Aspectos jurídico-constitucionais e práticos do ressarcimento ao sistema único de saúde

Abstract

This study deals with the issue of reimbursement to SUS, analyzing, in particular, its concept, its constitutionality, its legal nature and its relevance in Brazil. Briefly, reimbursement to the Unified Health System (SUS) is the obligation of health plan operators to return to the public coffers the amounts spent with their users in the public health network in procedures contractually covered by the respective health plan. Since its establishment in 1998, reimbursement to SUS has generated controversy, including in the case of a Direct Action of Unconstitutionality (ADI nº1931-8 / DF). In this sense, it was sought, in the present study, to highlight the concept and legal-constitutional aspects of reimbursement to SUS, based on the mentioned ADI and on doctrinal lessons, concluding by the constitutionality of this institute and by its legal nature of civil obligation. At the end, some procedural and statistical information on the situation of reimbursement to SUS was pointed out based on the year 2017, highlighting the constant improvement of the reimbursement process, the social relevance of the institute and the role of the National Supplementary Health Agency (ANS) on the effectiveness of the collection of the amounts due.