December 5, 2022

The Catholic Transcript

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Placebo health plans and the growth of popular clinics

Placebo health plans and the growth of popular clinics

for every Joe Sistello

Folk clinics have grown exponentially in the country in recent years. The breach, at the time of its constitution, allowed these companies to act outside the regulation of the National Supplemental Health Agency (ANS). In practice, this means that in addition to not being subject to the regulator’s rules regarding adjustments, provisioning, and structuring the help network, they are also not obligated to comply with the list of actions and events in Health, offering only the essentials – outpatient care and low-complexity exams -, leaving The user is without help when he needs it most.

The “affordable health plan” marketed by these clinics does not deliver on its promises. On the other hand, if business groups collect profits, in the end the user has a false sense of security. Because it is restricted and limited in scope, the beneficiary ends up being pushed into the unified health system (SUS), both for urgent and emergency care, as well as in cases where you need more complex and expensive procedures – hospitalization, surgeries, very complex exams. Therefore, it is of no use to the customer who paid and did not take it, as well as to the Public Health Network. This overload becomes even more betrayal when this patient is staged late in the system.

The proposal to implement the popular plans sent by the government of then-President Michel Temer for analysis by the National Security Agency had a negative impact on all entities in the Strip. Brazilian Institute for Consumer Protection (idec), for example, at the time, that affordable plans were not able to provide services that would guarantee the consumer the minimum necessary quality and safety, which caused serious damage and caused the legalization of supplemental health.

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It is known that a small segment of the Brazilian population has health insurance and most of them depend on the public service. However, it should be noted that the SUS is a right guaranteed by the Constitution. I propose a reversal: if the rate of supplemental health coverage grows in accordance with the conditions of the population contracting to the plan (as an individual or a legal entity), then we can say that the increase in the number of contracts with popular clinics is an indicator of this. Refers to difficult access to SUS?

In addition, harming public clinics is a legal setback. The list of coverage determined by the law of the health fund is the right of the beneficiary, which states that operators must ensure that all actions stipulated in it are performed by their own, approved, contracted or indicated assistance network, regardless of the scope of the plan or the operational capacity of the operator.

It is essential that the user be aware of the risks when purchasing an affordable plan, at a price much lower than the price practiced by the market. Through the magic of popularly priced ads, you end up receiving much less than you expect. As if you were paying for one, but taking only half the product. It is necessary to make the calculation to check the advantages and disadvantages, especially when the subject is a guarantee of help. Finding information about the best terms of care and coverage is the best way. After all, how much is your life and your family’s life?

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*Joé Sestello is the CEO of Unimed Nova Iguaçu.