Read the Conversation
EF: What is the role of ANS in the Brazilian Healthcare System, and what are the priorities in your 2023 agenda?
PR: 2023 is a challenging year. Issues of demographic transition, incorporation of new technologies, and changes in morbimortality have impacted the supplementary health sector. We now need to confront changing characteristics regarding the principle of mutuality and the generational pact.
There have also been alterations concerning the legal framework of the supplementary health sector and ANS’ list. This list contains technologies incorporated within the system after being evaluated and analyzed by the agency. The recent changes in the framework affect the time and terms of this integration. The current scenario creates uncertainty, as actuarial studies have yet to determine the impact of these measures on the sector.
Last year, almost 43% of private health companies presented economic and financial difficulties. However, the sector is resilient and has a strong point in favor: the quality of the service provided.
Therefore, complementary health is highly solicited in Brazil. Especially during the pandemic, we registered a significant increase in health plans in the system, and the number keeps growing. In April 2023, we counted 50.6 million beneficiaries. This record number alone demonstrates supplementary insurance’s important role within the Brazilian health system.
The Brazilian constitution states that Health must be free and comprehensive. All 215 million Brazilians have the right to be served by the public health system (SUS), yet 50.6 million Brazilians have paid health plans, an action that “alleviates” the public sector, which is underfunded, despite its excellent service. The solid complementary health sector contributes to the functioning of the public sector.
EF: What emerging technologies and market trends can we expect in the next five years in the private health sector?
PR: Incorporating new technologies in the supplementary health sector used to take up to 2 years. With the legal milestones changing, the agency has around 180 days plus 90 days - or 120 days plus 60 days for oral antineoplastics – to incorporate novelties into the system.
This is the shortest period for new technology incorporation in the world. With little room for access discussion, admission is provided quickly, deeply impacting the system’s financing capacity as new technologies generate very high costs.
Recently incorporated drug costs around R$ 9 million per year, yet 20% of our 690 private health insurers do not earn the corresponding value of this drug in their insurance plans. This example illustrates the concern about the sector's sustainability and the ability to serve people with a private health plan.
As access is non-negotiable, we must find new ways of funding. That is why ANS engaged in discussions with all relevant stakeholders in the field. Even thou our agency only regulates private health insurers and not providers or the pharmaceutical industry, we must consider all the players in the health ecosystem to find a solution. Topics of these discussions are risk sharing, the creation of funds, and the establishment of new resources based on the logic of mutualism. We are even exploring the possibility of creating a single queue for high-cost drugs and advanced therapies with the Ministry of Health (MoH).
Looking to the future, we must rethink the organization of this health system. Instead of focusing on diagnosing and treating, we must shift to anticipation and prevention. In this sense, operators have stopped acting as mere financial intermediaries and are beginning to play a greater role in healthcare management.
Given the difficulties we are experiencing within the sector, in Brazil and globally, with increasing healthcare costs, it is an opportune moment for all players to start constructive dialogues.
To avoid the sector´s inefficiencies and the overuse of some technologies and resources, we need to bring the patient back to the center of discussions. The purpose of all action is patient care. We want to offer timely access, quality care, and sustainability.
EF: How does the ANS see digital technologies advancing in Brazil, and how can they be leveraged to improve the country’s health sector?
PR: The Agency has always encouraged digital transformation and initiatives that promote telemedicine. While technology will not replace doctors, those lacking proficiency in utilizing it may be excluded from this emerging new moment and the evolving value chain it brings.
In Brazil, the Federal Council of Medicine regulated topics regarding telehealth and was very active during the pandemic. To further encourage the use of these tools, which proved to be very important in terms of access, ANS is engaged in regulatory aspects to bring new digital technologies to the country. Especially artificial intelligence (AI) could be an interesting collaborator in healthcare management and integrated healthcare coordination.
Today, everyone has a phone and other smart devices that can provide data. By integrating and connecting this information, AI and new technologies will bring innovation and benefits to patients, improving the quality of care.
EF: As the population is aging, home care needs to be considered as an alternative to decompress the healthcare system. Could you elaborate on ANS’ position on this matter?
PR: Home care is something positive. Staying at home provides a much more friendly environment for the patient. ANS does not impose any type of obstacle to this form of care, and as long as it is included in the operator's contract with the beneficiary, we encourage this type of service.
Nevertheless, there still exist legal impediments to home treatment. Our system is hospital-centric and focuses on taking the patient to the hospital, so there is still a need for a change in the law.
Hospital Mãe de Deus, a clinic I recently visited, has established a hospital residence or backup beds. When healthily possible, patients are taken out of the hospital and transferred to this other unit to reduce costs. Measures like this are positive, healthy for the system, and more comfortable for the patient. Actions like these are encouraging, and the ANS has no restrictions for this service. However, legislative changes are needed to regulate different approaches to care within the supplementary health sector.
EF: What three pillars are needed to build a more sustainable health system in Brazil?
PR: Public-private integration is a key topic of discussion with the Ministry of Health. This integration will be possible with cooperation between our different states. Brazil is a large and complex country, and to regulate the sector, we need to look at it as a whole.
Districts where we currently have supplementary health services collect lots of data but still gain little information from it. We are mitigating this problem by adapting to electronic medical records. This initiative is part of a joint agenda with the MoH, set to be achieved by 2028.
Electronic medical records will bring more efficiency to the whole sector. We want to preserve all people's health information, always respecting the General Data Protection Act and following European standards. Patients must be aware of their data, and information must remain in a single repository for all patients treated, whether by the public or private system.
A second item is addressing the long waiting times in the public health system. As there are often idle beds in the private sector, we propose to use these spaces to alleviate the system. The ever-increasing integration between the public and private is positive, as we can deliver more value, better healthcare, and improved assistance to beneficiaries of both systems.
The third pillar is the mentality change needed in the sector. We need to focus on prevention and health promotion. By placing the patient at the center of all discussions and giving value to our beneficiaries' health, we will achieve broader coordination and an integrated journey without fragmentation in the sector.
Adjusting these points will already be a big step for the sector, promoting savings for both sides.
EF: What role has digital transformation in the Brazilian healthcare sector, and how would you rate the technological adaption in the country?
PR: Integrating the public and private with electronic medical records is the step we need to complete to reach further into technology.
In a country of continental dimensions, there are several places where there is not even the internet to provide treatment or care via telemedicine. We need to develop infrastructure to provide comprehensive care to all Brazilians. The pandemic accelerated this process and helped break restrictions in social and cultural dimensions, as people first resisted speaking to a doctor through a phone screen. If there is something positive to say about the pandemic, it is this mentality change.
Technology will reduce costs and facilitate faster access, which is what we want: timely access, quality of care, and sustainability.
EF: What milestones would you like to celebrate in your career, and what do you still want to achieve?
PR: With an unprecedented pandemic and its repercussion, my term as president of the ANS has been challenging. The agency structure changed drastically when incorporating remote work and cutting personal contacts. However, we kept delivering results. During these difficult times, the health field gained visibility, which was something positive.
We face extensible issues, such as the legislative change that defined tighter deadlines and economic problems. Still, even in this difficult situation, I wake up every day and seek to provide more assistance and quality healthcare to 215 million Brazilians.
We aspire to a future that provides the best outcomes for our beneficiaries. We want to change the operator’s logic from being a financial intermediary to being a guarantor of health and increase a healthier population. ANS regulates only one “leg” of the system – the operators – but we have to look beyond. In the private healthcare industry, we must pursue sustainability above all else. My focus is to see everyone healthy, and as long as I live, I will fight for this to happen.