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

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

Consumer associations are more aware of adjustments. Institutions draw attention to the low-paying capacity of policyholders and argue that the high demand for medical services over the past two years has been extraordinary due to the CoVID-19 epidemic and, consequently, increased. Is not working as a base. On the other hand, representatives of health plans claim that there was a negative adjustment last year and the sector needs to make up for losses due to inflation.

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

However, we need to move forward with the debate over the reliance of approximately 50 million Brazilians on private health projects. Does it make sense in the light of the federal constitution that established a single, public and universal healthcare system? Why does SUS fail to meet all its demands within reasonable time frame? To what extent does the private sector complement the provision of health services in the public system? If we have a public and universal system, why are private spending on health more than public spending?

These and other issues urgently need a broad discussion among all stakeholders in the delivery of health services. The aim is to reach out to the entire population on health services and to try to solve quality problems at the lowest possible cost.

No sector (public or private) currently has a service delivery structure to meet all the needs of the population. Therefore, coordination between them is essential to avoid waste and facilitate population access to health care. Guidelines for this have already been laid down in the Constitution: the private sector complements the public system.

There is no competition between the two sectors, the loser is the population that needs services. In addition, the future scenario is one of increasing costs due to aging of the population, which imposes financing, performance and challenges of new models in the treatment of population health.

New products often appear on the market, such as popular health plans or low-cost consulting networks as a solution to meet demand that is not met by SUS. This proliferation of proposals without systematic discussion with all interested parties shows the lack of leadership in conducting public health policy.

This lack of leadership is not conducive to a healthy and in-depth discussion of ideas that are created to improve the delivery of health services to the population in society and to provoke unnecessary controversy in this area. It is always good to remember that no one has a monopoly on the truth and that the debate should be based on the public interest.

To improve rhetoric between the public and private sectors, it is important for the Ministry of Health to lead the debate and for the National Congress to make an effective commitment to the SUS. Finally, it is important that the discussion involves all stakeholders in society.

If this continues, without public leadership, SUS is committed to development and, on the other hand, the private sector seeks to expand the scope of its operations in the delivery of healthcare services, further disintegrating our healthcare system. Will be distributed, and even more harm to the health care of the population.

Thus, the debate over the reorganization of health plans will remain superficial and will be limited to indicators that harm the population’s access to health services.

Ricardo de Oliveira is a production engineer and from 2005 to 2010 Espírito Santo was Secretary of State for Management and Human Resources. ES Secretary of State for Health from 2015 to 2018. Author of the book: 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 Humanitarian Committee of UMANE.

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