Popular plan should aggravate the lack of legal certainty between operators

São Paulo-Without legal certainty, popular plan can be the path to the increased judicialization on health. For specialists, improve market conditions and reduce costs with lawsuits are more realistic outputs to increase the number of beneficiaries in the Covenants.
"This model would only be a means of reducing the queue of SUS in low complexity, but today the problem is with the high and media complexity," says the Chief Judge of the Court of the State of Minas Gerais, Renato Dresch.
According to him, the trend is that the plan is a restricted access to queries, which is not desafogaria with health and Government spending could aggravate judicialization on private area which is already high. "If the operator makes a plan that costs 50 or 100 R$ R$ will limit the service because she can''t afford," says he.
According to the Brazilian Association of Health plans (Abramge), in 2015 the spending on lawsuits reached 1.2 billion R$. And, in lecture during United event, the judge of Rio Grande do Sul, Martin Schulze, stated that the provision of service by virtue of a court decision, with values, can be four times more costly than when provided directly due to the expense of the State and the short term to comply with, which makes the purchase of raw material.
"It''s a distortion to think that the health is substitution. Often the consumer requires a degree of coverage that is not in the List ", highlights the technical consultant of the National Union of self-management in Health Institutions (joined), Luiz Toro.
For him, today the judgments have no technical basis. "This is a serious problem. We''ve seen decisions that forced carriers to give experimental treatment and at the end, who pays directly or indirectly is the consumer, "he says.
To Toro, more efficient than the popular plan, would be measures to encourage existing plans. "Self-management could be a way out. Not-for-profit and have lower incidence of legal problems. Could be a more affordable plan ", he comments. The problem, however, is the strong regulation, very similar to for-profit operators. "We can''t be charged to equity values adjusted, technical provision and guarantors as commercial assets. With encouragement, we could have a more accessible, "he says.
Another question sought would be the easing of some legal aspects. "Self-management is restricted, if the concept was expanded for example in the aspect of occupational categories would make a better performance. Today I can only have self-management of specific category and don''t have enough scale, "places.
Optimization measures
To better illustrate the problem, judge Renato Dresch, points out that on 31 December 2016 in Minas Gerais (MG), the processes in private health care came to 24820. In public health, were 29050 processes. For him, to optimize the resolution of cases the main measures recommended are the production of technical information for magistrate and the implementation of technical cameras to bring the Manager of the judiciary. In Minas Gerais, for example, with the creation of the 829/16 Resolution, the State gave to the judges of Second priority competence Pole have on the demands of health in all counties that have more than one stick of civil jurisdiction, a jurisdiction''s qualifying attempt.
Already in the practice of operator, it highlights that clearer contracts for consumers and production of technical content from the beginning of the processes are matters that can help in resolving.
According to Superintendent FenaSaúde adjustment, Sandro Leal, the members have as a strategy the communication, i.e. investment in qualified service in channels like SACs, Ombudsman''s offices and sites. According to him, many doubts have just remedied after the consumer get the Freeview availability avoiding action.
This subject will be debated today (11) on the 8th Seminar in Brasilia (DF).