Readjustment in health plans gives relief to operators and shares rise, but second-order consequences can be negative

The National Health Agency (ANS) announced the day before (26) the annual readjustment ceiling for individual health plans of 15.5%. The adjustment came earlier than in previous years (July 8, 2021 and 2020 and July 23, 2019), allowing operators to anticipate the recognition of these resources in their results by at least one month. The increase is applied on the contract anniversary, from May 2022 to April 2023.

This was the biggest readjustment in 22 years, but it was in line with the estimate by Bradesco BBI, which projected an increase of 15.8%.

The methodology used by ANS takes into account, as pointed out by XP, the (i) average medical cost per beneficiary of the previous year – which in turn is a function of price, mix and frequency -, (ii) inflation (IPCA) and (iii) an efficiency factor.

The +15.5% readjustment cap follows a value of -8.2% in 2021, which, according to ANS, was a consequence of a 17% drop in utilization due to Covid-19-related measures during 2020. Thus, the average price adjustment for 2021 and 2022 (which considers the factors mentioned above for 2020 and 2021) is 3%.

The argument for the adjustment is that there was an increase in the expenses of operators, with elective procedures, for example, in 2021.

Market analysts highlighted that the news brings relief to the sector, which presented pressured results in the first quarter of 2022. However, the second-order impact is more nebulous.

BBI highlights that, although widely expected, we see the confirmation of the readjustment as positive for health plan operators. The most impacted is Hapvida (HAPV3), as almost 21% of revenues come from individual plans, against something like 10% in SulAmérica (SULA11). Following yesterday’s announcement, HAPV3 shares closed up 5.22%; SulAmérica, on the other hand, closed Thursday’s session up 5.41%. This Friday, a new day of appreciation: HAPV3 had gains of 1.27%, at R$7.15, while SULA11 had a rise of 1.50%, at R$27.68.

Analysts also highlight that the news of lower volumes of procedures in 2021 compared to pre-pandemic levels in 2019 is a point to be clarified, as normalization in 2022 would negatively impact operators, favoring providers.

Itaú BBA sees a positive impact for actions in the health sector with an increase authorized by the ANS, but also recalls the negative readjustment of 8.2% last year, as well as the high costs generated by the second wave of Covid-19 in 2021 and the recovery in elective procedures, which pressured the profitability of health plan operators in recent quarters.

Thus, the readjustments announced in the individuals segment, combined with negotiations for similar readjustments in the corporate and affinity plans, should bring some relief to the health sector throughout the year.

“We see the announcement as a positive one for Hapvida (although widely anticipated), as the price readjustment of individual plans should gradually improve its claims levels from 2Q22 onwards”, he analyzes.

As the loss ratio of health operators was being pressured by last year’s price drop, this year’s increase will begin to offset the effect, points out XP. For analysts, providers Rede D’Or (RDOR3), Kora Saúde (KRSA3), MaterDei (MATD3), Oncoclínicas (ONCO3), Fleury (FLRY3) and Hermes Pardini (PARD3) – may also have some benefit, as they will be able to negotiate best prices with operators.

Analysts expect the double-digit price adjustment ceiling to give providers a strong case for negotiations with paying sources, which could have a positive effect on both revenue and margins for hospitals, labs and clinics.

On the other hand, second-order consequences can also be negative, according to XP analysts, as it can put pressure on beneficiaries’ ability to continue paying their health plans, impacting the total number of individual plans (currently at 8 million ).

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