Projeção da população de beneficiários de planos de saúde médico-hospitalar no Brasil: contribuição do envelhecimento populacional e do pacto intergeracional para a espiral crescente da seleção adversa de beneficiários na saúde suplementar

Abstract

The phenomenon of aging in Brazil is progressing at an accelerated pace, causing effects within a short timeframe that are more pronounced compared to other countries. The typically triangular shape of the population pyramid, with a broad base, is giving way to a demographic profile characteristic of a society undergoing rapid aging. Brazil's supplementary health sector is embedded within this context, having experienced significant aging of its beneficiary base over the past 20 years. In addition to population aging, three specific factors exacerbate the challenges faced by supplementary health: adverse selection, intergenerational pact, and Health Maintenance Value, which act concomitantly and cyclically. Given these factors, the objective of this research is to project the coverage of Brazil's medical-hospital health plans until 2050, assessing the speed, magnitude, and inflection points of this transformation during this period, as well as the relevance of each specific factor, particularly population aging. The hypothesis of this research is that the aging Brazilian population will be the primary driver of an increasing spiral of adverse selection, leading consequently to the aging of supplementary health beneficiaries and a reduction in coverage. To achieve the stated objective, the study focused on key variables influencing plan coverage. This knowledge facilitated the establishment of assumptions and the modeling of a predictive regression equation for coverage. These elements enabled the development of an automated system for projecting health plan coverage, capable of conducting tests under various scenarios and providing long-term estimates. The results indicate a negative outlook, predicting that the current coverage of approximately 25% will decrease to less than 10% by the 2050s. This negative trend is driven by the observation that plan prices are adjusted at a faster rate than household income, primarily due to VCMH. Population aging has played a supporting role in this process, a phenomenon explained by the surprising finding that the intergenerational pact established in 2003 generally did not and will not act as a mechanism to counter adverse selection, as intended. Instead, ANS regulations inadvertently increased intragenerational solidarity among younger and older elderly, while weakening the intergenerational pact. On the other hand, it is crucial to note that experiments conducted in this research demonstrate that if the intergenerational pact were truly functioning, its effects have the potential to bankrupt Brazil's supplementary health sector. The projected scenario underscores the responsibility of public policymakers overseeing Brazil's supplementary health policies and regulations to make timely decisions. The potential collapse of the supplementary health system would not only affect the Brazilian population under its protection but also have negative repercussions on the public health system, which would need to absorb the healthcare demands of millions of Brazilians left without private coverage, predominantly among those with lower income levels.