Reversal of the profitability rates of health plans according to age

Abstract

OBJECTIVE:In this study, we will analyze assistance costs and profitability rates of a private health insurance company. METHODS: A private health insurance company of an inland city of Sã o Paulo was analyzed. Assistance costs and profitability rates were analyzed in a time interval of seven years according to age and gender. The assistance cost (sum of medical appointments, exams, surgical intervention) was calculated by the absorption counting method, which consists of the analysis of direct and indirect, fixed and variable costs caused by the use of medical and hospital resources. The profitability rate was calculated based on the difference between the premium (monthly fee and co-insurance [20%]) and the cost assistance. RESULTS: Although the number of users decreases as age increases, costs increase disproportionally. The growth of unitary premiums from the age group of 50 to 59 years contrasts with the unitary results. There is a surplus until the age of 59 years and subsequent deficit from this age on. This deficit progresses according to the age group. In this case, while the first age groups present a balanced unitary profit, there is a growing progression of the unitary cost that causes costs to increase above the premium, especially in individuals over 60 years of age. CONCLUSION: Our results consistently support the hypothesis of inversion of profitability rates according to age, regardless of the decrease of the number of individuals at the age group of 60 years.