Placebo health plans and the growth of popular clinics

Per Joe Sestello

Popular clinics have grown dramatically in the country in recent years. The breach, at the time of its constitution, allowed these companies to act outside the regulation of the National Supplementary Health Agency (ANS). In practice, this means that, in addition to not being subject to the rules of the regulatory body regarding readjustments, provisioning, structuring of the assistance network, they are also not obliged to comply with the List of Procedures and Events in Health, offering only the basics – care outpatient clinics and low-complexity exams –, leaving the user without assistance when he needs it most.

The ‘affordable health plan’ marketed by these clinics does not deliver on its promises. If, on the one hand, business groups accumulate profits, at the end the user has a false sense of security. Because they are restricted and limited in scope, the beneficiary ends up being pushed into the Unified Health System (SUS), whether for urgent or emergency care, as well as in cases where you need more complex and expensive procedures – hospitalizations, surgeries, highly complex exams. Therefore, there is no advantage for the customer who paid but did not take it, as well as for the public health network. And this overload becomes even more disloyal when this patient is regulated late in the system.

The proposal to implement popular plans sent by the government of then President Michel Temer for analysis by the ANS had a negative impact on all entities in the sector. The Brazilian Institute for Consumer Protection (idec), for example, declared, at the time, that affordable plans were not able to offer services that would ensure the consumer the minimum necessary quality and safety, causing serious damage and causing the judicialization of supplementary health to ‘explode’.

It is known that a small portion of the Brazilian population has health insurance and most depend on the public service. However, it is worth mentioning that SUS is a right guaranteed by the Constitution. I propose a reflection: if the supplementary health coverage rate grows according to the conditions of the population contracting the plan (as an individual or legal entity), then we can say that the increase in the number of contracts with popular clinics is an indicator that points to the difficulty access to SUS?

The disservice of popular clinics also represents a setback from a legal point of view. The list of coverage established by the health plan law is the right of the beneficiary, establishing that operators must guarantee the performance of all procedures provided for therein through their own, accredited, contracted or referenced assistance network, regardless of the scope of the plan or the operator’s operational capacity.

It is essential for the user to be aware of the risks when purchasing an affordable plan, with a price well below that practiced by the market. By being enchanted by the popularly priced ad, you end up receiving much less than you expect. As if paying for one, but taking only half the product. It is essential to make the calculation to verify the advantages and disadvantages, especially when the subject is assistance guarantee. Seeking information about the best conditions of care and coverage is the best way. After all, how much is your life and that of your family worth?

*Joé Sestello is the CEO of Unimed Nova Iguaçu.

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