Análise da adequação dos ativos garantidores em relação às provisões técnicas em operadoras de saúde no período de 2019 a 2022

Abstract

The supplementary health sector in Brazil underwent transformations with Law No. 9,656/1988, which regulates health plan operators (OPS), culminating in the establishment of the National Health Agency (ANS) as a regulatory and supervisory body. With approximately 50 million users, representing a considerable proportion of the population. The financial adequacy of these operators is fundamental to the sustainability of the entire sector, assessed by the relationship between guarantee assets and technical provisions. A ratio equal to or greater than zero indicates sufficient resources to meet obligations, while a negative ratio denotes financial inadequacy. Insufficiency compromises access to health services and the stability of the supplementary health market, making it essential that operators maintain a positive relationship to guarantee the quality and safety of services provided to beneficiaries. The objective of this study is to analyze the sufficiency of health operators' guarantee assets in relation to their technical provisions during the period 2019 and 2022. The information available from Health Plan Operators actively registered with the National Agency was used as a data source. of Supplementary Health (ANS) during the period from 2019 to 2022. In general, the results of the study revealed a worsening in the number of operators that presented insufficient guarantee assets over the years. When analyzing the sufficiency index 1 (IS1) in a sample of 621 operators, it was found that, at the end of 2022, 200 operators (32.20% of the total) had insufficient guarantee assets in relation to the required amount of technical provisions Finally, the modalities with greater exposure to insufficiency scenarios were found to be group medicine, medical cooperatives, self-management and philanthropic practices.