Ressarcimento ao SUS e os custos assistenciais das operadoras de planos de saúde no Brasil, 2006 a 2016

Abstract

In Brazil there are two health systems, the public, which is governed by the Unified Health System (SUS), where the state has a duty to guarantee everyone the right to health in an egalitarian way, and the private, who are the plan operators regulated by the National Supplementary Health Agency (ANS). Since its inception, ANS has developed a series of measures to correct failures in the private health sector, one of which concerns reimbursement to the SUS, in which it requires private health care providers to SUS in the eventual attendance of its beneficiaries that are covered by their respective plans. This issue is quite controversial and controversial between the State and health plan operators. The State defends the constitutionality because it believes that if the user uses the SUS there is a financial benefit for the operator, besides seeking to instigate the operators to obey the policies and avoid the negative of the procedures. On the other hand, the operators consider unconstitutional, among other arguments, that health is the right of everyone and the duty of the state, so when seeking the SUS, the user only exercises a right that is constitutionally guaranteed. They further allege that the reimbursement imports into double payment made by the beneficiary. Therefore, the study aims to verify, financially, the effect of reimbursement to SUS on the healthcare costs of Brazilian health plan operators, conducting a temporal analysis between the years 2006 and 2016, using the databases made available on the website of the ANS, and it was perceived that the elderly are the ones that cause the most cost to the operators, especially the procedures related to cancer. In the period 2006 to 2016, the expenses of the reimbursed operators were approximately 8 billion reais, an amount equivalent to about 1% of the assistance costs in the period in question.