Judicialization in supplementary health: an evaluation of lawsuits against a health plan operator, Belo Horizonte, Minas Gerais, 2010- 2017

Abstract

Judicialization in supplementary health surpasses that which occurs in the public sector, evidencing the  fragility of its regulation and making access to health  plans difficult. Lawsuits against a Supplementary Health operator in Belo Horizonte, between 2010 and  2017, will be analyzed. Legal proceedings were  analyzed using a document analysis technique.  Variables were related to the nature of the legal  process, the profile of the beneficiaries and the  characteristics of the demands. Poisson Regression  was used to assess the impact and relevance of the  selected variables, and the R software version 3.6.1 for the significance tests. In the period from 2010 to  2017, 6090 actions were filed. The main causes are  contractual issues, denial of procedure, orthosis/prosthesis and exams. Plans prior to the  ‘Health Plan Law’, correspond to 3% of the portfolio  and 37.4% of the judicialization. This study showed  that the possibility of taking legal action is greater  among male clients, individual contracts, plans  assisted in a wide network, without co-participation.  Judicialization is more accessible to citizens of higher  economic status. Contractual issues show fragile  regulation. Adequate regulation reduces the  imbalance between customers and operators. The  National Supplementary Health Agency needs to  exercise its regulatory function.