Supplementary Health and aging after 19 years of regulation: where are we now?

Abstract

The present article aims to analyze the changes in supplementary health and their effects on the adherence to and maintenance within health plans of the elderly, to demonstrate the current state of the care model offered, and to begin the debate regarding the importance of changing care models and remuneration in the sector. It was observed that turnover in health plans was lower among the elderly than among the non-elderly population, with greater adherence to individual and pre-regulation plans and a very low adherence to dental plans. The elderly were also more representative over the previous year, demonstrating a greater need for permanence in times of economic crisis. Care and cost data point to the urgent need to reformulate the care practice, supported by structures that are practically non-existent in Brazilian supplemental health care today and are not funded in the sector (such as palliative care and care management physicians, among others).

Longevidade e custo da assistência: o desafio de um plano de saúde de autogestão

“…Several aspects influence health costs, varying by national category of income, more or less poor population strata, lifestyle, health use behavior and access to care resources. However, while it influences less the costs of care than other factors 12 , the aging process, in which people spend a long time living with chronic diseases, has great relevance for the financing of both public 13 and private 6 health care.…”

“…Besides their small size, the self-management operators include populations that are older than the mean of the supplementary health sector, since, as a rule, they continue to provide care to their beneficiaries when they retire, a characteristic observed especially in self-management operators linked to the public sector, including in mixed economy companies 6 .…”

A contemporary care model for older adults should seek coordinated care, greater quality and the reduction of costs

“…In the field of Collective Health, epidemiological information translates into the ability to predict events, enabling early diagnosis (especially in relation to chronic diseases), delaying the onset of these diseases, improving quality of life and supporting the therapeutic approach. 20 The role of the health professional, in these cases, is not to prevent the disease (as it is already installed) or to seek a cure, but to seek stabilization and the reduction of harm, aimed at maintaining quality of life. 10 It is agreed that greater knowledge of patient history among health professionals leads to more positive results.…”

“…This simple care procedure adds value by providing and facilitating effective support for the client and their family, as they feel protected and informed about everything that is going on. 20 Although several healthcare actions are not considered part of this model, it is expected that more than 85% of clients in this portfolio will be low-intensity users. Therefore we intend to change the logic through which health plans operate, as with this intensity of care we hope to diminish the use of hospitals and/or reduce the length of hospital stays, the excessive use of specialist doctors, and unnecessary examinations requested by numerous medical specialists.…”

New model of health care improve quality and reduce costs

“…9 However, the discussion about population aging brought about by the new epidemiological and demographic reality suggests a need for the creation of a more resilient and effective model. 10 One question therefore emerges: if everyone is discussing this issue and the solutions are already part of decision-making meetings, why is the situation unchanged? Why do leaders and managers not change the situation?…”