[ad_1]
Elderly (oneinchpunch / Thinkstock)
São Paulo – Age group paying the highest monthly fee when hiring a health plan the elderly are experiencing the fastest growth
Data from the National Agency for Supplementary Health (ANS) tabulated by the newspaper O Estado de São Paulo show that in ten years the number of beneficiaries with more than 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 By 2030, 20% of all plan clients will be seniors, according to a projection made in an unpublished study from the Institute of Supplementary Health Studies (IESS) obtained by the O Estado newspaper of São Paulo.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 over the period, the IESS estimated that health care spending plans will jump 157.3% from R $ 149 billion to R $ 383 billion in 2030.
The study warns that if the health system does not change to stop high spending, the plan can become a very expensive and almost "priceless" service for the majority .
"There is no way to imagine that such a substantial increase will be absorbed by operators.This increase will result in readjustments for beneficiaries or at the end of economic sustainability and financial sector, "says Luiz Augusto Carneiro, executive superintendent of IESS." This would be a bad thing for operators, beneficiaries and the rest of the country, because an additional 47.3 million would depend on the SUS, which has already Excess demand. "
Currently, the average monthly cost of agreement for a senior is four times higher than that charged for under 18s, according to ANS. Retired Aico Nakamura, 84, struggles to pay the monthly fee of $ 800. "It's not easy, it's very expensive." Even without serious health problems, she signed a deal out of fear to have problems at this stage of life. health, thank God, is fine, but even using little, it can not be without. "
Solutions
For Ram, measures should be implemented such as the fight against According to him, 19% of operators' expenses were wasted in 2016. "It is also important to encourage disease prevention and healthy aging."
President of the National Federation of Supplemental 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 says that operators and hospitals will also have to adapt. "There are already companies that mainly work 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 [19659004]
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 co-participation, in addition to the monthly payment, 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? [19659004]
The recipient may be able to pay up to 40% of the cost of the project, the value of each service. This amount can not, however, exceed the maximum planned per year by the agency.
There are two problems, 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.
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. 19659004] 7) Are the amendments valid for existing plans?
[ad_2]
Source link
