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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 ANS (National Agency for Supplementary Health) tabulated by the newspaper The State of São Paulo shows that in ten years the number of beneficiaries over 80 years 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 By 2030, 20% of all plan clients will be seniors according to a projection made in an unpublished study of the Institute of Supplementary Health Studies obtained by the newspaper O Estado de São Paulo .
The aging of the population will lead to 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 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. "There is no way to imagine that such a substantial increase will be absorbed by the operators.This increase will result in readjustments for the beneficiaries or the end of the economic and financial sustainability of the project. sector, "says Luiz Augusto Carneiro, executive superintendent of IESS." This would be very bad for operators, beneficiaries and the rest of the country, as an additional 47.3 million would depend on the SUS, which already has an excess demand "
Currently, the average monthly amount is four times higher than that practiced for young people under the age of 18. According to ANS, the retired teacher Aico Nakamura, 84, is struggling to pay the monthly fees of $ 800. "It's not easy, it's very expensive." Even without serious health problems, she signed an agreement for fear of having problems at this stage of life. life "My health, thank goodness, is fine, but even using little, it can not be without. "
Solutions
For Aries, measures should be implemented such as the fight against fraud and According to him, 19% of expenses of operators were consumed 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 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. "There are already companies that work primarily with their own network, others that focus on a certain audience."
Asked, the National Agency for Supplementary Health said that rapid aging is "one of the most urgent issues to discuss" and stressed that the solution is a change in the model of care, putting more emphasis on preventive actions and health promotion. In this context, ANS highlights the creation of the Elderly Well Care project, an initiative that involves "partner institutions engaged in research and implementation of measures in the field of active aging, quality of care, costs and [19659002]
Last week, the ANS issued a resolution that sets out rules for two convention terms: co-participation and franchising.
(1) What is co-participation and franchising?
In addition to the monthly contribution, 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 the beneficiaries of medical and hospital plans (ie 24.7 million beneficiaries) have a contract with one of these mechanisms
3) Why did the ANS publish the changes?
The Rules That Generate These Changes
4) What Changes in Co-Participation Plans?
The recipient will be able to afford up to 40% of the value of each service. This amount can not, however, exceed the maximum planned per year by the agency.
5) What about the franchise?
There are two problems. 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 the case of limited access, a franchise value will be stipulated by procedure and not by year.
6) Are 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.
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