Private plan coverage should be the same as SUS coverage – 04/14/2022 – Opinion

Recently, a well-known TV presenter made a dramatic appeal to the Superior Court of Justice (STJ), through a video that went viral on social media, urging everyone to say “no” to the exhaustive list.

It is impossible not to sympathize with the presenter, who is the father of an autistic young man who probably needs health services that are not included in the list of procedures of the National Supplementary Health Agency (ANS) – the body that defines the mandatory coverage that health insurance operators private health plans have to offer to their beneficiaries.

The STJ will judge whether the list is exhaustive or exemplary. If it is exhaustive, any and all procedures that are not listed in the list will not be covered by the operators. If it is an example, well, someone will have to define whether the requested treatment should be covered by the operator — and the sky may be the limit.

In Brazil, health is a citizen’s right and a duty of the State. Many understand that the health system must offer everything to everyone, but that is not what the Federal Constitution says. No health system in the world, whether public or private, can offer everything to everyone. The Constitution says that access to health care is universal and must be guaranteed by public social and economic policies, seeking to eliminate unfair inequalities. Although few know it, the SUS (Unified Health System) also has its list of procedures: it is the Renases (National List of Health Actions and Services), provided for by decree 7,508, of 2011.

Every person who lives in Brazil and pays for a private health plan also uses the SUS, especially in urgent cases or when they need high-cost procedures not covered by the operators. These operators keep the filet mignon, and the SUS pays the bill for what is more expensive. It is capitalism without risk, with guaranteed profit.

Part of the expenses of individuals and companies with health plans is deducted from their taxes. Luxury hospitals, which only serve the most expensive health plans, when they are philanthropic entities fail to collect taxes, such as payroll charges and others. Taxes that finance public services such as the SUS are no longer collected for the benefit of the private health system and people with better purchasing power. In Brazil, we have a private health system that, like a parasite, lives off the SUS and tax breaks.

But the operators of private plans think little. FenaSaúde, an entity that brings together the largest companies in the sector, fights in Congress to change the law and allow the creation of segmented plans, a new version of popular plans. They want to offer fewer services while taking a bigger piece of the market. Citizens will buy a cheaper plan, but when they get really sick, they will refer them to the SUS. It’s a lot of face!

Important changes are needed in Brazil’s health policies and, in particular, in the relationship between public and private systems. The coverage of the SUS and the private system must be exactly the same. The citizen who has a private plan must be assisted in the service network of his health plan and, when he is assisted in the SUS, the operator must reimburse the State for the expense for the service provided to the beneficiary of the private plan. The tax waiver kick-off must end.

The role of ANS, both he and Renases, must be exhaustive, there is no way to be different. We need to adopt a model similar to the UK National Health Service, in which the coverage of health services is defined by the technical body responsible for the incorporation of health technology, ensuring the best composition of services to serve the whole of society equitably. In Brazil, this role must be played by Conitec (National Commission for the Incorporation of Technologies). The cost of access to health for all, without inequalities, must be shared among all in a solidary way: those who can afford more will pay more, those who can afford less will pay less, and those who cannot afford it will pay nothing.

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