Regulatory Agenda: An ANS Commitment to Society

The Regulatory Agenda is a planning tool that clusters together the set of high-priority strategic topics that are necessary for an even balance in this sector, which will be addressed by the activities of the ANS over a two-year period.

The objective of the Regulatory Agenda is to draw up the schedules for high-priority activities, in order to ensure greater transparency and predictability for regulatory actions allowing society to monitor the commitments that have been pre-established by the ANS.

Regulatory Agenda 2013/2014

This is the second ANS Regulatory Agenda, forging ahead with the work began with the schedules proposed for 2011/2012, which closed this two-year period reaching 86% of its goals.

The initial purpose of the Agenda blends analyses of the challenges faced by this sector, with Projects arising from the strategic planning drawn up by ANS technical areas and Projects extending over from the previous Agenda (2011-2012).

The Agenda construction process was participatory and may be divided into three contribution phases: internal consultation (for civil servants working for the ANS); pre-consultation (for representatives of the Private Health Insurance and Plans Advisory Committee - CAMSS); and Public Consultation Nº 52 in December 2012 (for society in general). The contributions were analyzed and consolidated, resulting in the definition of the ANS Regulatory Agenda for the forthcoming two-year period.

The 2013/2014 Regulatory Agenda consists of seven key areas, each with its own Projects.


Core themes

Check out below the issues involved in the nine themes of the 2013 and 2014 ANS Agenda.

Guaranteed Access and Good Quality Care

Designed to ensure good quality care with timely, adequate access to contracted healthcare services.

Projects:

  • Encourage monitoring of Network Dispersal and Guaranteed Access.
  • Qualify the entry of beneficiaries into the plans: implement a new treatment policy for contracting, in case of pre-existing disease or injury prior to the contract.
  • Study and encourage the adoption by the health insurers of the healthcare model centered on the Care Plan.
  • Study alternatives that allow/encourage financial incentives for promotion and prevention actions.
  • Implement the QUALISS program for disclosing and monitoring service provider quality.

Sector Sustainability

Pursue the economic and financial balance of the sector and the qualification of health insurer management.

Projects:

  • Conduct studies on the implementation of Corporate Governance principles in this sector.
  • Conduct studies on the current impacts of economic regulation on this sector and alternative models.
  • Conduct studies on the implementation of a Sector Development Fund.
  • Extend studies in greater depth on restatement models for individual plans.
  • Conduct studies mechanisms of network transfers and risk sharing, as well as the feasibility of operating limits models, care (network) and economic and financial capital.
  • Draw up a proposal for mapping the production chain of most frequently used Ortheses, Prostheses and Special Materials – OPMEs, and study regulatory alternatives.

Relationships between Health Insurers and Service Providers

Designed to minimize conflicts in the relationships between health insurers and service providers, resulting in higher quality care.

Projects:

  • Assess and disclose new Hospital Remuneration Systems functioning in the Supplementary Healthcare sector.
  • Develop a procedure ranking methodology.
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  • Fine-tune the rules on relationship between private healthcare insurers, service providers and healthcare practitioners.

Incentive for Competition

Focus on the competitive and productive structure of the Supplementary Healthcare sector, in order to generate greater efficiency.

Projects:

  • Conduct studies on the production structure of this sector.
  • Fine-tune and extend studies in greater depth on relevant markets.
  • Move ahead with Grace Period Portability for corporate group health insurance.
  • Analyze possible predatory competitive practices.

Guaranteed Access to Information

Designed to strengthen the power of choice for the consumer and qualify the relationship between health insurers and beneficiaries.

Projects:

  • Endow beneficiaries with information on healthcare and rights, stressing the use of clinical guidelines.
  • Provide information on contracts and correlated documents related to beneficiaries.
  • Pursue the consolidation and compilation of the normative acts issued by the ANS.
  • Rationalize quality indicators, making them more straightforward for consumers.
  • Systematize and disclose the regulation oversight criteria for this sector.
  • Lay down the policy bases for relationships between health insurers and beneficiaries.

Integration of Supplementary Healthcare with the SUS

Designed to fine-tune the SUS reimbursement process while fostering the integration of health-related information, enhancing the effectiveness of the care.

Projects:

  • Continue the development of the Electronic Healthcare Records - RES.
  • Fine-tune the reimbursement process for Brazil's Unified Health System - SUS.
  • Implement a health insurer certification model, together with SUS reimbursement.
  • Construct an SUS usage map by beneficiaries, as a tool for regulating health insurer coverage.

Regulatory Governance

Designed to upgrade regulatory quality and fine-tune the institutional management of the ANS.

Projects:

  • Implement an operating and regulatory impact analysis at the ANS.
  • Extend the participation of society.
  • Fine-tune the external Services Charter and implement an internal version: generating value and trust in the institution.
  • Implement process management, moving towards an electronic regulator, stressing electronic inspection processes.
  • Implement Project management for regulatory efficacy.
  • Foster sustainable social and environmental management.
  • Implement a knowledge management policy.
  • Study the consolidation of the presentation of periodic information to the ANS.

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