Cashback na saúde suplementar: um estudo de caso na definição do preço médio de mensalidade

Abstract

Supplementary health in Brazil has been constantly increasing costs, due to factors such as increased frequency of use, increased value of inputs, revision of offered procedures, new health technologies and aging of users. These constant increases put pressure on the sector's financial sustainability, representing a growing challenge. With this in mind, the development of health insurance pricing based on actuarial assumptions and the incorporation of costs from a cashback reward system was considered. This system is a return policy of a part of the payment, in accordind with the accumulation of points by use of the plan. The objective of this work is to develop an innovative actuarial product, with an unprecedented methodology that estimates the monthly price for an individual / family plan with co-participation and cashback from information obtained from the Agência Nacional de Saúde (ANS). And the brazilian national health survey 2013. The study was applied to the case of the State of São Paulo, where the largest contingent of health insurance users in Brazil is concentrated. The composition of the monthly payment was based on the Product Registration Technical Note (NTRP), the costs of healthcare expenses, the co-participation rules, the statistical safety margin and loadings, as well as the filter of the variables that would respond to cashback. The reward system was obtained through criteria established for the clinical segment; prevention of chronic diseases; lifestyle changes; the user's mental health; efforts for disease screening; proper use of the accredited network of general doctors; as well as the controlled use of emergency services. Regarding the conditions of use, the cashback will be available for users who seek general doctors, those who do physical activity, preventive examination, treatment, diet, preventive consultation, among others preventive aclions. The cashback result found was a weighted arithmetric mean of 25.16% that will be included in the monthly individual / family plan as a kind of load. The sinister had an average percentage of 47,21%. Even with the application of the pricing method pointed out by ANS resolution, it is noteworthy that the inputs to the calculations are actuarial assumptions, which may or may not be confirmed with the data observed in an operator. Therefore, it is necessary to apply it in another study with a database from an carrier, with care costs and frequencies per user, in order to highlight the validity of the proposed model. A review of the criteria and percentages proposed in the verification of other scenarios. Finally, it is indicated that the criteria for cashback should be based on ethical principles, in a literature review on health and behavior regarding the use of a cashback health plan.