‘Screaming’ against health plans raises ‘stands’, but ignores market reality

With health plan readjustments on the order of the day, the outcry against the “greed” of insurance companies and group medicine companies is multiplying. There are also insults to the ANS, responsible for the regulation and inspection of the sector, which authorized an increase of up to 15.5% in individual and family contracts, for the period from May 2022 to April 2023.

Even President Bolsonaro, who was elected in 2018 claiming to have become a herald of liberalism and then – with an eye on reelection – unleashed an interventionist crusade to try to contain the soaring prices in the country, gave his opinion on the matter: “Increasing 15 % the health plan? I had to say a bad word here and I won’t,” he said, in a tone of indignation.

Photo: Marcos Nagelstein/Estadão

It is the same logic behind the complaints against the rise in fuel prices, which would be the result of Petrobras’ “abusive profit”, and against the rise in gas and electricity prices. Deep down, it reveals a profound lack of understanding about the functioning of the market economy and exposes how much the belief that the State should be the great arbiter of the price system is impregnated in the country.

Obviously, no one likes to be surprised by a “stick” in the monthly health plan, which can considerably compromise your monthly budget, or when it’s time to fill the tank and pay the electricity bill. Even more so at a time of generalized high prices, which erodes the purchasing power of the population, as is happening now.

It is always painful to have to adapt consumption to a new market reality, often giving up a better product for another that is not so good, or even putting aside certain things, to make the month fit into the salary. Most of us have been there and we know what it means.

Ideology.
Now, with all due respect for the cause, which concerns the millions of Brazilians who have health insurance, the issue is much more complex than it may seem at first glance. In order to have a more realistic and balanced view of the readjustment of the plans, it is necessary to go beyond the surface, leave ideology aside and try to understand the different aspects that involve the matter.

First, it must be taken into account that inflation in the health sector, which reflects the increase in the costs of consultations, exams, therapies and hospitalizations, in addition to the frequency with which policyholders seek care, was much higher than the average inflation of the Country. In the 12 months ended in September 2021, the latest data available, “health inflation” rose by 27.7%, according to data from the Instituto de Estudos de Saúde Suplementar (IESS), almost double the readjustment authorized by the ANS and almost three times more than the inflation measured by the IPCA, calculated by the IBGE, of around 10% in the same period.

In 2021, according to IESS figures, the demand for health services, which had dropped significantly at the height of the pandemic, increased exponentially, with the increase in vaccination and the reduction of serious cases of covid, which ended up leading to the considerable rise in plan expenses and the “salty” readjustment in monthly fees.

Co-payment.
It is also necessary to consider the well-known profusion of exams and consultations that many policyholders usually carry out. It is not by chance that companies in the sector have created plans with users’ co-participation in expenses, so that they feel more responsible for the use of medical, laboratory and hospital services.

In these plans, policyholders receive a discount on monthly fees, which usually amounts to 20% or 25% of the values ​​of the modalities without co-payment, in exchange for the payment of a small portion of the expenses, usually a symbolic amount, which does not even come close to the deduction. received. Most, however, prefer to pay more, to be entitled to the total free services.

It should also be considered that, despite the increasing supervision of insurance companies, there are still cases of fraud in the system, both on the part of policyholders and clinics and hospitals, which overvalue the use of drugs and materials in procedures and surgeries, in effect inevitable in the prices of plans for everyone.

Game rules.
This Wednesday, the 8th, the Superior Court of Justice (STJ) decided that health plans do not need to cover procedures not provided for by the ANS in contracts and perhaps this will have some impact on tuition from now on. But, until now, in Brazil, the general perception has always been that health plans should cover anything – and the courts, especially in the 1st instance, used to win the case to those who questioned the legitimacy of eventual exclusions by insurers. . The result is that the account was left over, one way or another, for all policyholders.

Even doctors end up contributing to encumber the plans. I am a witness to a case that took place ten years ago, in which, on his own initiative, a doctor decided to spend five minutes a day in the apartment of a patient who was admitted to the hospital where he worked. The professional accompanied the patient in another area and was not even taking care of the problem that led to the hospitalization, but even so, he decided to check in daily in the room.

Only at the time of discharge, the relatives discovered that the doctor had left a bill of BRL 10,000, referring to the “consultations” he had given during the twenty days the patient was hospitalized, at a cost of BRL 500 each. . When asked about the reason for the invoice, he did not beg: “It’s not you who will pay, it’s the plan”.

There are also other issues, such as the idea that each laboratory should have its own tomography and ultrasound machines, even without a demand that justifies their purchase, to make it possible to reduce the prices of services, instead of looking for concentrate them in a few addresses (municipalities or neighborhoods, as the case may be), with the aim of optimizing their use.

All of this – and then some – inevitably contributes to increasing “health inflation” and is reflected in the prices of plans. As the old maxim popularized by economist Milton Friedman (1912-2006), which has already become a buzzword among his peers, says, “there is no free lunch”.

It is clear, however, that, at the time of readjustments, it is more popular to fire bazooka shots at insurance companies and group medicine companies. This raises the stands, generates outbursts of indignation in the mass and generates clicks in abundance on social networks. Obviously, they must be supervised, to ensure that they operate within the rules of the game. Now, putting them in the position of villain in the increases, with an alleged connivance of the ANS, is something quite different.

About Jenni Smith

She's our PC girl, so anything is up to her. She is also responsible for the videos of Play Crazy Game, as well as giving a leg in the news.

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