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Age group that pays the highest monthly premiums when underwriting a health insurance plan, seniors constitute the fastest growing public among the customers of the country's medical commitments, especially 80 years. Data from the National Complementary Health Agency (ANS) tabulated by O Estado de São Paulo show that in ten years, the number of beneficiaries over 80 years has jumped 62%. The index is more than triple that of the general customer volume (18%) and higher than the growth rate of this population group in the period – by 55%, according to IBGE
. has experienced growth in the sector over the past three years, a period of economic crisis in which the number of additional users of health has declined in Brazil. The phenomenon, mainly explained by the increase in longevity, must be maintained. By 2030, 20% of all plan clients will be seniors, according to a projection made in an unpublished study from the Institute of Supplementary Health Studies (IESS) obtained by the O Estado newspaper of São Paulo.
The aging of the population will result in a significant increase in operator costs and, as a result, 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 aging population Hospital costs in the period, the IESS estimated that health care spending plans will jump 157.3% – from R $ 149 billion to R $ 383 billion in 2030.
For the institute, the study raises an alert: if the health care system does not change to prevent high expenses, the scheme can become a service very expensive and almost "priceless" for the most part. 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 amount is four times higher than that 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
Measures should be implemented for Ram, as the struggle against fraud and According to him, 19% of operators' expenses were consumed in 2016. "It is also important to encourage the prevention of diseases and healthy aging."
President of the National Federation of Complementary Health (Fena Saúde), Solange Mendes stresses the 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 Plans (Abramge), Marcos Novais said 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 address "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 provider remuneration ".
Last week, the ANS released a resolution that sets out rules for two types of commitments: co-participation and franchising.
1) What is it? in co-participation and in the franchise?
In co-participation, in addition to the monthly fee, the client pays part of the cost of each procedure. In plans with a 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 beneficiaries of medical and hospital plans (or 24.7 million beneficiaries) have a contract with one of these mechanisms.
3) Why did the ANS change the changes?
[4] What changes in co-participation plans?
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 advised 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. 19659002] 7) Are the amendments valid for existing plans?
They come into force in 180 days.
The information comes from the newspaper O Estado de S. Paulo
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