Today percentages of 50%, 60%, 70% are applied. The standard sets a ceiling of 40%. In addition, it sets limits – monthly and annual – for billing by operators, effectively protecting the budget of consumers, thus preventing them from being surprised by excessive fees. It should be noted that currently, under the Consu No 8 of 1998, there is no established limit, so that operators are free to apply the values and percentages that are suitable for them in consumer contracts.
it is worth noting the prediction contained in RN No. 433/18, through which ANS also determined the collection exemption for more than 250 procedures, including chemotherapy, radiotherapy and radiotherapy. ;hemodialysis.
It is clear that the only novelties created by ANS since the publication of the RN 433/18 were to protect and defend the consumer, giving them predictability and security.
Agência Brasil: Prior to the resolution, there was no definition of a maximum percentage of co-ownership in each service, but the NSA ordered operators not to practice values higher than 30%. Rodrigo Aguiar: It should be noted that there has never been an ANS standard stipulating the collection limit of 30% or any other percentage. Nor is it true that ANS has asked operators to keep practicing values by 30%. Over time, several preparatory and preparatory documents have been developed by ANS to define the maximum percentage to be determined for the co-participation collection and in these documents different percentages have been suggested from different criteria, ranging from 30% to 50%. or even defending the stipulation of a maximum percentage, so that cases were badyzed according to their circumstances. However, none of these percentages had been officially defined by ANS until the edition of RN 433/18, which set the maximum limit at 40%.
With the percentage set in RN 433, operators become a collection limit that has never been before, protecting the consumer. The percentage stipulated, based on several studies, takes into account a value capable of stimulating the conscious and rational use of the plan, without leading to an excessive value to the point where the beneficiary does not seek the service actually necessary. . (limit of financial exposure, waiver of recovery in various procedures and granting of premiums and rebates to beneficiaries to encourage good health habits and prevention routines), ends up reducing the financial impact for the consumer who also knows in advance that the maximum that he will pay – if he uses the scheme – will be the same as the monthly payment.
This is a very intense use of the health regime in this particular month. If its use is possible, it will only be charged for the execution of this particular procedure or the use of a certain service, being limited, in case of co-participation, in percentage, to 40 % of its value. Example: if you make a consultation of R $ 70, you will pay a maximum of R $ 28.
The inclusion of more than 250 procedures and health events exempt from coparticipation and franchise will benefit, for example, to many patients (19659029) collection on preventive examinations (mammograms, oncocyte cytology and fasting glucose, for example); for treatments such as hemodialysis, chemotherapy and radiotherapy; natal [19659] and and neonatal screening tests, in addition to conducting four consultations per year with a general practitioner.
It is important to note that in products registered with the ANS and available for with co-ownership and franchising are, on average, 20 to 30% cheaper than plans without co-participation and franchise , with cases of larger reductions of 40%, for example.
Agência Brasil: The Brazilian Bar Association ("OAB") described as "abusive" the percentage of collection up to 40% by the beneficiaries, in the case of co-participation and franchise health plans. Rodrigo Aguiar: I reiterate that the definition of the 40% percentage for the collection of the co-participation (which must always be cumulated with the limit of the consumer's monthly and annual financial exposure) has been carried out on the basis of in-depth technical studies as well as badyzes of the application of co-participation and franchising in the health systems of other countries, as the report of the Analysis of the regulatory impact available on the ANS website
. ANS is sure of the adequacy of the percentage set, so that there is no technical reasons to promote an amendment already at this time, in which the approved standard is neither in force neither (being in the vacancy period and be suspended by decision of the Supreme Court
However, out of absolute and undeniable respect and submission to the Judiciary and Legislative Powers, as well as to the dema If any of these decisions gives the decision to change this percentage, ANS will do it quickly, as it could not be.
Finally, it is important to note that the percentage set by the ANS is a percentage Operators can, as a measure of competition in the sector, market products with lower percentages or without adopting mechanisms, ensuring that companies offer different products and meet different profiles and needs. of the consumers, which power of choice.
Agência Brasil: Law No. 9.961 / 2000, which created the ANS, indicates that the purpose of the institution is to "promote the defense of the "Public interest" in complementary health care. You recently said that the agency is not a consumer protection agency. What I said when I said this sentence, which was decontextualized in the press calls, was that the role of regulatory agencies is to promote the balance of the sector.
Rodrigo Aguiar: As the consumer is the most vulnerable link on the regulated market, must have duly supported service and rights. This is the main function of ANS and any other regulatory agency. But to achieve this goal, the regulator must ensure that the industry is balanced so that the service to consumers is adequate and qualitative.
I note that, in this context, I stated that the ANS is not one of the bodies that make up the national consumer protection system, but has a very close relationship with it in order to 39, observe the interests and rights of consumers.
Edition: Carolina Pimentel
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