The list of health actions and events has always been comprehensive and should continue. This is a list set by the National Agency for Complementary Health (ANS) that outlines what health plans must cover. Its comprehensive character is the greatest guarantee of patient safety, without which there is room for inequality resulting from discretionary decisions which tend to collide with the collective interest.
There are a lot of jurisprudence that determines and defines the comprehensive nature of the list. Since the issuance of the law regulating health plans in the country, in 1998, in its fourth paragraph of Article. 10, until the decision of the Fourth Committee of the Supreme Court of Justice at the end of 2019, through Art. 4, 3 of Law No. 9961 of 2000 establishing the Afghan National Army.
Brazil currently has one of the fastest, most transparent and participatory processes for integrating new health procedures, medicines and technologies in the world. If not the fastest: the deadline is a maximum of nine months, while countries like the UK and Canada take an average of 11-14 months.
The process for determining what is or is not offered on the list is based on collective decisions, with broad community participation, in a democratic and fair manner, with medical associations, patient representatives, scientists, regulators, managers and operators. To abandon this pluralistic trait, and to make the role merely a model, is to give the individual pen, to physicians or judges, more weight than that of a fellow working on the best scientific evidence.
Today, the list covered by the plans includes 3,379 actions. Since the new rules for adopting new technologies came into effect, there have already been seven new integration rounds, approximately one each month, with 21 new items added to the mandatory list. The process that used to be used every two years is now continuous, uninterrupted and extremely fast.
All diseases covered by the International Classification of Diseases 11, the World Health Organization’s Classification of Diseases, are covered. Covered options are always those considered to be the best therapeutically, when the effectiveness of a treatment is compared to its cost. It is a process that demonstrates that new technology is not always superior to what is already available. More: Novelties have not always been adequately tested.
The comprehensive nature of the menu is a pillar of Complementary Health’s work, which currently serves 78 million Brazilians who benefit from Medicare and Dental plans. As part of a system that operates on the basis of insurance rules, based on odds, risks, and premiums (i.e. monthly fees), health plans calculate the costs of care and share them among all beneficiaries.
The list of examples equates to a system in which the risks become unquantifiable. So, one of two things: either the prices will not be able to keep up with the expenses – and the system will become unfeasible – or they will have to make great efforts to cope with the uncertainties associated with unlimited coverage. In both cases, the final cost will be borne by the user.
The ratification of the comprehensive nature of the list by STJ, scheduled for next Wednesday (8), will determine the sustainability of complementary health in Brazil. It would be equivalent to giving priority to the collective interest over the individual. Health deals with limited resources, and increasingly, choices must be made. The best option for the community is a comprehensive and specific list that provides adequate coverage for patients, with the safety necessary to continue saving lives and treating people.
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