ANS and health plans disagree on changes to readjustment.
After two days of public hearings to discuss changes in the methodology for adjusting individual health plans, promoted by the National Supplementary Health Agency (ANS), operators and the regulatory agency failed to reach a consensus.
By Akemi Nitahara – Reporter for Agência Brasil
After two days of public hearings to discuss changes in the methodology for adjusting individual health plans, held this Tuesday and Wednesday (24 and 25) by the National Supplementary Health Agency (ANS), operators and the regulatory agency did not reach a consensus.
According to the ANS (National Supplementary Health Agency), the objective is to analyze all the proposals presented and "arrive at a methodology that brings more transparency, predictability, and objectivity to the calculation of the readjustment." Approximately 180 people participated in the two-day event, including representatives from the sector, consumer protection agencies, and the general public.
The ANS (National Supplementary Health Agency) presented the results of a study conducted since 2010. According to the agency's proposal, the Annual Adjustment Factor for Individual or Family Health Plans in the supplementary health sector (FRPI) will be calculated taking into account the Medical-Hospital Cost Variation Factor for all Individual Plans (VCMH), the Age Range Variation Factor (FFE), and the Productivity Variation Factor (FGP), all of which can be calculated by an external entity "through a prior cooperation agreement established with the ANS".
The draft proposed by the agency It is available on the ANS website..
FenaSaúde
According to the National Federation of Supplementary Health (FenaSaúde), an entity that brings together 19 health plan operators with 24,4 million beneficiaries (34,8% of the Brazilian market), price controls lead to product shortages. According to the organization's president, Solange Beatriz Palheiro Mendes, there is no good price control policy. "It is necessary to let the market operate freely, providing total transparency in the costs of the entire chain, so that consumers themselves can evaluate and make decisions regarding the products and services offered."
The federation advocates for differentiation by size and plan level for the Medical-Hospital Cost Variation (VCMH) and that the Productivity Factor proposed by the ANS (National Supplementary Health Agency) be calculated by a specialized external entity. FenaSaúde proposes the adoption of the American model, "which combines an authorized percentage with a ceiling on claims." "Companies that exceed the claims limit may apply an individualized readjustment, based on their cost structure," the entity informed in a statement.
The ANS (National Supplementary Health Agency) informed that it will consolidate all contributions into a document to be made available online, without necessarily approving a change in methodology. The readjustment of individual plans impacts more than 8 million plan beneficiaries. Last month, a 10% readjustment was authorized after a legal dispute.