Private health plans are provided for in the Federal Constitution, which in article 199 defines the rule for the participation of the private sector in public health, determining that the action must be complementary to the action of the government.
According to the Constitution, it is up to the State, through the SUS (Unified Health System), to provide dignified health care for all Brazilians and the private sector to act in a complementary manner.
The regulation of the performance of private health plans is in Law 9,656, of June 3, 1998. A parenthesis is in order here. It is one of the worst laws voted by the National Congress of a country where the quality of the laws is invariably quite poor.
The original text was so bad that, 24 hours after it was edited, an interim measure was issued altering most of it. And, in the following months, successive provisional measures were issued to try to improve and even make the functioning of the system viable.
With a strong ideological bias, the law is based on a series of good intentions, all theoretical and, consequently, impossible to be implemented in the real world, in the day to day of the operation.
Its main problem is to plaster the models of possible private health plans, prohibiting the creation of plans outside its rules, although closer to reality. In addition, it determines the unlimited liability of operators in serving their consumers.
Law 9,656/98 imposes models of plans, dividing them into individual and family plans and corporate collective plans. The individual plans are absolutely rigid plans and with one more aggravating factor: the government establishes the annual readjustments, that is, from the beginning, they suffered from demagogic increases that ended up having the power to practically extinguish their commercialization.
In proof of the high level of Brazilian creativity, the market has developed collective membership plans, which are products designed to work collectively, through contracting by unions, class bodies, professional associations, etc., but meeting the individual needs of their contractors.
As these plans have increases outside the control of the National Supplementary Health Agency (ANS), they became viable and, even though, due to the contracting model, having a smaller scope, they began to replace individual plans.
Recently, new operators have started to offer individual plans again, which expands the spectrum of insureds served, with obvious advantages for everyone.
Brazilian private health plans not only work and guarantee the health needs of 50 million people, they are also indispensable for the public health system to do its part. Without them, the SUS would not be able to serve the population.
What the system needs to work better is a new law that allows it to offer products designed according to the needs of policyholders and at compatible prices.