Health plans record operating losses of 11.5 billion Brazilian riyals in 2022 | SEGS

The results of medical hospital plans should directly influence the readjustment rate of health plans

With an operating loss of R$ 11.5 billion, medical hospital health plans in 2022 achieved the worst result since the beginning of the historical series released by the National Complementary Health Agency (ANS) in 2001. In light of the results, FenaSaúde considers the scenario critical and warns of the impact on readjustment Health plans. The readjustment index for individual and family plans should be revealed in May.

According to the entity, among the factors affecting these outcomes are the growth in frequency of use of health plans; the end of outpatient appointments and therapy sessions with speech therapists, psychologists, and more; High prices of medical supplies. the obligation to provide very expensive treatments, with doses reaching millionaires; fraud occurs. And the judiciary.

Complementary health suffers direct effects from the mismatch between income and expenditure and the increased cost of health care, medications, hospital procedures, and treatments. This escalation should have a direct impact on the plan adjustment index. This scenario jeopardizes the balance of the system, which could lead to the departure of thousands of beneficiaries, thus increasing the burden on the SUS, ”explains FenaSaúde Executive Director Vera Valiente. Despite the fact that the fourth quarter saw lower operating losses (0.6 billion) compared to the quarter Previously – Q1 (-1.1 billion), Q2 (-4.4 billion) and Q3 (-5.5 billion) – the sector has already accumulated 7 negative quarters in a row.

The FenaSaúde executive points out that this scenario tends to get worse with Law 14454/2022, enacted in September 2022, which changed the blanket character of the list, creating fragile and subjective coverage conditions. “This is a crucial change, as it directly interferes with the work of a sector that operates on the basis of mutuality and appropriate risk pricing,” he says.

The relationship between revenues and expenditures in the sector is highly imbalanced. Between 2021 and 2022, revenue had a positive variance of 5.6%, while operator expenses increased by 11.1%.

Another negative feature in 2022 has to do with the loss percentage of medical and hospital plans. Among the main indicators of the sector, the index reached 89.21% in the fourth quarter. The percentage indicates that for every R$100 in revenue from health plan operators in the quarter, R$89.21 was allocated to paying care expenses with consultations, exams, hospitalization and surgeries, among others. In the third quarter, the index reached 93.2%.

“We need to look for solutions aimed at the rational use of health plan resources and the enhancement of the operational efficiency of complementary health. This will only be possible from the sum of the efforts of all agents in the health service chain, such as operators, service providers and suppliers, with the support of the community itself, which is the main beneficiary of A system that helps relieve the public health system, providing medical assistance to 50.4 million people,” concludes the Executive Director of FenaSaúde.