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Issues and Events of Consumer Protection Entities, such as Idec, or the Brazilian Bar Association, or Minister Carmen Lúcia, of the Federal Supreme Court, concerning the criteria used by the Agency National Complementary Health (ANS) to correct and correct the values of health plans seem to yield results.
On the 24th, the ANS held a public hearing in Rio de Janeiro to discuss pricing policies and health plan adjustments, with the participation of several representative sectors of society and also the administrators of the agreements . And the novelty is that the Agency admits, as a first step and immediately, review the criteria for readjustment of individual plans. The proposal is that the readjustment follows the variation in hospital medical costs (HMDC), which is an index that measures sector inflation.
Today, the ANS fixes the correction of individual plans according to the average of the increases applied by the operators to their collective plans with more than 30 beneficiaries. In turn, the correction percentage of the collective plans is based on the evidence of increased costs of the operators, in worksheets sent to the ANS.
Only, as verified by the Court of Auditors of the Union (TCU), these sheets to be verified, in a clear demonstration that the ANS is not able to identify and restrict abusive increases in tuition fees. Of the approximately 47.5 million participants, 80% or 38 million are part of group plans.
In theory, collective health contracts are linked to employees of the same company or professionals of the clbad entities. But in reality, there are many people who, without access to individual plans that have disappeared from the market, have ended up hiring a collective plan through microenterprises and starting with two or three family members. This year, these plans are corrected, on average, by something between 18% and 19%, but which can be higher, if the spreadsheet presented by the operator justifies an increase in its costs higher than that- this.
The correction of the individual plans being based on the average correction of the collective plans, the consequences are distributed on the 9.1 million remaining participants of the sector. No wonder, the annual correction of individual plans was 10% this year.
It is because of this link in the readjustments of the various contracts that the Idec Health researcher and lawyer, Ana Carolina Navarrete warned that a policy readjustment plans the discussion of collective plans. "The readjustments in the collective plans, which are the majority of the plans of the Brazilians, and do not have the control of the ANS, are part of the calculation and have a great influence in the readjustment of the individual plans", did she say. In his opinion, "it does not make sense for a price debate and readjustment of health plans that does not include the root of the problem, which are the collective plans."
Operators' representatives agree to adopt other criteria for readjusting plans but argue that the size of each director and the level of services provided should be taken into account, with differences in the indices correction between them.
The most important thing seems to be the transparency with which the subject begins to be treated. In principle, by adopting an index reflecting the increase in industry costs, it should be clarified that participants update their commitment and that they make more sense than the current criteria. , drawn from a real box. industry. As a table, we expect the increases to be more consistent with official inflation and, consequently, with the adjustment of the incomes of the vast majority of participants (wages and pensions). .
It is also fundamental that there is the same concern with collective plans, where most users are currently. After all, as Minister Carmen Lúcia pointed out, "health is not a commodity, life is not a bargain, dignity is not a profit."
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