would go through a negative readjustment of -8.19% this year. The decision was associated with a general decrease in the use of health insurance in the previous year, due to Covid-19 and will mainly affect individual and family insurance. But while users can see benefit in the negative adjustment, some institutions have taken a stand showing concern with the decision.
According to the Brazilian Association of Health Plans (Abramge), the index calculated by the ANS clashes with what was evaluated by the association. In a note, Abramge stated that “the formula for calculating the readjustment index of health plans is known, regulated by standard, and the data that comprise it are public, available on the Federal Government’s portal.” Thus, Abramge is still trying to understand why there is a difference between the values found.
In this matter, the Unimed System emphasizes that the calculation “does not reach the exceptional character of an event like the Covid-19 pandemic”, as the health crisis has caused fluctuations in care and costs. In other words, many consultations and procedures were postponed during 2020, but what was not carried out during the previous year returned in the first half of 2021.
“Starting this year, the resumption of procedures and the magnitude of the second wave of Covid-19, with a record number of hospitalizations and high prices for medicines and supplies, have been causing a strong increase in expenses – and will pressure the readjustment index upwards next year, also in an atypical way, reaching double digits. These extremes do not benefit either the customers or the operators”, explains Unimed in a note.
This means that, if customers can now see a favorable cost drop for their pockets, there is no good evidence that the same will happen in 2022. Another point is related to the issue of sustainability of healthcare providers themselves. Abramge claims that the pandemic year was responsible for the closure of 124 health care providers that together would serve around 14.1 million beneficiaries.
The financial loss was associated with the drop in the total received by monthly fees for individual plans. “The application of a negative index will further increase this imbalance, which could permanently condemn the existence of these operators and the continuity of these plans”, says the association.
Addressing this same topic, Unimed argues that “it is necessary to consider that this context tends to inhibit the offer of individual and family plans, excluding the access of an important portion of the population to supplementary health and overloading, even more, the Unified Health System. Health (SUS)”.