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Despite the STF's decision, ANS director Rodrigo Aguiar argues that the co-participation client pays up to 40% of medical expenses (BrianAJackson / Thinkstock )
Supreme Court of Brazil ( STF ), Minister Cármen Lúcia, to suspend the rule fixing up to 40% the payment of examinations and consultations in joint health plans, the director of the sectoral development of the National Agency of (19459008) ANS ), Rodrigo Aguiar, continued to defend, in an exclusive interview with Agência Brasil by e-mail, the maintenance of the 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 described as "totally" the statement that there has been an "irresponsible expansion" of the limits 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%."
Although he continues to defend the 40% ceiling, Rodrigo Aguiar acknowledged that "if the judicial and legislative power (…) makes a determining decision
Agência Brasil : In her decision, the Minister Carmen Lúcia affirms that the ANS did not not "the appropriate jurisdiction" to regulate financial regulatory mechanisms and that the issue should go through Congress because it involves the right to health.In the badessment of the lord, does the agency have extrapolated its competence in publishing the case?
Rodrigo Aguiar : The badessment of the legality and / or competence of the ANS to edit a standard is carried out by the Union Advocacy General (AGU) which, as in all the regulations issued by the ANS, has already badyzed on three rme which resulted in the publication of the RN No. 433/18 and has not identified any illegality or unconstitutionality in the performance of the agency The Brazilian Institute for Consumer Protection (Idec) has clbadified the Normative Resolution No. 433 as a "retrocession" and accused the ANS of extending "irresponsibly" the limits of co-participation in telecommunications
Agência Brasil : plans. Did the agency expect such a reaction from society and the judiciary itself?
Rodrigo Aguiar : The criticism does not continue. 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 organizations made some 140 contributions to the Regulations, of which 74 were wholly or partly fulfilled 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 society and public research relied on 645 contributions
The statement on "irresponsible expansion" of co-participation limits is totally wrong. 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 Decision No. 8 of 1998, there is no established limit, so operators are totally free to apply values and percentages that suits them in contracts with consumers.
it should be noted the prediction contained in RN No. 433/18, by which ANS also determined the collection exemption for more than 250 procedures, including chemotherapy, radiotherapy and the treatment of cancer. hemodialysis.
It is clear that the only news created by ANS from the edition of RN 433/18 was to protect and defend the consumer, giving them predictability and security.
Agência Brasil : Before the resolution, there was no definition of a maximum percentage of co-ownership in each service, but the ANS ordered the operators to do not 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 No. 433, operators have a collection limit that has never been before, protecting the consumer. The stipulated percentage, based on several studies, takes into account a value likely to stimulate 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 (mammograms, oncocyte cytology and fasting blood glucose, for example); for treatments such as hemodialysis, chemotherapy and radiotherapy;
It is important to note that in products registered with the ANS and available for sale, plans with co-participation and franchise are, on average, 20-30% cheaper than plans without co-participation and franchise, with cases of larger 40% cuts, for example.
Agência Brasil : The Brazilian Bar Association (OAB) even called the "abusive" the percentage of collection of up to 40%, from the beneficiaries, in cases of joint ownership and of franchise health plans. : I reiterate that the definition of the percentage of 40% for the perception of co-participation (which must always be cumulated with the monthly and annual financial exposure limit of the consumer)
Rodrigo Aguiar ) was 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 demonstrated by the regulatory impact badysis report 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 vacation 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 rise to a change in this percentage, the ANS will do so quickly, as it could not be.
Finally, it is important to note that the percentage defined by ANS is a operators can, as competitors in the sector, market products with lower percentages or without adopting the mechanisms, ensuring that companies offer different products and meet the different profiles and needs of consumers , which will have their power of choice expanded [19659004] Agência Brasil : Law 9.961 / 2000, which created the ANS, indicates that the objective 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, is that the role of the regulatory agencies is to promote the balance of the sector .
Rodrigo Aguiar :
The consumer is the most vulnerable link on the regulated market, so it must be properly supported and protected from its rights, not in favor of an audience but of all the actors who are part of it. 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 have stated that the ANS is not one of the bodies that make up the national consumer protection system, but maintains a very close relationship with it to observe the interests and consumer rights.
