The result equals 1.3% of the total revenue accumulated in that period, which amounted to about R$154 billion.
Gilmara Santos
The increase in group health plans was greater than that of individual ones
Health plans reported a net profit 2 billion Brazilian reals In the first six months of this year, according to data released on Friday (first) by the ANS (National Agency for Complementary Health).
According to the agency, the result is equivalent to approximately 1.3% of the total revenue accumulated in that period, which amounted to about R$154 billion. For every R$100 of revenue in the first half of 2023, the sector generated a profit of about R$1.3.
The survey also showed that the net result for the first half was positive for all segments:
- Benefit managers reported a profit of R$260.6 million;
- Dental operators made a profit of R$327.4 million;
- and medical hospitals with an amount of R$1.46 billion.
Medical hospital operators (the sector’s main segment) ended the semester with a negative operating result of R$4.3 billion, a dynamic already observed in the past year.
This operating loss was offset by the record financial result of R$5.9 billion which resulted mainly from its financial investment bonuses, which at the end of the period had accumulated approximately R$105.7 billion.
loss ratio
The loss ratio is the relationship between operators’ revenues and expenses with assistance expenses. High levels of the index affect the entire sector.
In the first half, the loss ratio closed at 87.9% (about 0.9% lower than the figure recorded in the same period of the previous year). According to ANS, the finding was strongly driven by some of the country’s largest operators and shows that roughly 88% of revenue from monthly fees is “spent” on assistance expenses.
“We are of the opinion that operators’ profitability generally comes from income generated from financial operations. This situation is undesirable because, at the end of the day, the plan process must be sustainable in itself. So operators need to review their management and analyze what they can improve on.” It is very important to carry out a more forward-looking actuarial study, analyzing possible scenarios and impacts”, explains Jorge Aquino, Director of Standards and Qualification of Operators.
It is important to note that the percentage of loss recorded in the first half of 2018 and 2019 amounted to about 84%. The higher loss ratio levels post-Covid (since 2021) can be explained more as a result of the slow recovery of plan revenues – mainly from large operators – than the variance in care expenditures due to health service utilization.
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modifications
In terms of adjusting plans, the National Social Security Service maintains that the average monthly fee (adjusted for inflation for that period) increased more than each beneficiary’s assistance expenses (also adjusted for inflation).
In June, the NSA authorized a 9.63% cap adjustment in individual and family health plans. This measure affected approximately 8 million beneficiaries of contracts signed up to January 1999 (or adapted to Law No. 9656/98).
Research recently released by the Brazilian Institute for Consumer Protection has shown that in the past five years adjustments to group health plans have been nearly twice as high as those made to individual plans.
While the variance in average monthly fees for individual health plans, contracted in 2017 for the 39-44 age group, increased from R$522.55 to R$707.59 in 2022, corporate groups contracted for groups of up to 29 Persons (small and small businesses) rose from R$539.83 to R$984.44.
“We are observing the current scenario of health plan operators in an alarming way. Arbitrary adjustment practices, often exceeding 30%, have become an affront to consumers’ pockets. High profit is also due to difficulties,” says lawyer Rafael Roba, partner at Vilhena Silva Advogados. that operators impose full access to treatments to consumers and unjustified refusals to pay.
In recent months, the lawyer adds, scheme beneficiaries have been in dispute with operators to obtain coverage for essential medical treatments. He concludes, “By preventing access, costs are reduced, showing a clear prioritization of financial interests.”
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