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The regulation of the rules of application of co-participation and franchise in health plans, published today (28) by the National Agency of Complementary Health (ANS), has sparked controversy. Specialists point out that the new rules will make plan beneficiaries pay for consultations and other health care procedures.
For the Brazilian Institute of Consumer Protection (Idec), the resolution will have three consequences: the consumer debt, the reduction of the search for care in the private network and the increase of the pressure on the unified health system (SUS).
The standard establishes a percentage of 40% to be charged by the operator for the execution of procedures and determines the monthly limits (can not exceed the amount of the monthly payment) and annual (can not exceed the equivalent of 12 monthly payments) to be paid by the consumer by coparticipation and deductible. The resolution exempts the incidence of coparticipation and franchise in more than 250 procedures, including cancer treatment and hemodialysis. In addition, the use of coparticipation and franchise for illness or disease is prohibited.
"We consider that in general, ANS has raised interesting issues, such as exemptions from certain procedures and the establishment of a financial exposure limit." D & # 39; on the other hand, these mechanisms still do not help to avoid consumers' potential for debt, "says Ana Carolina Navarrete, Idec Health Researcher
. reached what they can spend for this service. As soon as others are charged, the risk of debt increases.
Idec argued that the percentage of 30% for joint ventures, which can now reach up to 50%, be maintained in case of collective plans. The organization even asked the agency to open a public consultation on this topic, which did not happen. Now, Navarrete argues that one way to mitigate this potential negative impact is to clearly inform recipients that, in the form of franchising and joint ownership, the monthly fee can be doubled for one year, in part. According to the procedure carried out [19659007] Debt
In order to avoid debt, consumers can think twice before asking for consultations and exams.
In the resolution itself, franchising and co-participation are presented as regulatory financial mechanisms. the use of medical, hospital or dental services in the supplementary health sector. "
" As you condition access to payment of a certain amount, you create limits for such access.
Even in cases of procedures that have no incidence of co-ownership and franchising by the resolution, the reduction may occur, because private health care providers may use "health care regulatory mechanisms" health to manage the demand for services, as provided in a contract. "One of these mechanisms is the network targeting, which means that the operator can
Popular Plans
The representative of the Brazilian Center of 39, Health Studies (Cebes) and National Health Advisor, Heleno Rodrigues Correa Filho, pointed out that the stimulus to the adoption of these mechanisms results from a balance: the Constitutional Amendment 95, when setting limits on health insurance, weakens the SUS and prolongs the exploration of the sector by private agents.The evidence of this, he says, is the exponential growth of new plans, such as those which present themselves as "popular plans".
These private groups traditionally offer low-complexity services, such as consulting, and, depending on the contractors' ability to pay for complex plans, services. "They promise these three things, but they are not empowered by the infrastructure, the budget, and the tradition to offer them."
"They promise these three things, but they are not empowered by the infrastructure, the budget, and the tradition, so there will be a very big shock of expectations, and the way to solve that is to charge As the ability to pay is limited, it will work like a sorting wheel.Those who can not pay will have the plan, but will not be served, "he said. A logic that contrasts with that of the public health service, whose goal is the universalization of care.
In addition to containing the pressure on care, the collection "is a strategy of converting expenses for health plan shareholders into more profit," said the NSC adviser, who criticizes the speed with which the resolution was developed and approved.
Public Consultation
Joint participation and frankness are provided for in a resolution of the Supplementary Health Council of November 1998, but there is no detail on the subject. To move in this direction, the ANS held a public consultation in April 2017, just over a year before the publication of the standard.
An unanswered issue in the regulation consultation, which also raises concerns, is the possibility of health plans offering discounts, bonuses or other benefits to consumers who maintain good eating habits. health.
ANS believes that the measure encourages the participation of beneficiaries in health promotion and disease prevention programs.
According to Navarrete, Idec "very carefully looks at the positive stimuli that involve the carrier to collect data on the health of the consumer.If this is the case, he can use this information for purposes other than those expressly consumers, "because health data are sensitive data," he warned.
Edition: Maria Claudia
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