Regulation of the private health sector by a governmental agency in Brazil: A public policy to promote integration and interoperability of private health sector data with the national health information systems

Brazil’s national health system is composed of a public and a private sector. The private sector is responsible for the healthcare delivery of nearly 50 million Brazilians and is under the regulation of a governmental agency, the Federal Regulatory Agency for Health Plans and Insurances (ANS). ANS has instituted the mandatory adoption of a standard, a collection of rules, for electronic data interchange between health care providers and health plan operators, the TISS (Information Interchange for the Private Sector) standard. The TISS standard was implemented in 2007 aiming quality improvement and availability of the data produced by the private sector and has the following components: data structure, security, semantic content and data interchange. Data will be used for regulation and monitoring purposes, as well as to promote integration and interoperability of data with the national health information systems. The TISS standard has been built considering its harmonization with preexisting national standards. Building private sector indicators that can be comparable with the ones from the public sector already in use will enable the evaluation of health care access, health determinants and health status of the private health sector population, facilitating the implementation of programs in health promotion and disease prevention, development of reports and research, organization, monitoring and evaluation of health actions in the country. Data on the private health sector population, specifically, is one of the essential elements for appropriate planning, development and execution of public policies related to the fulfillment of ANS institutional mission that is the defense of the public interest in the private health sector and to contribute to the construction of a national health information infrastructure.