A regulação da atividade empresarial das operadoras de plano de saúde: avaliação de falhas de mercado, consequências e propostas de políticas

Abstract

This study deals with the regulation of the business activity of health plan operators in Brazil, about the emergence of operators, the transfer of state duty to individuals, different types of operators, regulation, aspects of the contract, principles, applicable legislation and the judicialization as a consequence of a flawed system, from the perspective of the economic and financial balance of the contract. The main objective is to present a reflection in relation to the judicialization of supplementary health, drawing attention to the effects that this phenomenon causes in the regulatory activity. In view of the State's deficiency in providing health services, this obligation was transferred in part to private companies. Thus, private systems for financing health risk coverage mediate the relationship between consumers and medical-hospital providers. Regulation plays a fundamental role, as this market will only be sustained if all parties have their interests met. The judicialization of supplementary health requires reflection on the economic impact on regulation, since the decisions that impose, extinguish or relativize rights and obligations within a health plan contract, generate effects for the entire universe of beneficiaries linked to an operator and for the economic and financial balance of the contracts. For such analysis, some judicial issues with more recurrence were highlighted, as well as the effects that the decisions resulting from such cases can cause in the regulatory activity. It concludes by the need to improve regulation, as well as the inspection of health plan and insurance activities and, consequently, a greater uniformity of jurisprudence. Finally, policies are proposed to correct market failures. The work falls within the concentration area of the Master's Program: Justice, Business and Sustainability.