Adjustment of collective health plans should reach double digits even with profit

After a historic loss in 2022, healthcare operators made a profit of R$3 billion in 2023, according to data from the National Supplementary Health Agency (ANS). But even given the best performance after the pandemic, users of collective plans should already prepare their pockets: the projection is that the 2024 adjustment will be in the double digits. The forecast is from a report by XP Investimentos, based on ANS data from December 2023 to February 2024.

According to the document, the health plan market has increased prices by more than 15% in recent months. While Sula, Bradesco and Amil have readjusted their plans well above 20% since mid-2023, Hapvida and NotreDame Intermédica are increasing prices at market levels, putting pressure on the rate downwards. To give you an idea, the average adjustment of health plans in Minas, in February this year alone, was 13.8%.

“We expect more aggressive pricing to continue for at least another year in the health plan market, as companies seek improvements in claims rates, which could continue to limit market growth,” details the report.

The dental plan market, in turn, contrasts with health plans, as price increases have consistently been in the single digits. However, companies that offer both present much higher adjustments. In February this year, while Hapvida had an increase of 10.3%, Sula by 20.2% and Amil by 19.2%; at Odontoprev, exclusively for dental health, the increase rate was 4.1%.

In a note, the National Supplementary Health Federation (FenaSaúde) clarified that the readjustment of health plans reflects the variation in healthcare expenses and is essential to guarantee the maintenance and improvement of the provision of medical assistance to its beneficiaries. According to the entity, among the factors that influence the adjustment are health inflation, represented by the evolution of the cost of care; the obligation to offer increasingly expensive treatments, with doses, in some cases, worth millions of dollars; the occurrence of fraud; and judicialization.

“The Brazilian supplementary health sector, made up of more than 700 medical and hospital plan operators, faces specific challenges in terms of costs and frequencies of use, reflecting the increases in medical expenses incurred by several health service providers. In other words, the adjustments are a thermometer of persistent health inflation, a global phenomenon”, highlighted Fenasaúde.

Around the world, health inflation is calculated based on the prices of hospital medical services and products and the frequency of use. According to data from international consultancy AON, medical inflation in Brazil is expected to reach 14.1% in 2024. The rate is higher than the global average of 10.1% and also higher than the official inflation predicted by the Focus Bulletin, of 4 .03%.

In a statement, the National Association of Benefit Administrators (Anab), which represents companies that manage and sell collective health plans, reinforced that annual adjustments are extremely necessary to maintain the Brazilian supplementary health system in balance. “The rates practiced by health operators year after year reflect the sector’s scenario, which faces a series of instabilities due to several factors: adoption of the exemplary list, which increases unexpected coverage and leads to economic and financial imbalance in current contracts; increase in fraud in the use of plans; mandatory supply of high-cost medicines; high accident rates in recent years (reaching 100% in some contracts); among others, reflecting in the calculation of adjustment rates for collective health plans, which are being announced in each contract throughout this year”.

Consumer is held hostage by healthcare providers

The collective, corporate and membership plans cover around 50.9 million people in the country, around 88.6% of service users. The adjustment is annual and freely negotiated between companies and contractors. The ANS only regulates the readjustment index for individual and family plans.

Marina Magalhães, researcher at the Health program at the Consumer Protection Institute (Idec), states that the lack of transparency in healthcare operators’ billing creates an extra barrier for consumers to question the adjustments imposed by operators year after year. “Health plan adjustments, in theory, do not exist to balance companies’ accounts. These adjustments exist to ensure that the plan contract does not become unbalanced over time,” she states.

She explains that, to “rebalance the contract”, companies would need to correct two points: inflation on medical services, which is always higher than the official inflation average, and the variation in the use of the plan in relation to the previous year.

The researcher remembers that it is exactly these two factors that are used by the ANS to define the annual adjustment percentage for individual plans. “It turns out that in collective health plans, as there is no such regulation, we don’t know if these two components are being reflected or if, in fact, companies are using adjustments to compensate for economic losses in other areas”, he says. she.

Mariana remembers that the average adjustments for collective plans are usually double those for individual plans. Last year, the ANS adjustment was 9.63% for individual plans, but the average increase for collective plans was 14.38%.

She explains that the justification for higher accident rates for increasing prices for collective health plans would only make sense if there was much greater use of services. “And the data we have even shows that, often, in individual plans, the average usage of users is higher,” she says.

According to projections from consultancies such as Citi and Milliman, the readjustment of individual plans should be below 10% this year.

“Very often, operators calculate an adjustment percentage that, in our view, is abusive. It’s about double digits, sometimes it reaches 20%, 25%… In short, they have no transparency at all about how it was calculated”, observes the Idec researcher.

According to Mariana, the practice of operators setting the adjustment at a very high rate and only agreeing to negotiate with the contractor if he downgrades the plan, in other words: changes to a worse category, has also been a recurring practice. Or, even, if the plan’s co-participation percentage increases. “And the consumer is forced to accept a more precarious health plan contract to be able to continue paying,” she says.

In search of regulation for the readjustment of collective health plans, Idec has a campaign called ‘No more increases’. https://idec.org.br/chega-de-aumento The objective is, at least, to achieve greater transparency in the companies’ adjustment calculations.

Bill 7419-2006 is also being processed in the Chamber of Deputies, which would allow the ANS to establish a limit on adjustments to collective plans and release Procon to monitor these increases. The project, however, is on hold. The president of the Chamber, deputy Arthur Lira, wants to discuss the proposals with the operators.

Entity says it negotiates lower impact for beneficiaries

The National Association of Benefit Administrators (Anab) says that it works to negotiate adjustments with operators that have the lowest possible impact on beneficiaries who have plans managed by benefit administrators. “Last year, we managed to generate savings of R$2 billion for consumers, which is the difference between the adjustment amount requested by operators and the percentage actually applied. From 2013 to 2023, the savings generated in contracts managed by benefit administrators exceeded R$8.6 billion,” the entity said in a note.

The report of The time has also contacted the National Supplementary Health Agency (ANS) and the Brazilian Association of Health Plans (Ambramge) and is awaiting feedback.

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