publicado em 17/10/2013 às 11h55:00
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Punishment unclear

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Coriolanus Serôa Marcio Araujo, president of the National Federation of Health Insurance
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Coriolanus Serôa Marcio Araujo, president of the National Federation of Health Insurance

There is currently an intense controversy since prosecuted, involving the model adopted by the National Health Agency (ANS) to monitor the performance of carriers and health insurance plans and results, quarterly, the suspension of marketing contracts, according lists widely publicized in the media.

Although the regulations that gave rise, in 2012, not characterized as such, it is a real punishment of private. And also just to punish the people who want to buy the plans suspended, and even the beneficiaries of collective plans that have been achieved by the measure and who wish to enter in contracts after editing the lists. Are created, thereby citizens of different classes within the same company who hired the benefit, those who remain enjoying the coverage plans and those who are prevented from joining them.

Besides the obvious distortion of the model, this punishment, operators and beneficiaries, not going through due process. The various standards of ANS existing penalties include the necessary steps to calculate the alleged infraction, with ample protection, the right to resort to adversarial and administrative bodies therein. Under this standard monitoring, which causes legal uncertainty for operators who have been authorized to operate by the Agency.

There claim that, with the extent objetivase acautelatório effect to prevent damage to the consumer. However, nothing can go beyond that provided by law and forecasts infralegal ANS. It is necessary to punish the offenders, but with obedience to the right of defense, hard achievement of democracy.

But the background that led to this state of affairs is even more complex, unpredictable future. The alleged violations of the monitoring program are identified and assessed as statistical model fragile and dangerous unpredictability to the agents of the health system. The model is based on identification through consumer complaints notifications research "preliminary" - of alleged breaches of terms of service, roofing and other contractual, receiving unilateral treatment subsequently classified according to "median" statistics, which end to result inexorably in lists quarterly plans suspended. According to this model, even though the entire market offeror plans and health insurance continually improve their performance, the "median" there will always be operators "guilty" and will be punished.

The creation of the agency was an evolution formidable supervision by the State of sectoral markets, secured their independence and effective functioning. It is clear that the sectoral regulator fits ensure the proper functioning of a market responsible for the health of 25% of Brazilians and over 9% of them when it comes to dental care. The Federation of National Health Insurance, which brings together 17 groups of private operators already consolidated, has expressed full support to government regulation, including intense participation in technical chambers prior to the public consultation of the normative. Unfortunately, the monitoring program did not follow that rite healthy.

The market plans and health insurance is too important to its image and its operation may be compromised by insufficient and a model that results in punishment unclear what caused it. It is therefore wide review of the rules and models for calculating the monitoring program of the NSA, in order to ensure the predictability of results and indispensable right to legal defense and contradictory.

Source: FENAM
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National Health Insurance    health insurance providers    health plans    Marcio Araujo Serôa Coriolanus    health   
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