The meeting was held in the office of the federal deputy, Dr. Zacharias Calil, from Goiás
In the last two years, an imbalance in the regulations and actions of the National Health Agency (ANS) has been identified. All new regulations bring immediate negative impacts to healthcare providers and benefit healthcare providers. As if the readjustments released by ANS for operators, which are above inflation, were not enough.
The CBR has been closely monitoring the actions of two large health operators that are threatening clinics that do not reduce the values of their exams with disqualification by an average of 30%, contrary to Law 13,003/14 on annual readjustment (RN 363, Art. 5th The following practices and conducts are prohibited in contractualization between Operators and Providers: VIII – establish forms of readjustment that maintain or reduce the nominal value of the contracted service).
“Furthermore, one of these health operators has been forcing clinics to 'bundle tests', claiming that this facilitates the billing process. However, the operator has required a reduction in values above 30% and for clinics that do not accept it, disqualification is carried out. In this imposition, it requires that, regardless of the exam requested, whether with or without contrast, the amount of remuneration is the same. This will directly impact the beneficiaries because, in practice, the higher cost exams will no longer be carried out for the beneficiaries of these health operators”, explains Carlos Moura, CBR's economic advisor.
Carlos also adds that another large health operator held a reverse auction of exam values, stipulating an initial target value, and whoever offers the lowest price wins. “Detail that this initial value is already, on average, 45.33% below the current average value in the region. At the moment this auction is suspended by court order, but in fact it should never have taken place. We are discussing the precariousness of health in Brazil and the bodies that should protect this subtle balance between health operators and providers are not acting with the necessary speed and force, which is why these practices have proliferated”, he warns.
The CBR draws the attention of the Administrative Council for Economic Defense (CADE), as the health operators that are practicing these acts in the market hold a dominant share in their operating markets, making it impossible for providers to negotiate. Likewise, it draws the attention of the PROCON Foundation, because when beneficiaries purchased their plans, they based it on the quality and diversity of providers accredited by the health operator. The practices denounced above, in addition to reducing quality and diversity, make it difficult to assist beneficiaries, since the proposed values make it unfeasible to maintain the clinics.
The ANS, in turn, has argued that, due to the regulation full of loopholes and lack of complaints, it cannot regulate these situations.
Meeting with federal deputy, Dr. Zacharias Calil, from Goiás
On March 19, the CBR held a meeting at the office of the Federal Deputy of Goiás, Dr. Zacharias Calil, with the presence of Dr. Cibele Alves de Carvalho, director of Professional Defense at CBR, Carlos Moura, economic adviser to the College, and the directors summoned from ANS, Rodrigo Rodrigues de Aguiar, director of sectoral development, and Daniel Meirelles Fernandes Pereira, deputy director of the directorate of sectoral development (DIDES).
“At this meeting we had the opportunity to present the above situation and demand practical measures to contain such abuses, as well as explain that any provider who files a complaint with the ANS is, summarily, disqualified, without any protection. RN 365, which regulates the replacement of providers, is ineffective as it is written, information confirmed even by director Rodrigo, from ANS”, says Dr. Cybele.
It was suggested again by the CBR that the ANS, regardless of complaints, supervise the supplementary health market, use mechanisms to check the effective application of regulations. “Once a few operators are punished for failing to comply with regulations, the others will not follow the same path”, adds Dr. Cybele.
The CBR, through its Professional Defense Commission, will receive reports of abuses by healthcare providers so that it can work with government agencies, aiming to help balance the sector, raising awareness of the need for urgent measures to stop the identified abuses .
Photograph: Carlos Moura, CBR economic adviser, together with the deputy, at the end of the meeting