Readjustment in health plans: the same debate? – 06/21/2022 – Public Health

The news that the ANS authorized a maximum readjustment of 15.5% for individual and family health plans sparked a public debate about the size of the authorized increase.

Consumer associations consider the adjustment high. The entities draw attention to the low payment capacity of policyholders and argue that the high demand for medical services in the last two years was atypical, occurring due to the Covid-19 pandemic and, therefore, not serving as a basis for the increase. On the other hand, representatives of health plans claim that there was a negative adjustment last year and need to recover the sector’s losses due to inflation.

This debate is important because we have about 25% of the population served by private health plans, whether individual, family or corporate.

However, we need to advance the debate on the reason for the dependence of around 50 million Brazilians on private health plans. Does this make sense in light of the federal constitution that established a single, public and universal healthcare system? Why is the SUS unable to meet all its demand within an adequate timeframe? How far does the private sector complement the provision of health services in the public system go? Why is private spending on health greater than public spending, if we have a public and universal system?

These and other issues urgently need a broad debate among all stakeholders in the delivery of health services. The objective is to try to solve issues related to access and quality of health services to the entire population at the lowest possible cost.

No sector (public or private) currently has a service provision structure to meet all the population’s needs. Therefore, coordination between them is necessary to avoid waste and facilitate the population’s access to health care. The guideline for this is already defined in the Constitution: the private sector is complementary to the public system.

It makes no sense to have competition between the two sectors, who loses is the population that needs the services. In addition, the future scenario is one of rising costs due to the aging of the population, which imposes challenges of financing, efficiency and new models in the treatment of the population’s health.

New products often appear on the market, such as popular health plans or a low-price consultation network as a solution to meet a demand not met by the SUS. This proliferation of proposals, without going through an organized debate with all interested parties, suggests a lack of leadership in the conduct of public health policy.

This lack of leadership does not favor a healthy and in-depth debate on the ideas that arise in society with the aim of improving the provision of health services to the population and ends up stimulating unnecessary conflicts in the sector. It is always good to remember that no one has a monopoly on the truth and that the debate must be based on the public interest.

In order to improve the articulation between the public and private sectors, it is necessary for the Ministry of Health to take the lead in the debate and for the National Congress to effectively commit to the SUS. Finally, it is essential that the debate involve all stakeholders in society.

If it continues like this, without public leadership committed to the development of the SUS and, on the other hand, the private sector seeking to increase its space of action in the provision of health services, our health system will become more fragmented and segmented, harming even more population health care.

In this way, the debate on the readjustment of health plans will continue to be superficial and limited to indices to the detriment of the population’s access to health services.

Ricardo de Oliveira is a production engineer and was Espírito Santo State Secretary of Management and Human Resources from 2005 to 2010. ES State Secretary of Health from 2015 to 2018. Author of the books: Gestão Pública: Democracia e Eficiência, FGV /2012 and Public Management and Health, FGV/ 2020. Counselor of the Institute of Studies for Health Policies (IEPS). Member of the philanthropy committee of UMANE.

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