January 17, 2022

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Representatives evaluate the end of coverage for all diseases by health funds

Representatives evaluate the end of coverage for all diseases by health funds

The initial text circulating in the room allows new diseases to not be treated in the private network and changes other rules regarding coverage

The Brazilian Institute for Consumer Defense (Idec) sent to the Chamber of Deputies, this Tuesday (7), a document containing an analysis of a series of points that were considered problematic in the initial text of a bill that changes the rules of health plans. The analysis was sent to MP Herran Gonsalves (PP/RR), author of a text to replace 250 parliamentary motions aimed at changing Health Insurance Act 1998. The content of the draft is spread to parliamentarians of the Special Committee on Health Plans, which was formed in July of this year.

For an entity, there are a series of points in the initial text that are detrimental to the interests of consumers. One of the most important is to end the obligation that companies currently have to cover the treatment of all diseases classified by the World Health Organization (WHO). Thus, new diseases will be out of coverage until approval by the National Supplementary Health Agency (ANS).

If this is the legislation for the private sector in March 2020, many people who sought care in private hospitals for Covid treatment at the start of the pandemic would end up paying for treatment out of their own pocket.

The service will be dependent on agency approval, which could lead to a very long delay in covering new disease plans. Coverage of testing, counseling and hospitalization for new diseases depends on the agency, says attorney and Idec health program coordinator Anna Carolina Navarrete.

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Law 9656, of 1998, states that “a health care reference plan has been established, with coverage for medical, outpatient and hospital care, including deliveries and treatments, performed exclusively in Brazil, with standard nursing, an intensive care center, or what Like, when hospitalization is necessary, of diseases included in the International Statistical Classification of Diseases and Related Health Problems, of the World Health Organization.”

Simpler plans

This wouldn’t be the only change in health plan coverage. There will also be permission for operators to offer more affordable plans, for simple procedures, such as routine consultations and exams, and to remove more complex examinations from coverage and more expensive treatments, such as chemotherapy and dialysis.

“The point is that in order to make a diagnosis, more complex tests are often needed. And that will also affect emergency care. If you break an arm, it is likely that you will not need very complex care, but the patient will be excluded from coverage. The truth is that this plan will deliver very little when people really need it,” explains the attorney.

If the result of selling health plans with this profile can affect the unified health system, private health users will end up moving to the public network. “If that happens, then instead of the complementary network being a healthcare support, it will end up overburdening the SUS.”

The proposal also puts in place mechanisms to mitigate fines for companies in cases of denial of service, hampering investigations into cases of disrespect. By sending the document to the proposal’s deputy rapporteur, Idec hopes to broaden the discussion between the committee and civil society. The entity argues that the bill cannot ignore the Consumer Protection Act.

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Anna Carolina Navarrete also recalls that the private health sector is doing well financially and has made good profits since the start of the pandemic – despite being treated to hospitals by Covid, there has been a significant drop in the search for consultations, elective procedures and surgeries. “There hasn’t been an increase in defaults, because the last thing consumers are giving up is the health plan. What we’ve seen with the pandemic has been an increase in user incomes, people who are afraid to stand in long queues at SUS, which serves 3/4 of patients by 40% % of the family.

Higher cost for the elderly

Another controversial point in the alternative text is an amendment to the Seniors Act, which prohibits age discrimination in charging users over the age of 60. Currently, the fees are the same for a 61- or 90-year-old. But the text circulating among the deputies allows for a “divided amendment” for the elderly in the last age groups.

“This audience loses the ability to pay over time and, on the other hand, requires a closer look in terms of health. It is a more vulnerable and idiosyncratic population, which is why the Seniors Act was created,” says Anna Carolina.

This point of the alternative text reached the public on Friday (3) and was widely criticized by entities that defend the interests of the elderly. This point was also made clear by some parliamentarians and Federal Representative Alexandre Padilla (PT-SP) submitted a request for a joint public hearing to discuss the importance of prohibiting the imposition of different amounts on the elderly.

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The president of the Ibero-American Network for the Association of the Aged (RIAAM Brazil), Maria Machado Cota, said it was disgusting to see representatives in the legislature trying to withdraw the rights of older people, who have worked for years and were important to labor production. “If we work, we build the country’s wealth, we have the right to enjoy what Brazil has to offer. If they spend more on prevention and health promotion, which is cheap, we won’t have many problems and we will need medium and high complexity care,” he says.

For Maria Machado, 73, it’s not so interesting that the private network is investing in primary care. “Entrepreneurs make a fortune out of sick people. They set up secondary and tertiary care clinics and don’t want to invest in prevention, because they don’t stop making profits.”

The report contacted Representative Hiran Gonsalves. On Friday, he answered and said he couldn’t talk because he was busy. This Tuesday, his cell phone was turned off. The report sent an email to the attorney’s office and is awaiting his return.