Health plans: ‘We defend the beneficiary. We are not executioners’, says director of ANS – Saúde

RIO – A National Supplementary Health Agency (ANS) has been under heavy criticism for the past two weeks after announcing a 15% readjustment in the value of health plans and, more recently, defend the exhaustive list of procedures to be paid by operators. Director-president of ANS, the lawyer Paulo Rebello said, in an interview with Estadão, that there is a lot of misunderstanding about the role of the agency and that he can no longer stand being accused of defending the operators. “Our job is to defend the beneficiary,” he said. “We are not executioners.”

Does the decision on the exhaustive and non-exemplary role go against the interests of the beneficiaries?

There is a great lack of understanding about what we do. People accuse us of defending operators. Our job is to defend the beneficiary, guarantee a quality service. Obviously, if we put this under the logic of the exemplary role, what will happen? First, one of the principles enshrined in the regulatory framework (Health Plans Law 9656/98) is to be able to establish an exhaustive list, to have predictability in what is being placed. If you start to lack criteria, we have a problem from an economic point of view, the cost will increase. This is a problem all over the world, not just in Brazil. To give a rough example, we have a Silver water and a Perrier water. Both are water, they hydrate the same. Now, if you only offer Perrier, instead of paying R$100, you will pay R$1,000. Doing this analysis is our job.

Family groups of people on the autism spectrum have complained, saying many will go untreated. How do you respond to that?

Everything about autism is included in the list. What is emerging now? These are techniques for caring for these children. That’s not on the roll. But for us to study this, it needs to be submitted to the agency. We are not failing to serve any autistic patient, no one can say that. Do you have a service technique that is not being paid for by the role? Okay, but was she ever submitted to the ANS? Other times they are very specific situations. For example, horse riding. Obviously you can’t put everything, there are choices. We have to look at scientific evidence, cost-effectiveness.

Another recurring criticism is that the list is always out of date, that it takes a long time to incorporate new things…

It is not true that the list only takes obsolete medicines and procedures, quite the opposite. If today we have quality medicine in this country, this is due to supplementary health, which ends up bringing new technologies and incorporating them and raising the level of our medicine. There was a very strong criticism regarding the incorporation time, but this is no longer supported. We had a two-year deadline to incorporate and within that deadline there was a single submission window. The deadline has been reduced, we have 180 days for analysis and 90 days for incorporation. I repeat: each and every disease is covered by the list. We are not excluding A at the expense of B.

Couldn’t the big operators offer more than they offer?

The big operators are 10% of this market. We have 62% of small operators. We have to look at them all. A small operator cannot afford a rare disease, for example. She will break. And those people who are in there are going to be thrown into the market. Or they will no longer be able to pay for a health plan and go to SUS. Regulation needs to analyze the regulatory impact, what are the consequences of that decision.

Critics say it will be harder now for users to get a victory in court…

There has always been judicialization. Judicialization will always exist. But there is good judicialization and bad judicialization. Good judicialization is one in which there is a service to be provided that has not been provided. Now, when you want a drug that has not been approved by Anvisa, a drug that has not been incorporated into the list, then it is different. It must be remembered that there are other specific interests involved in this process. Other actors who are interested in the role being exemplary, because they manage to market certain drugs. It is necessary to understand the whole. If you don’t understand the whole, it becomes a problem. It seems that we are the executioner, that we do not want to serve the beneficiary. Quite the opposite.

The 15% readjustment in the value of the plans was highly criticized, especially at this time of pandemic and economic crisis. Don’t you think it was excessive?

We worked for almost a year to make this standard, we took it to the Federal Audit Court (TCU), to the Ministry of Economy. USP spoke, FGV spoke out. Here comes an action by the Sustainability Network questioning the increase and it doesn’t criticize the methodology used, it doesn’t criticize anything. That’s the problem. The moment we are living is one of inflation everywhere. It has 49% in fuel, 15% in housing, 25% in energy. If you look at the context of the pandemic, considering that in 2021 the readjustment was negative, putting these two years together, we will have a readjustment of 6%. It gives 3% per year, considering these two years. These are the questions that we are making ourselves available to clarify, so that people understand the formula.

The Minister of Health, Marcelo Queiroga, has been talking a lot about the so-called “Open Health”, what do you think about it? Could it be a solution?

The minister bought an idea, but later he understood how Open Health actually works. He said he’s drinking from the Australian fountain. The problem with the Australian source is that it’s not about Open Health, it’s about electronic medical records, which is something other than portability. In Open Bank, for example, if you have a loan with a bank and pay a fee of 2%, another bank can offer a fee of 1.5% and you migrate. It can view your data. The problem with health data is that it is sensitive and cannot be offered by other operators without authorization. Another point is that in the supplementary health sector you cannot choose people with whom you will market your plan. I cannot charge R$100 from a healthy person and R$500 from a guy who smokes and drinks. Then I’m going to start making a complicated selection. The elderly will be out of the market or will have to pay an absurd monthly fee. Nobody will want the chronically ill. The minister has calmed down, has begun to better understand the constitutional constraints.

How can the health plan be cheaper?

Some situations need to improve a lot. There are many distortions and waste that end up increasing the price charged. Operators act as financial intermediaries. They receive money and pay providers and are not directly involved in patient care. This logic needs to be changed. Today, younger people, who use the plan less, subsidize older people, who use more. By 2030, however, people over 60 will be the majority in Brazil. So this account doesn’t close when the pyramid changes. We need to change the view of this model in the medium and long term.

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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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