Health care private sector in Brazil: Three waves of the private health insurance state regulation

Although Brazil has a public system that guarantees universality, it also counts on a meaningful private health care sector. This sector is submitted to the State regulation by the National Supplementary Health Agency (Agência Nacional de Saúde Suplementar - ANS), created in 2000, which acts on regulation, control and inspection private health insurance (PHI).  From health system regulation on, which started in 1998, important changes occurred in a sector that presented several problems as: heterogeneous contracts, with the exclusion of several diseases; abusive increase of prices; coverage denial; and unilateral contract cancellation. The sector counts on two thousand active PHI, and 50 millions of clients (fourth part of Brazilian population). The objective of this work is to describe the trajectory of private health care in Brazil. Qualitative approach was the methodology used to evaluate the implementation process, through documental analysis, bibliographic research and analysis of data of the sector. Three different stages characterizes regulatory path in Brazil. The first one was marked by the financial-economic regulation, from the establishment of clear rules to the inclusion and exclusion of enterprises and from the demands of financial guarantees given by the PHI. The second stage is marked by the focus on techno-assistance regulation, with the definition of assistance rules that would reduce the asymmetric information, emphasizing the definition of a list of mandatory coverage procedures, the monitoring action of given assistance through the indicators of supplementary health qualification program and the stimulus to the development of health promotion and prevention from risks and diseases programs. Finally, the third stage points at the focus on competition and on the clients. We can conclude that regulation brought advancement to the private health assistance sector in three different waves and contribute to enforce the normative principles of the ANS in order to defend public interest.